Intravenous anaesthesia has undergone a profound transformation over the past five decades, evolving from intermittent bolus administration to highly sophisticated automated delivery systems. Propofol, introduced in the 1980s, enabled continuous infusion techniques and later the development of target-controlled infusion (TCI), fundamentally changing anaesthetic practice. Advances in pharmacokinetic–pharmacodynamic modelling, many of which involved key contributions from Belgian research groups, facilitated increasingly precise drug delivery. More recently, closed-loop systems (CLS) integrating physiological feedback such as electroencephalographic or hemodynamic variables have demonstrated improved control of anaesthetic depth and cardiovascular stability compared with manual titration. Despite these advances and the wide clinical use of TCI nowadays, widespread clinical adoption of full closed-loop systems remains limited, and robust evidence demonstrating improved patient-centred outcomes is still lacking. This review traces the evolution of intravenous anaesthesia, highlights key scientific contributions, including those from Belgian teams, and critically appraises the current evidence supporting automation and artificial intelligence in perioperative medicine. While automation offers clear advantages in standardization and workload reduction, its future integration will depend on demonstration of clinical benefit, usability, and regulatory acceptance.
Four years before Dogliotti, Emile Van Erps published a study on epidural anesthesia that clearly inspired the Italian author.
Organized professional defense per medical specialty is a recent historical phenomenon, particularly for anesthesiologists, as modern anesthesia only emerged in the mid-19th century. In Belgium, such a corporatist association for anesthesiologists, which stands up to discuss and negotiate matters of training, qualification and working conditions was first founded in 1947 as the APSA (Association Professionnelle des Spécialistes en Anesthésie). This association played a crucial role in the nationwide introduction of structured anesthesia facilities shortly after World War II, before which no specific training, dedicated physicians or professional working conditions existed.
The medical specialty of anesthesia and intensive care medicine is relatively young, insofar as it emerged during the 1950’s and was officially recognized during the 1960’s. Despite this young age, the last 50 years have seen considerable progress in available anesthetic drugs, monitoring and security of anesthetized patients, life support, intensive, emergency and perioperative care, and the management of increasingly complex surgeries. Pioneers and passionate anesthesiologists thereafter have made this progress possible. In this paper, we retrace that story at the Liege University Hospital, from the early beginning to the present time, highlighting the contributions of figures of the Department of Anesthesia and Intensive Care Medicine.
The Norton scale (NS) is a widely used instrument to estimate the risk for pressure ulcers in adult, hospitalized patients. Lower NS scores, with the cut-off less than 15, indicate higher risk for pressure ulcer development. The NS assesses 5 domains: mental condition, physical condition, mobility, activity in daily living and incontinence. However, its discriminatory power to predict pressure ulcers is rather low. Since the NS reflects the patients' daily functioning it might be an independent risk factor of outcome of patients in the Intensive Care Unit (ICU), apart from the severity of acute critical illness scores. We therefore performed a single center retrospective study in critically ill patients who were admitted to a tertiary intensive care unit in 2021. NS scores and patients' characteristics and outcomes were collected from computerized databases. The primary outcome was 90-day mortality. Of the 2271 patients who were admitted to the ICU in 2021, 1889 patients were included, of which the NS was measured upon admission (83%). In this cohort, the mean age was 64 years, the Apache III score 59 and the Charlson Comorbidity index 4.4. Increased risk for pressure ulcers (NS <= 14) was detected in 9.7% of patients. Patients with a NS <= 14 were older, more severely ill upon admission and had more comorbidities. The 90-day mortality was 32% in the NS <= 14 group and 11.6% in the NS of more than 14 group (p<0.0001). A reduction in one point in the NS score was inversely associated with a relative increase in mortality by 13%. Furthermore, when corrected for disease severity and comorbidity, NS <= 14 was still independently associated with lower survival (OR 0.47 (0,32-0,70). NS may be an independent prognostic marker for mortality in critically ill patients and could be used in prognostication for critically ill patients. These findings need to be confirmed in prospective, multicentric observational studies.
Background: Preoperative anxiety is pervasive among surgical patients and associated with several complications, particularly in older patients. However, its assessment in older surgical patients remains challenging. Objectives: To select the most appropriate instrument(s) for assessing preoperative anxiety in older surgical patients aged >= 65 years, assess their content validity, and reach consensus on a theoretical definition for preoperative anxiety. Design and Setting: Three-round Delphi study. Method: Experts in clinical management and/or research of (preoperative) anxiety, preoperative care, anaesthesiology, geriatrics, and psychiatry were included. Consensus required >= 70% agreement on instruments selection and their relevance, comprehensiveness and feasibility, and on definitions. The Content Validity Index (CVI) of each scale (S-CVI) and its items (I-CVI) were calculated for the selected instruments. Results: Fourteen international experts participated in the study. The Surgical Anxiety Questionnaire (SAQ) was preferred for measuring preoperative anxiety in research settings, but not considered suitable for clinical practice. The Visual Analogue Scale-Anxiety (VAS-A) was preferred as the most appropriate instrument for measuring preoperative anxiety in clinical settings. The VAS-A had a higher S-CVI (0.92), while the SAQ had a lower S-CVI (0.74) with 10/17 items having I-CVI values below 0.78. Although the anxiety subscale of Amsterdam Preoperative Anxiety and Information Scale (APAIS-A) was highly recognized by the panel and had a high S-CVI score (0.91), it was not selected as the most appropriate for either research or clinical settings. Consensus was achieved regarding the theoretical definition of preoperative anxiety, emphasizing that preoperative anxiety is state anxiety. Conclusions: This study provides a reference for enhancing preoperative anxiety management in older patients. Preoperative anxiety was defined as state anxiety, with VAS-A identified as the most appropriate instrument for clinical use, and SAQ preferred in research, although SAQ is a relatively new instrument that requires further validation.
Background: Goal-directed hemodynamic therapy (GDHT) is applied to optimize cardiac output and perfusion in patients undergoing major abdominal surgery. Dobutamine (DOBU) and norepinephrine (NOR) are commonly used agents with distinct systemic profiles, yet their comparative effects on hepatic blood flow (HBF) remain underexplored. Objectives: To compare the effects of DOBU and NOR on hepatic and systemic hemodynamics during major abdominal surgery. Design and Setting: Prospective observational study conducted in a tertiary academic center on patients undergoing elective pancreaticoduodenectomy. Methods: Two observational cohorts were analyzed. One group received titrated doses of NOR to achieve a targeted increase in mean arterial pressure (MAP), while the other received incremental doses of DOBU. Hemodynamic parameters-including portal vein flow (PVF), hepatic artery flow (HAF), and total HBF-were measured using intraoperative transit-time flow measurement. Measurements were obtained at baseline and following two predefined dose escalations. Main Outcome Measures: Changes in indexed PVF, HAF, and HBF, as well as cardiac index (CI), heart rate (HR), and MAP. Results: DOBU significantly increased CI and HR, with a corresponding rise in PVF and total HBF, but reduced HAF at higher doses. NOR induced a dose-dependent increase in MAP but significantly reduced total HBF due to decreased HAF, without notable changes in CI or PVF. Conclusions: DOBU enhances total HBF primarily via increased cardiac output but at the cost of tachycardia. NOR maintains MAP effectively but may compromise HBF due to vasoconstrictive effects. These findings support a tailored vasoactive strategy in perioperative management, especially in patients at risk for hepatic dysfunction.
Background: The retrolaminar approach of paravertebral block (PVB) is a recent approach which could replace the ordinary approach of PVB as it may have the same analgesic effect with decreased risk of side effects. Study Objectives: This prospective randomized clinical trial aimed to compare the effect of retrolaminar and ordinary approach of PVB on postoperative analgesic profile after breast surgeries. Design: Randomized clinical double-blinded trial. Setting: Operative room, postoperative care unit, and follow-up clinic. Methods: Sixty female patients scheduled for unilateral breast surgery under general anesthesia and PVB were randomly and equally distributed into two groups; group O, in which the patients received PVB by the ordinary approach, and group R, in which the patients received the PVB through retrolaminar approach. Main outcome measures: The primary outcome was the total dose of morphine consumed in the first 24 hours after surgery and the secondary outcome was the incidence of complications. Results: In comparison to the ordinary approach, the use of retrolaminar approach of PVB did not significantly change the postoperative morphine consumption (9 (9-6) mg versus (9 (9-6) mg P= 0.823) and did not significantly change the incidence of perioperative complications (P > 0.05). Also, it did not significantly affect the postoperative Numeric Metric Score (NRS) score (P > 0.05). Conclusion: The retrolaminar approach of PVB has the same effect on the postoperative morphine consumption, the postoperative pain score, and the duration of postoperative analgesia as the ordinary approach in patients undergoing unilateral breast surgery without significant effect on the incidence of complications.
The recent 2022 European Society of Cardiology Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery emphasize the role of cardiac troponin assessment in the evaluation and management of potential perioperative myocardial injury. This central role is however challenged. The current contribution assesses the current knowledge on the place of cardiac troponin in the assessment of perioperative myocardial injury in non-cardiac surgery patients. Additionally, it explores the implications of routine cardiac troponin surveillance for healthcare systems, focusing on costs, resource allocation, and organisational challenges.
The recent and ongoing evolution towards minimally invasive procedures came with the exciting challenge for anesthesiologists to share the airway with the interventional pulmonologist or the otorhinolaryngologist. This narrative review aims to summarize the anesthesiologic considerations when preparing and performing these procedures. Medical Subject Headings (MESH) terms include 50 articles from PubMed® and Excerpta Medica Database (EMBASE) databases. Sharing the airway has led to several challenges, such as the possible loss or collapse of a safe airway. Several solutions have been found, each of which can be used in specific cases. Communication between the anesthesiologist and the interventionalist is crucial to settling on the best airway type. The literature is clear, and a thorough preprocedural assessment is needed. When surgery is performed during the apneic time, high-flow nasal oxygenation is suggested to prolong the apneic time. High- flow jet ventilation is advocated to ensure an approachable surgical field when a smaller-sized endotracheal tube is too big. Combining a flow-controlled ventilator and a small-lumen cuffed endotracheal tube can counter their possible drawbacks. A laryngeal mask is proposed in cases of high tracheal stenosis or bronchoscopic interventions. Total intravenous anesthesia is the golden standard when general anesthesia is needed, accompanied by the Bispectral Index to monitor the depth of anesthesia. The use of supplementary medication such as anticholinergics has been described and can be beneficial.
