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Suzanne C Cannegieter - One of the best experts on this subject based on the ideXlab platform.

  • venous thrombosis following lower leg cast immobilization and Knee Arthroscopy from a population based approach to individualized therapy
    Thrombosis Research, 2019
    Co-Authors: Banne Nemeth, Suzanne C Cannegieter
    Abstract:

    Abstract Venous thromboembolism (VTE) is a major complication following lower-leg cast immobilization and Knee arthroscopic surgery. In this review, we aimed to give a comprehensive overview of the literature on the epidemiology, prevention and prediction of VTE in these patients. First, the cumulative incidence of VTE was estimated by performing a meta-analysis in untreated patients only. In lower leg-cast patients with various injuries, asymptomatic VTE occurred in 18.0% (95%CI 12.9 to 23.1) and symptomatic VTE in 2.0% (95%CI 1.3 to 2.7). In Knee-Arthroscopy patients, asymptomatic VTE was seen in 5.9% (95%CI 3.9 to 7.9) versus a symptomatic rate of 0.6% (95%CI 0.4 to 0.7) following heterogeneous types of arthroscopic Knee procedures. Second, the efficacy of thromboprophylaxis was determined by performing a meta-analysis of all RCTs that have been performed till date. Following Knee-Arthroscopy, there was no clear benefit of thromboprophylaxis on the prevention of symptomatic VTE (RR 0.65, 95%CI 0.23 to 1.81), while in contrast, this seemed to prevent asymptomatic DVT. In lower-leg cast patients, thromboprophylaxis appeared to reduce symptomatic VTE (OR 0.31, 95%CI 0.13 to 0.73). However, the validity of these results may be questioned as many trials had several methodological weaknesses. Concerning the bleeding risk (and costs) of thromboprophylaxis, treatment seems only prompted in high risk patients. Such patients could be identified based on individual risk factors such as higher age, obesity or presence of Factor V Leiden. In conclusion, we propose to use risk assessment models to identify patients at risk and to decide on individualized thromboprophylactic therapy, rather than one standard treatment for all patients.

  • thromboprophylaxis after Knee Arthroscopy and lower leg casting
    The New England Journal of Medicine, 2017
    Co-Authors: Raymond A Van Adrichem, Banne Nemeth, Ale Algra, Saskia Le Cessie, F R Rosendaal, Inger B Schipper, Rob G H H Nelissen, Suzanne C Cannegieter
    Abstract:

    BackgroundThe use of thromboprophylaxis to prevent clinically apparent venous thromboembolism after Knee Arthroscopy or casting of the lower leg is disputed. We compared the incidence of symptomatic venous thromboembolism after these procedures between patients who received anticoagulant therapy and those who received no anticoagulant therapy. MethodsWe conducted two parallel, pragmatic, multicenter, randomized, controlled, open-label trials with blinded outcome evaluation: the POT-KAST trial, which included patients undergoing Knee Arthroscopy, and the POT-CAST trial, which included patients treated with casting of the lower leg. Patients were assigned to receive either a prophylactic dose of low-molecular-weight heparin (for the 8 days after Arthroscopy in the POT-KAST trial or during the full period of immobilization due to casting in the POT-CAST trial) or no anticoagulant therapy. The primary outcomes were the cumulative incidences of symptomatic venous thromboembolism and major bleeding within 3 mon...

Yota Kapessidou - One of the best experts on this subject based on the ideXlab platform.

  • ed50 and ed90 of intrathecal hyperbaric 2 prilocaine in ambulatory Knee Arthroscopy
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2014
    Co-Authors: Emmanuel Guntz, Bausard Latrech, Constantin C Tsiberidis, Jonathan Gouwy, Yota Kapessidou
    Abstract:

    Purpose Hyperbaric 2% prilocaine (HP) is increasingly used for spinal anesthesia in day-case surgery. The aim of this prospective double-blind study was to determine the effective dose (ED)50 and the ED90 of HP for patients undergoing Knee Arthroscopy.

  • ed50 and ed90 of intrathecal hyperbaric 2 prilocaine in ambulatory Knee Arthroscopy
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2014
    Co-Authors: Emmanuel Guntz, Bausard Latrech, Constantin C Tsiberidis, Jonathan Gouwy, Yota Kapessidou
    Abstract:

    Hyperbaric 2% prilocaine (HP) is increasingly used for spinal anesthesia in day-case surgery. The aim of this prospective double-blind study was to determine the effective dose (ED)50 and the ED90 of HP for patients undergoing Knee Arthroscopy. Doses of HP were determined using an up-and-down sequential allocation technique. Sequences were analyzed by isotonic regression analysis. A subsequent observational study was performed with the calculated ED90 in 50 patients to confirm the initial result and to describe the induced blockade effects and side effects. Times corresponding to onset and duration of sensory and motor block, surgical data, and side effects were recorded. The ED50 was estimated at 28.9 mg (95% confidence interval [CI]: 26.5 to 35.3) and the ED90 was estimated to be 38.5 mg (95% CI: 35.7 to 39.5). A 40 mg dose of HP provided efficient anesthesia in 46 patients (92%, 95% CI: 82 to 98). The average (SD) time to effective anesthesia was 14.5 (3.9) min. Complete sensory block at level T12 was obtained after ten minutes in 44 of 50 patients. The average (SD) duration of the sensory block was 205 (36.1) min. Maximal level of sensory block was obtained at the T8-T11 levels in 41 of 50 patients without hemodynamic instability. A Bromage 3 score was obtained in 40 of the 46 patients who achieved successful anesthesia after 30 min. Patients did not experience urinary retention, nor were any signs of transient neurologic symptoms observed. This study determined the ED50 of HP is 28.9 mg and suggests that a 40-mg dose of HP is adequate to provide successful spinal anesthesia for outpatient Knee Arthroscopy.

Marc D Schmittner - One of the best experts on this subject based on the ideXlab platform.

Peter P Koch - One of the best experts on this subject based on the ideXlab platform.

M A De Leeuw - One of the best experts on this subject based on the ideXlab platform.

  • esra19 0571 chloroprocaine versus prilocaine for spinal anaesthesia in ambulatory Knee Arthroscopy a double blind randomised trial
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: Elsbeth J Wesselink, G Van Den Hurk, R Van Der Vegt, Cornelis Slagt, J Van Der Aa, Christa Boer, M A De Leeuw, P Van De Ven
    Abstract:

    Background and aims In ambulatory lower limb surgery, spinal anaesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster full recovery from motor block compared to prilocaine. a difference of 15 minutes was considered as clinically relevant. Methods 150 patients were randomly allocated to receive either spinal 40 mg 2-chloroprocaine or 40 mg prilocaine. Primary outcome was the time to complete recovery from motor blockade. Secondary outcome parameters included time to full regression of sensory block, peak sensory block level, urine retention needing catheterisation, time until hospital discharge, TNS and patient satisfaction. Results Time to complete recovery from motor blockade was 15 minutes shorter for 2-chloroprocaine (median: 60 min; interquartile range (IQR) 60–82.5) than for prilocaine (median: 75 min; IQR 60–90; p = 0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared to 165 min; IQR: 135–190, p Conclusions In Knee Arthroscopy, spinal anaesthesia with 2-chloroprocaine results in sufficient anaesthesia with a faster recovery of motor and sensory block, leading to quicker hospital discharge compared to prilocaine.

  • chloroprocaine versus prilocaine for spinal anesthesia in ambulatory Knee Arthroscopy a double blind randomized trial
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: Elsbeth J Wesselink, R Van Der Vegt, Cornelis Slagt, J Van Der Aa, Christa Boer, P Van De Ven, Godelief Janssenvan Den Hurk, Eric Franssen, Noortje Swart, M A De Leeuw
    Abstract:

    Background In ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in Knee Arthroscopy. A difference of 15 min was considered clinically relevant. Methods 150 patients were randomly allocated to receive intrathecally either 40 mg of 2-chloroprocaine or 40 mg of prilocaine. The primary outcome was the time to complete recovery from motor blockade. Secondary outcomes included time to full regression of sensory block, peak sensory block level, urine retention needing catheterization, time until hospital discharge, incidence of transient neurologic symptoms and patient satisfaction. Results Time to complete recovery from motor blockade was 15 min shorter for 2-chloroprocaine (median: 60 min; IQR: 60–82.5) than for prilocaine (median: 75 min; IQR: 60–90; p=0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared with median: 165 min; IQR: 135–190, p Conclusions In Knee Arthroscopy, spinal anesthesia with 2-chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine. Trial registration number NTR6796.