Marc Van de Velde

Universitair Psychiatrisch Centrum KU Leuven, Cortenberg, Flanders, Belgium

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Publications (216)437.9 Total impact

  • E H A Maas · B M A Pieters · M Van de Velde · S Rex
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    ABSTRACT: Background: Transcatheter aortic valve implantation (TAVI) is becoming a valuable alternative to surgical aortic valve replacement in patients with severe aortic stenosis that are at high surgical risk or deemed inoperable. The optimal anesthesia technique for TAVI is still undecided. We performed a systematic review and meta-analysis to compare the safety of locoregional anesthesia (LRA) with or without conscious sedation and general anesthesia (GA) for the TAVI-procedure. Methods: We searched PUBMED, MEDLINE, EMBASE and the Cochrane central register of controlled trials from January 1st 2002 to February 15th 2015. The primary outcome parameters searched were 30-days mortality, hospital length of stay, procedure time, use of adrenergic support, stroke rate, incidence of myocardial infarction, incidence of acute kidney injury, rate of procedural succes. Results: Ten studies, including 5919 patients, fulfilled the inclusion criteria. None of these studies was randomized resulting in a considerable risk of bias. The choice for a specific anesthesia technique did neither affect the average 30-day mortality rate [RR 0.91 (95% CI: 0.53 to 1.56), p=0.72] nor a wide variety of safety endpoints. LRA for TAVI was associated with a significantly shorter procedure time when compared to GA, and a reduction in hospital length of stay. However, LRA significantly increased the risk for implantation of a permanent pacemaker (RR 1.23, p=0.02) and for paravalvular leakage (RR 1.31, p=0.006.). Conclusion: Neither mortality nor the incidence of major adverse cardiac and cerebrovascular events after TAVI is affected by the choice for either LRA or GA.
    No preview · Article · Dec 2015 · Current pharmaceutical design
  • M. Van de Velde · B. Carvalho
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    ABSTRACT: This manuscript reviews the available literature on remifentanil patient-controlled intravenous analgesia in labor focusing on efficacy and safety. Remifentanil compares favorably to other potent systemic opioids but with fewer opioid-related neonatal effects. However, remifentanil provides modest and short-lasting labor analgesia that is consistently inferior when compared to neuraxial analgesia. The initial analgesic effect provided with remifentanil also diminishes as labor progresses. In several studies, remifentanil induced significant respiratory depressant effects in laboring women with episodes of desaturation, hypoventilation and even apnea. Given the safety concerns, we recommend that remifentanil patient-controlled intravenous analgesia should not be a routine analgesia technique during labor. In cases where neuraxial analgesia is refused or contraindicated and the use of remifentanil justified, continuous and careful monitoring is required to detect respiratory depression to provide safe care of both the pregnant woman and unborn child.
    No preview · Article · Dec 2015 · International journal of obstetric anesthesia
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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).
    Full-text · Article · Dec 2015 · Trials
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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).
    Full-text · Article · Oct 2015 · Trials
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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
    No preview · Article · Sep 2015 · BJA British Journal of Anaesthesia
  • 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.
    No preview · Article · Sep 2015 · International journal of obstetric anesthesia
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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.
    No preview · Article · Aug 2015
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    Full-text · Dataset · Aug 2015
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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.
    Full-text · Article · Jul 2015 · PLoS ONE
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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.
    No preview · Article · Jul 2015 · Regional anesthesia and pain medicine
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    Full-text · Conference Paper · Jun 2015
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    Full-text · Conference Paper · Jun 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.
    No preview · Article · Jun 2015 · Anaesthesia
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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.
    No preview · Article · Jun 2015 · European Journal of Anaesthesiology
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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.
    No preview · Article · Jun 2015 · Regional anesthesia and pain medicine
  • 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.
    No preview · Article · Jun 2015 · International Journal of Obstetric Anesthesia

  • No preview · Article · Jun 2015 · Obstetric Anesthesia Digest
  • Marc Van de Velde · Karin Becke · Natalie F. Holt

    No preview · Article · Jun 2015 · Current Opinion in Anaesthesiology
  • 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.
    No preview · Article · Mar 2015 · Current opinion in anaesthesiology
  • 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!
    No preview · Article · Mar 2015 · Current opinion in anaesthesiology

Publication Stats

2k Citations
437.90 Total Impact Points

Institutions

  • 2015
    • Universitair Psychiatrisch Centrum KU Leuven
      Cortenberg, Flanders, Belgium
    • University of Miami Miller School of Medicine
      • Division of Trauma Anesthesiology
      Miami, Florida, United States
  • 1993-2015
    • 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