Nieuwe richtlijnen voor cardiopulmonale reanimatie 2010 bij volwassenen

Op 18 oktober 2010 verschenen nieuwe richtlijnen voor cardiopulmonale reanimatie (CPR). Deze werden gepubliceerd in het kader van de vijfjaarlijkse vernieuwingscyclus van reanimatierichtlijnen opgesteld door de European Resuscitation Council (ERC); ze zijn gebaseerd op het consensusdocument van het International Liaison Committee on Resuscitation (ILCOR). Dit artikel belicht de veranderingen en gelijkenissen met de reanimatierichtlijnen van 2005 over “basic life support” en “advanced life support”. De richtlijnen van 2010 kunnen gedownload worden van het internet (http://www.erc.edu).status: publishe

Food safety standards in the fresh produce supply chain: advantages and disadvantages

Abstract : Food safety standards in the fresh produce supply chain are discussed in view of the outcomes of a European Union Directorates General (EU DG) Research project FP7 Veg-i-Trade ‘Impact of climate change and international trade on the safety of fresh produce’. Various standards are outlined and their role in the international (global) trade of fresh produce to guarantee hygiene and safety (related to both microbiological and chemical hazards) of fresh produce along the supply chain is addressed. Stringent food safety requirements, of both legislative and private nature, are identifi ed as important bottlenecks to gain access to the high value EU market. The challenges of translating the set requirements into a food safety management system are explored

Comparison of antimicrobial resistance patterns and phage types of Salmonella Typhimurium isolated from pigs, pork and humans in Belgium between 2001 and 2006

Infections with non-typhoid</p

Deep Neuromuscular Block and Surgical Conditions During Bariatric Surgery In Response

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The Effect of Deep Versus Moderate Neuromuscular Block on Surgical Conditions and Postoperative Respiratory Function in Bariatric Laparoscopic Surgery: A Randomized, Double Blind Clinical Trial

Item does not contain fulltextBACKGROUND: In recent literature, it has been suggested that deep neuromuscular block (NMB) improves surgical conditions during laparoscopy; however, the evidence supporting this statement is limited, and this was not investigated in laparoscopic bariatric surgery. Moreover, residual NMB could impair postoperative respiratory function. We tested the hypotheses that deep NMB could improve the quality of surgical conditions for laparoscopic bariatric surgery compared with moderate NMB and investigated whether deep NMB puts patients at risk for postoperative respiratory impairment compared with moderate NMB. METHODS: Sixty patients were evenly randomized over a deep NMB group (rocuronium bolus and infusion maintaining a posttetanic count of 1-2) and a moderate NMB group (rocuronium bolus and top-ups maintaining a train-of-four count of 1-2). Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome measures were the quality of surgical conditions assessed by a single surgeon using a 5-point rating scale (1 = extremely poor, 5 = optimal), the number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery. Secondary outcome measure was the postoperative pulmonary function assessed by peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity, and by the need for postoperative respiratory support. Data are presented as mean +/- standard deviation with estimated treatment effect (ETE: mean difference [95% confidence interval]) for group comparisons. RESULTS: There was no statistically significant difference in the surgeon's rating regarding the quality of the surgical field between the deep and moderate NMB group (4.2 +/- 1.0 vs 3.9 +/- 1.1; P = .16, respectively; ETE: 0.4 [-0.1, 0.9]). There was no difference in the proportional rating of surgical conditions over the 5-point rating scale between both groups (P = .91). The number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery were not statistically different between the deep and moderate NMB group (0.2 +/- 0.9 vs 0.3 +/- 1.0; P = .69; ETE: -0.1 [-0.5, 0.4] and 61.3 +/- 15.1 minutes vs 70.6 +/- 20.8 minutes; P = .07, ETE: -9.3 [-18.8, 0.1], respectively). All the pulmonary function tests were considerably impaired in both groups when compared with baseline (P < .001). There was no statistically significant difference in the decrease in peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity (expressed as % change from baseline) between the deep and the moderate NMB group. CONCLUSIONS: Compared with a moderate NMB, there was insufficient evidence to conclude that deep NMB improves surgical conditions during laparoscopic bariatric surgery. Postoperative pulmonary function was substantially decreased after laparoscopic bariatric surgery independently of the NMB regime that was used. The study is limited by a small sample size