Marc Van de Velde

University of Miami Miller School of Medicine, Miami, Florida, United States

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Publications (189)418.97 Total impact

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    ABSTRACT: Xenon has minimal haemodynamic side effects when compared to volatile or intravenous anaesthetics. Moreover, in in vitro and in animal experiments, xenon has been demonstrated to convey cardio- and neuroprotective effects. Neuroprotection could be advantageous in paediatric anaesthesia as there is growing concern, based on both laboratory studies and retrospective human clinical studies, that anaesthetics may trigger an injury in the developing brain, resulting in long-lasting neurodevelopmental consequences. Furthermore, xenon-mediated neuroprotection could help to prevent emergence delirium/agitation. Altogether, the beneficial haemodynamic profile combined with its putative organ-protective properties could render xenon an attractive option for anaesthesia of children undergoing cardiac catheterization. In a phase-II, mono-centre, prospective, single-blind, randomised, controlled study, we will test the hypothesis that the administration of 50% xenon as an adjuvant to general anaesthesia with sevoflurane in children undergoing elective cardiac catheterization is safe and feasible. Secondary aims include the evaluation of haemodynamic parameters during and after the procedure, emergence characteristics, and the analysis of peri-operative neuro-cognitive function. A total of 40 children ages 4 to 12 years will be recruited and randomised into two study groups, receiving either a combination of sevoflurane and xenon or sevoflurane alone. Children undergoing diagnostic or interventional cardiac catheterization are a vulnerable patient population, one particularly at risk for intra-procedural haemodynamic instability. Xenon provides remarkable haemodynamic stability and potentially has cardio- and neuroprotective properties. Unfortunately, evidence is scarce on the use of xenon in the paediatric population. Our pilot study will therefore deliver important data required for prospective future clinical trials. EudraCT: 2014-002510-23 (5 September 2014).
    Trials 12/2015; 16(1):587. DOI:10.1186/s13063-015-0587-3 · 1.73 Impact Factor
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    ABSTRACT: Postoperative delirium (POD) is a manifestation of acute postoperative brain dysfunction that is frequently observed after cardiac surgery. POD is associated with short-term complications such as an increase in mortality, morbidity, costs and length of stay, but can also have long-term sequelae, including persistent cognitive deficits, loss of independence, and increased mortality for up to 2 years. The noble gas xenon has been demonstrated in various models of neuronal injury to exhibit remarkable neuroprotective properties. We therefore hypothesize that xenon anesthesia reduces the incidence of POD in elderly patients undergoing cardiac surgery with the use of cardiopulmonary bypass. One hundred and ninety patients, older than 65 years, and scheduled for elective cardiac surgery, will be enrolled in this prospective, randomized, controlled trial. Patients will be randomized to receive general anesthesia with either xenon or sevoflurane. Primary outcome parameter will be the incidence of POD in the first 5 postoperative days. The occurrence of POD will be assessed by trained research personnel, blinded to study group, with the validated 3-minute Diagnostic Confusion Assessment Method (3D-CAM) (on the intensive care unit in its version specifically adapted for the ICU), in addition to chart review and the results of delirium screening tools that will be performed by the bedside nurses). Secondary outcome parameters include duration and severity of POD, and postoperative cognitive function as assessed with the Mini-Mental State Examination. Older patients undergoing cardiac surgery are at particular risk to develop POD. Xenon provides remarkable hemodynamic stability and has been suggested in preclinical studies to exhibit neuroprotective properties. The present trial will assess whether the promising profile of xenon can be translated into a better outcome in the geriatric population. Trial registration EudraCT Identifier: 2014-005370-11 (13 May 2015).
    Trials 10/2015; 16(1):449. DOI:10.1186/s13063-015-0987-4 · 1.73 Impact Factor
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    ABSTRACT: Background Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements. Methods Forty-two patients undergoing elective OPCAB surgery were enrolled in this prospective, single-blind, randomized controlled pilot trial. Patients were randomized to either xenon (50–60 vol%) or sevoflurane (1.1–1.4 vol%) anaesthesia. Primary outcome was intraoperative noradrenaline requirements necessary to achieve predefined haemodynamic goals. Secondary outcomes included safety variables such as the occurrence of adverse events (intraoperatively and during a 6-month follow-up after surgery) and the perioperative cardiorespiratory and inflammatory profile. Results Baseline and intraoperative data did not differ between groups. Xenon was non-inferior to sevoflurane, as xenon patients required significantly less noradrenaline intraoperatively to achieve the predefined haemodynamic goals {geometric mean 428 [95% confidence interval (CI) 312, 588] vs 1702 [1267, 2285] µg, P
    BJA British Journal of Anaesthesia 09/2015; 115(4):550-9. DOI:10.1093/bja/aev303 · 4.85 Impact Factor
  • V. Cuypers · M. Van de Velde · S. Devroe ·
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    ABSTRACT: Background: Intracranial subdural haematoma is a rare but serious complication of neuraxial anaesthesia. With early diagnosis and treatment, severe neurological sequelae can be avoided. A literature search of intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients was performed. Based on the findings, a flow chart on how to assess postpartum headache following a neuraxial procedure is proposed. Methods: Medline, Embase and Cochrane databases were searched for cases of intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients. Epidemiological factors, clinical symptoms and signs, treatment, outcome and the effect of performing an epidural blood patch were assessed. Results: Review of the literature identified 56 cases following neuraxial procedures (epidural n=34, spinal n=20, combined spinal-epidural n=2). Predisposing risk factors were present in only a minority of patients. Persistent headache that stopped responding to postural change was the most important symptom with occurrence in 83% of patients. Focal neurological signs were present in 69% of women. Eleven percent of women were left with residual neurological deficits; the mortality rate was 7%. Conclusion: Intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients is rare but serious complications may result. Vigilance is required whenever a headache becomes non-postural, prolonged and/or whenever focal neurological signs occur.
    International journal of obstetric anesthesia 09/2015; DOI:10.1016/j.ijoa.2015.09.003 · 1.60 Impact Factor
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    ABSTRACT: We describe a patient who presented with a bilateral pulmonary artery sarcoma, initially treated as pulmonary embolism, that necessitated concomitant pulmonary endarterectomy and pneumonectomy. We reviewed the anesthetic management used for this procedure, which bears many similarities to the management of patients undergoing pulmonary thromboendarterectomy. Right ventricular failure, pulmonary hemorrhage, and cerebral ischemia due to circulatory arrest are life-threatening perioperative complications. The anesthesiologist can play a key role in the prevention (or timely recognition and treatment) of these perioperative complications by establishing adequate hemodynamic, echocardiographic, and neurologic monitoring and by optimizing cardiopulmonary function and coagulation.
    08/2015; 5(4):64-8. DOI:10.1213/XAA.0000000000000181
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    Layth al tmimi · Bart Meyns · Marc Van de Velde · Paul Sergeant · Mark Coburn · Steffen Rex ·

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    ABSTRACT: Over the last several years, evidence has accumulated that the GABAA receptor is compromised in animal models for fragile X syndrome (FXS), a common hereditary form of intellectual disability. In mouse and fly models, agonists of the GABAA receptor were able to rescue specific consequences of the fragile X mutation. Here, we imaged and quantified GABAA receptors in vivo in brain of fragile X patients using Positron Emission Topography (PET) and [11C]flumazenil, a known high-affinity and specific ligand for the benzodiazepine site of GABAA receptors. We measured regional GABAA receptor availability in 10 fragile X patients and 10 control subjects. We found a significant reduction of on average 10% in GABAA receptor binding potential throughout the brain in fragile X patients. In the thalamus, the brain region showing the largest difference, the GABAA receptor availability was even reduced with 17%. This is one of the first reports of a PET study of human fragile X brain and directly demonstrates that the GABAA receptor availability is reduced in fragile X patients. The study reinforces previous hypotheses that the GABAA receptor is a potential target for rational pharmacological treatment of fragile X syndrome.
    PLoS ONE 07/2015; 10(7):e0131486. DOI:10.1371/journal.pone.0131486 · 3.23 Impact Factor
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    ABSTRACT: Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a joint committee practice advisory on pediatric regional anesthesia (PRA). Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA. The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air-loss of resistance or saline-loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children. High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.
    Regional anesthesia and pain medicine 07/2015; 40(5). DOI:10.1097/AAP.0000000000000280 · 3.09 Impact Factor
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    Layth al tmimi · Bart Meyns · Marc Van de Velde · Paul Sergeant · Mark Coburn · Steffen Rex ·

    The 30th Annual Meeting of the European Association of Cardiothoracic Anaesthesiologists, gothenburg, Sweden; 06/2015
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    Journal of Cardiothoracic and Vascular Anesthesia,, Gothenburg, Sweden; 06/2015
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    ABSTRACT: We recruited patients scheduled for shoulder rotator cuff repair or subacromial decompression under general anaesthesia and interscalene brachial plexus blockade (30 ml ropivacaine 0.5%). We allocated 240 participants into four groups of 60 that were given pre-operative saline 0.9% or dexamethasone 1.25 mg, 2.5 mg or 10 mg, intravenously. We recorded outcomes for 48 h. The median (IQR [range]) time to first postoperative analgesic request after saline was 12.2 (11.0-14.1 [1.8-48]) h, which was extended by intravenous dexamethasone 2.5 mg and 10 mg to 17.4 (14.9-21.5 [7.2-48]) h, p < 0.0001, and 20.1 (17.2-24.3 [1.3-48]) h, p < 0.0001, respectively, but not by dexamethasone 1.25 mg, 14.0 (12.1-17.7 [2.1-48]) h, p = 0.05. Postoperative analgesia was given sooner after rotator cuff repair than subacromial decompression, hazard ratio (95% CI) 2.2 (1.6-3.0), p < 0.0001, but later in older participants, hazard ratio (95% CI) 0.98 (0.97-0.99) per year, p < 0.0001. © 2015 The Association of Anaesthetists of Great Britain and Ireland.
    Anaesthesia 06/2015; 70(10). DOI:10.1111/anae.13156 · 3.38 Impact Factor
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    ABSTRACT: Postoperative nausea and vomiting (PONV) can be prevented. Alizapride is an established antiemetic that may be effective in this role. Our primary objective was to test the hypothesis that alizapride is noninferior to ondansetron for the prophylaxis of PONV. A randomised, placebo-controlled, double-blinded noninferiority study. University hospitals of Leuven, Belgium, from November 2008 to July 2011. A total of 523 patients undergoing laparoscopic gynaecological surgery were included in the study. Reasons for exclusion were American Society of Anesthesiologists (ASA) greater than 2, hypersensitivity to the study medication, pregnancy, mental disorders, psychiatric illness or consumption of antiemetic drugs within 24 h before initiation of the study. Patients received either alizapride 100 mg, ondansetron 4 mg or placebo intravenously 30 min before the end of surgery. The main outcome measures included the incidences of postoperative nausea (PON) and postoperative vomiting (POV) during the stay in the postanaesthetic care unit (PACU), with noninferiority testing for alizapride versus ondansetron. The region of noninferiority was defined as a relative difference in incidence of 25%. Secondary outcome was the incidence of PONV in the PACU and after 24 h. In the alizapride group, 32% of the patients experienced PON during the PACU stay, compared with 28% in the ondansetron group [relative risk 1.13, 90% confidence interval (CI) 0.87 to 1.46], exceeding the predefined margin of noninferiority. With respect to the incidences of POV during the PACU stay, 12.8% of the patients randomised to receive alizapride experienced POV, compared with 7.7% of who received ondansetron (relative risk 1.67, 90% CI 1.00 to 2.87). The incidences of PON and POV in the placebo group during the PACU stay were 34.2 and 9.8%, respectively. The 24-h incidences of PONV were lower than expected in this high-risk group of patients and were similar at 39.3, 36.8 and 31.5% in the placebo, alizapride and ondansetron groups, respectively (χ, P = 0.36). Patients treated with ondansetron required significantly less rescue medication than placebo-treated patients (P = 0.035). Due to the lower than expected incidences of PONV in this study, the power to conclude any noninferiority of alizapride was reduced to only 41%. We found no evidence to support the noninferiority of alizapride 100 mg when compared with ondansetron 4 mg for the intraoperative prophylaxis of PONV. However, the lower than expected incidences of PONV reduced the power of this study to conclude noninferiority or confirm significant beneficial effects for either antiemetic for PON and POV during the PACU stay. Eudra CT 2008-004789-20.
    European Journal of Anaesthesiology 06/2015; DOI:10.1097/EJA.0000000000000288 · 2.94 Impact Factor
  • Matthias Desmet · Dries Helsloot · Evie Vereecke · Carlo Missant · Marc van de Velde ·
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    ABSTRACT: The transversus abdominis plane (TAP) block can be used as part of a multimodal analgesia protocol after abdominal surgery. This study investigated whether a pneumoperitoneum during abdominal surgery influences the spread of local anesthetics. Nine fresh frozen cadavers were used for the study. Using an ultrasound-guided midaxillary technique, a unilateral TAP block-like injection with 20 mL of methylene blue dye was performed. After the injection, a pneumoperitoneum was immediately installed for 1 hour. After desufflation, this ipsilateral side was dissected, and a TAP block-like injection was performed on the contralateral side. One hour after injection, the contralateral side was also dissected. The anatomical dissection was used to determine the extent of dye spread and the nerves stained by the dye. In none of the specimens did the dye reach the posterior origin of the transverse abdominal muscle. There was no statistically significant difference in the number of stained nerves and spread of the dye in the insufflated side compared with the noninsufflated side. In 4 of 9 cadavers, we found a variant course of a nerve preventing staining of that nerve. The stretch of the abdominal wall caused by the insufflation of the abdomen does not influence the spread of dye in the abdominal wall. Because of the absence of posterior spread, regardless of the timing of a midaxillary ultrasound-guided approach, we believe that a posterior approach should be chosen if posterior spread is desired.
    Regional anesthesia and pain medicine 06/2015; 40(4). DOI:10.1097/AAP.0000000000000260 · 3.09 Impact Factor
  • S. Devroe · M. Van de Velde · P. Demaerel · K. Van Calsteren ·
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    ABSTRACT: We describe a case of subdural hematoma following accidental dural puncture (ADP) and epidural blood patching. Although the EBP is a frequently performed technique for PDPH, it can induce harm and vigilance is required. This accentuates once more the importance of follow-up of patients with PDPH and the responsibilities of the anaesthesiologist regarding post-EBP care.
    International Journal of Obstetric Anesthesia 06/2015; 24(3). DOI:10.1016/j.ijoa.2015.05.004 · 1.60 Impact Factor
  • T. Boogmans · J. Vertommen · T. Valkenborgh · S. Devroe · E. Roofthooft · M. Van de Velde ·

    Obstetric Anesthesia Digest 06/2015; 35(2):105-106. DOI:10.1097/01.aoa.0000463849.67884.94
  • Sarah Devroe · Marc Van de Velde · Steffen Rex ·
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    ABSTRACT: For most anaesthesiologists, the clinical experience with general anaesthesia for caesarean section is very low. General anaesthesia is mostly performed for emergency grade 1 caesarean section and due to a lack of time to apply a neuraxial anaesthesia technique. Unfortunately, the majority of anaesthesiologists rely on historical and partly outdated approaches in this stressful situation. We propose an evidence-based approach to general anaesthesia for caesarean section. Rapid sequence induction using propofol and rocuronium should become the standard for general anaesthesia in the obstetric patient. Short-acting opioids are still not given routinely but should never be withheld in case of severe preeclampsia. Cricoid pressure can only be accurately performed by trained caregivers and should be released if intubation appears to be difficult. Supra-glottic airway devices may safely be used in fasted, nonobese elective caesarean section, but endotracheal intubation remains the gold standard, especially in emergency caesarean section in labouring women. Both sevoflurane and propofol are appropriate for the maintenance of general anaesthesia during caesarean section. Awareness remains a major concern in obstetric anaesthesia. We present a review of recent evidence on general anaesthesia for caesarean section.
    Current opinion in anaesthesiology 03/2015; 28(3). DOI:10.1097/ACO.0000000000000185 · 1.98 Impact Factor
  • Marc Van de Velde ·
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    ABSTRACT: Remifentanil is a relatively new but commonly used opioid alternative in the management of labor pain relief. The present article evaluates efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief. Remifentanil PCIA provides analgesia that is superior to nitrous oxide or other opioids such as meperidine, but is less effective when compared with epidural analgesia. Recent evidence suggests it produces significant respiratory depression making routine use as first line analgesia strategy virtually impossible. Remifentanil PCIA is a valuable analgesic strategy whenever regional analgesia is contraindicated. Using it as first line strategy seems to be contraindicated because of significant respiratory side-effects to the mother. Whenever used advanced and continuous monitoring using capnography, saturation monitoring and one-to-one midwifery care are mandatory!
    Current opinion in anaesthesiology 03/2015; 28(3). DOI:10.1097/ACO.0000000000000191 · 1.98 Impact Factor
  • Marc van de Velde · Christian Diez · Albert J Varon ·
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    ABSTRACT: To provide a review of the current literature on the management of obstetric hemorrhage RECENT FINDINGS: Obstetric hemorrhage remains a prominent cause of maternal morbidity and mortality. When postpartum hemorrhage is refractory to manual and pharmacologic treatments, escalating interventions may be needed. Second-line interventions include the use of intrauterine balloon (or gauze) tamponade and uterine compression sutures. If these therapies fail to stop the bleeding, patients may need to undergo radiological embolization, pelvic devascularization, or hysterectomy. In recent years, pelvic arterial embolization has become a common treatment for intractable postpartum hemorrhage in an effort to avoid hysterectomy. The use of prophylactic arterial catheterization in the management of cases with expected major postpartum hemorrhage (e.g., placenta increta or percreta) has also been reported. However, the efficacy and safety of this technique requires further study. Postpartum hemorrhage is best managed by using a stepwise progressive approach. Manual and pharmacologic interventions are first-line treatments. Second-line treatments are used when bleeding continues; and hysterectomy is reserved for only the most extreme cases. Outcomes may be improved by thorough preparation, anticipating the risk of obstetric hemorrhage, and coordinating consultants for interventional procedures.
    Current Opinion in Anaesthesiology 02/2015; 28(2). DOI:10.1097/ACO.0000000000000168 · 1.98 Impact Factor
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    Geertrui Dewinter · Marc Van de Velde · Steffen Fieuws · Andre D Hoore · Steffen Rex ·
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    ABSTRACT: Despite the laparoscopic approach becoming the standard in colorectal surgery, postoperative pain management for minimally invasive surgery is still mainly based on strategies that have been established for open surgical procedures. Patient-controlled epidural and intravenous analgesia are considered standard postoperative analgesia regimens in colorectal surgery. Epidural analgesia provides excellent analgesia, but is increasingly scrutinized in laparoscopic surgery since postoperative pain after the laparoscopic approach is significantly reduced. Moreover, epidural analgesia can be associated with numerous complications. Therefore, epidural analgesia is no longer recommended for the management of postoperative pain in laparoscopic colorectal surgery. Likewise, patient-controlled intravenous analgesia is subject to significant side effects. Given these important limitations of the traditional strategies for postoperative analgesia, effective and efficient alternatives in patients undergoing laparoscopic colorectal surgery are needed. Both the transversus abdominis plane block and systemically administered lidocaine have already been reported to effectively reduce pain after laparoscopic colorectal surgery. We hypothesize that the transversus abdominis plane block is superior to perioperative intravenous lidocaine.Methods/design: One hundred and twenty five patients undergoing laparoscopic colorectal surgery will be included in this prospective, randomized, double-blind controlled clinical trial. Patients will be randomly allocated to three different postoperative strategies: postoperative patient-controlled intravenous analgesia with morphine (control group, n = 25), a transversus abdominis plane block with ropivacaine 0.375% at the end of surgery plus postoperative patient-controlled intravenous analgesia with morphine (TAP group, n = 50), or perioperative intravenous lidocaine plus postoperative patient-controlled intravenous analgesia with morphine (LIDO group, n = 50). As the primary outcome parameter, we will evaluate the opioid consumption during the first 24 postoperative hours. Secondary endpoints include the Numeric Rating Scale, time to return of intestinal function, time to mobilization, inflammatory response, incidence of postoperative nausea and vomiting, length of hospital stay and postoperative morbidity as assessed with the Clavien-Dindo classification. Recognizing the importance of a multimodal approach for perioperative pain management, we aim to investigate whether a transversus abdominis plane block delivers superior pain control in comparison to perioperative intravenous lidocaine and patient-controlled intravenous analgesia with morphine alone.Trial registration: EudraCT Identifier: 2014-001499-73; 31 July 2014.
    Trials 12/2014; 15(1):476. DOI:10.1186/1745-6215-15-476 · 1.73 Impact Factor
  • S. Verstraete · M.A. Walters · S. Devroe · E. Roofthooft · M. Van De Velde ·
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    ABSTRACT: Background Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of obstetric regional anesthesia. Inserting the catheter intrathecally after ADP to prevent PDPH has gained popularity. Nonetheless, data on the effect of an intrathecal catheter on PDPH and epidural blood patch (EBP) rates are mixed. Our primary objective was to examine if spinal catheterization reduces the incidence of PDPH after ADP in obstetric patients.Methods Anesthetic records of 29,749 regional blocks performed between January 1997 and July 2013 were analyzed retrospectively. In all blocks containing an epidural component, 18-gauge epidural needles were used. All patients who experienced a witnessed ADP or PDPH without ADP were identified. Data from patients with or without a prolonged spinal catheter were compared.ResultsThere were 128 events of witnessed ADP (0.43%). Following known ADP, 39 women had an epidural catheter placed at a different level and 89 had an intrathecal catheter (20-gauge) for at least 24 h. Sixty-one patients developed PDPH after observed ADP (48%). Prolonged intrathecal catheter placement significantly reduced the incidence of PDPH after ADP to 42% compared with 62% in those who have the catheter re-sited epidurally [odds ratio = 2.3 (95% confidence interval 1.04–4.86); P = 0.04].Conclusions The incidence of ADP, PDPH and blood patching is similar with previously published studies. After witnessed ADP, inserting the epidural catheter intrathecally significantly reduced the incidence of PDPH.
    Acta Anaesthesiologica Scandinavica 11/2014; 58(10). DOI:10.1111/aas.12394 · 2.32 Impact Factor

Publication Stats

2k Citations
418.97 Total Impact Points


  • 2015
    • University of Miami Miller School of Medicine
      • Division of Trauma Anesthesiology
      Miami, Florida, United States
  • 1996-2015
    • University of Leuven
      • Division of Anesthesiology and Algology
      Louvain, Flanders, Belgium
  • 1970-2015
    • Universitair Ziekenhuis Leuven
      • • Department of Anesthesiology
      • • Department of Gynaecology and obstetrics
      Louvain, Flanders, Belgium
  • 2013
    • St. Luke's Hospital
      CID, Iowa, United States
  • 2000-2013
    • Universitair Ziekenhuis Ghent
      Gand, Flanders, Belgium
  • 2010
    • Ghent University
      • Department of Organic Chemistry
      Gand, Flemish, Belgium
  • 2001
    • University of Antwerp
      Antwerpen, Flemish, Belgium
  • 1994
    • Catholic University of Louvain
      Лувен-ла-Нев, Walloon, Belgium