Anaesthesiol Intensive Ther
· 2025 Nov · PMID 41362929
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Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are now recognized as important but often underdiagnosed contributors to cardiovascular instability in critically ill patients. Recent studies h...Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are now recognized as important but often underdiagnosed contributors to cardiovascular instability in critically ill patients. Recent studies have clarified the mechanisms by which elevated intra-abdominal pressure (IAP) reduces venous return, raises intrathoracic pressure, and impairs both preload and contractility while increasing afterload. These pathophysiological changes can compromise organ perfusion even at modest IAP elevations, and the interplay between cardiovascular, renal, and hepatic dysfunction has led to the concept of the cardio-abdomino-renal syndrome. Advances in monitoring have shifted practice away from static pressure indices such as central venous and pulmonary artery occlusion pressures. Emerging evidence supports the use of abdominal perfusion pressure, mean perfusion pressure, and volumetric indices obtained by transpulmonary thermodilution, alongside echocardiography and ultrasound-based venous congestion assessment. These tools enable individualized resuscitation strategies, balancing fluid therapy with the risks of exacerbating IAH. The purpose of this review is to synthesize recent evidence on the cardiovascular consequences of IAH and ACS, highlight evolving monitoring techniques, and outline current approaches to management. By integrating updated concepts into clinical practice, early recognition and targeted interventions may mitigate multi-organ dysfunction and improve patient outcomes.
Danel JK, Rosada-Kurasinska J, Copik MM
… +5 more, Zdanowski S, Gola W, Misiołek H, Bartkowska-Śniatkowska A, Białka S
Anaesthesiol Intensive Ther
· 2025 Dec · PMID 41362928
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Assessing pain in non-communicative patients remains challenging in anaesthesia and intensive care. When self-report is unavailable, clinicians infer nociception from behaviour and physiology. Behavioural scales such as...Assessing pain in non-communicative patients remains challenging in anaesthesia and intensive care. When self-report is unavailable, clinicians infer nociception from behaviour and physiology. Behavioural scales such as the Behavioral Pain Scale and the Critical-Care Pain Observation Tool are simple and reproducible, supporting consistent practice; however, performance declines with deep sedation, neuromuscular blockade, or severe neurological injury. Where behavioural cues are absent or unreliable, physiological and neurophysiological signals provide partial information. Autonomic indicators, including heart rate variability, the Surgical Pleth Index, pupillometry, and skin conductance, capture sympathetic responses to noxious stimuli rather than perceived pain and are sensitive to drugs, haemodynamic instability, shivering, and agitation. Electroencephalography and functional near-infrared spectroscopy identify cortical responses to nociceptive input, yet clinically useful thresholds remain context dependent, and most applications are research-based. Emerging machine-learning systems that integrate behaviour and physiology show promise, but models validated in the operating room are not automatically applicable in the intensive care unit and require new external validation with potential recalibration. Evidence is generally stronger intraoperatively than in intensive care, and paediatric data are limited. No instrument directly measures subjective pain when self-report is absent. Available tools index nociception through behavioural and physiological correlates and must be interpreted within the clinical context.
Anaesthesiol Intensive Ther
· 2025 Nov · PMID 41283801
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BACKGROUND: Cricoid pressure (CP) is commonly used during rapid sequence induction and intubation to prevent regurgitation and aspiration of gastric contents. However, its effectiveness and safety have been questioned. P...BACKGROUND: Cricoid pressure (CP) is commonly used during rapid sequence induction and intubation to prevent regurgitation and aspiration of gastric contents. However, its effectiveness and safety have been questioned. Paratracheal pressure (PP) has emerged as a potential alternative. This study aimed to compare the adverse effects of PP versus CP on the glottic view during direct laryngoscopy. MATERIAL AND METHODS: This randomized, double-blind, non-inferiority trial included 200 adult patients undergoing general anaesthesia. Participants were randomly assigned to receive either PP or CP during anaesthesia induction. The primary endpoint was the incidence of deteriorated laryngoscopic view, assessed by a blinded observer using the modified Cormack-Lehane grade with a non-inferiority margin of -10%. Secondary endpoints included the percentage of the glottic opening score, ease of mask ventilation, changes in ventilation volume and peak inspiratory pressure (PIP) during mechanical mask ventilation, ease of tracheal intubation, and resistance during tube advancement. RESULTS: PP was found to be non-inferior to CP regarding the incidence of deteriorated laryngoscopic view (0% vs. 20%; absolute risk difference, -20%; 2-sided 95% CI, -26.68 to -13.32; P < 0.001). Mask ventilation was easier with PP (OR, 0.60; 95% CI, 0.15-2.17; P = 0.284). The increase in PIP was significantly smaller in the paratracheal group (0.47 (0.31-0.63) vs. 1.46 (1.22-1.69); P = 0.002). CONCLUSIONS: PP is non-inferior to CP concerning its effect on the glottic view during direct laryngoscopy. Additionally, PP may facilitate easier mask ventilation and reduce PIP during mechanical ventilation, making it a viable alternative to cricoid pressure.
Kwinta A, Bielański P, Szkudlarek O
… +9 more, Klimczyk T, Składzień T, Depukat R, Lonc T, Drygalski T, Załustowicz A, Krzanowski M, Bartuś S, Terlecki M
Anaesthesiol Intensive Ther
· 2025 Nov · PMID 41221563
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BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is predominantly performed in high-volume centres with extensive experience, which may limit its adoption by new facilities. However, data from the Extracor...BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is predominantly performed in high-volume centres with extensive experience, which may limit its adoption by new facilities. However, data from the Extracorporeal Life Support Organization registry indicate that ECPR is often performed in small-volume centres, suggesting potential for its successful implementation. The aim of the study was to assess the first-year periprocedural results and patient outcomes after launching an ECPR programme in a newly established referral centre. METHODS: Data from 22 consecutive patients (median age 44.5 years, 77.3% male) who underwent ECPR for out-of-hospital cardiac arrest between May 2023 and May 2024 were retrospectively analysed. The most frequent aetiologies were acute myocardial infarction (31.8%) and pulmonary embolism (22.7%). Periprocedural characteristics, complications, and survival and neurological outcomes at 3 months were assessed. RESULTS: The median cannulation time was 15.5 minutes (IQR: 15.0-20.0) and median time from cardiac arrest to extracorporeal membrane oxygenation flow was 59.5 minutes (IQR: 40.0-78.8). At 3-month follow-up, the survival rate reached 31.8% (7 patients), and a favourable neurological outcome (a score of 1 or 2 on the Cerebral Performance Category Scale) occurred in 27.3% of the study group (6 patients). The cannulation success rate was 100%. In one case, cannulation was complicated by a perforation of the right femoral artery, necessitating endovascular repair. CONCLUSIONS: The preliminary results from the first year of our ECPR programme indicate that initiation of such an advanced resuscitative strategy in a newly established centre is achievable, with acceptable short-term clinical and neurological outcomes.
Zielińska M, Bartkowska-Śniatkowska A, Mierzewska-Schmidt M
… +13 more, Biernawska J, Byrska-Maciejak E, Cettler M, Chęcińska M, Damps M, Kubica-Cielińska A, Mikaszewska-Sokolewicz M, Rosada-Kurasińska J, Rybojad B, Sikorski T, Świder M, Tałałaj M, Pągowska-Klimek I
Anaesthesiol Intensive Ther
· 2025 Oct · PMID 41133817
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The anaesthesia of a young child under 3 years of age is a challenge for every anaesthetist. The peculiarities of this group of patients, particularly neonates and infants, resulting primarily from differences in both ph...The anaesthesia of a young child under 3 years of age is a challenge for every anaesthetist. The peculiarities of this group of patients, particularly neonates and infants, resulting primarily from differences in both physiology, anatomy and the immaturity of individual organs which translate into different pharmacokinetics and pharmacodynamics of the drugs used in anaesthesiology, underlie the significantly more frequently recorded critical events during anaesthesia compared with the adult patient population. Concerned about the safety of children undergoing anaesthesia and aiming to ensure the highest possible quality and uniform standard of anaesthetic services, the Expert Panel of the Section of Paediatric Anaesthesiology and Intensive Care has prepared a Section position paper on anaesthesia in children under 3 years of age.
Bartkowska-Śniatkowska A, Zielińska M, Mierzewska-Schmidt M
… +13 more, Biernawska J, Byrska-Maciejasz E, Cettler M, Chęcicka M, Damps M, Kubica-Cielińska A, Mikaszewska-Sokolewicz M, Rosada-Kurasińska J, Rybojad B, Sikorski T, Świder M, Tałałaj M, Pągowska-Klimek I
Anaesthesiol Intensive Ther
· 2025 Oct · PMID 41133816
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Anaesthesia in children seems to be still a challenge for anaesthetists, who usually anaesthetize adult patients in everyday practice. The principles in the field of pediatric anaesthesiology in Poland are regulated by t...Anaesthesia in children seems to be still a challenge for anaesthetists, who usually anaesthetize adult patients in everyday practice. The principles in the field of pediatric anaesthesiology in Poland are regulated by the regulation of the Minister of the Health on the organizational standard as well as requirements regarding the equipment and staff skills, taking into account the safety and quality of the comprehensive perioperative care in hospitals where those procedures are performed in children. The most important rule in the perioperative care is ERAS concept i.e. improving the results of surgical treatment through a comprehensive approach to child in the perioperative period. Some components of this concept apply to anesthetic field such as shortening fasting time, avoiding pharmacological premedication, multimodal analgesia, prevention nausea and vomiting or emergence delirium. This article presents the updated consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on anesthesia in children over 3 years of age, regarding general and specific recommendations in selected surgical specialties. We hope that this statement, which is a continuation of the statement for children under 3 years, will be of interest to anaesthetists who perform anaesthesia in children and adolescents.
Składzień T, Maciejewski P, Szpunar W
… +7 more, Lonc T, Szpor J, Cicio M, Szkudlarek O, Kwinta A, Drygalski T, Terlecki M
Anaesthesiol Intensive Ther
· 2025 Oct · PMID 41099275
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BACKGROUND: The quadratus lumborum block (QLB) and erector spinae (ESP) block are relatively new, regional analgesic techniques adapted to abdominal surgery to reduce opioid consumption in the postoperative period. The a...BACKGROUND: The quadratus lumborum block (QLB) and erector spinae (ESP) block are relatively new, regional analgesic techniques adapted to abdominal surgery to reduce opioid consumption in the postoperative period. The aim of this study was to compare the effectiveness of the ultrasound-guided bilateral ESP block and the bilateral QLB for patients undergoing laparoscopic radical prostatectomy (LRP). METHODS: Adult patients who underwent LRP were randomly allocated to one of two equal groups. Group I received an ultrasound-guided ESP block with 30 mL of 0.35% ropivacaine on both right and left sides. Group II received an ultrasound-guided QLB1 with 30 mL of 0.35% ropivacaine on both right and left sides. RESULTS: There were 104 included patients, 52 patients in the ESP block group and 52 in the QLB group. There was no statistically significant difference in oxycodone consumption within the first 24 hours after surgery between the groups (P = 0.115, 95% CI, for ESP group 17.32-27.56, and for QLB group 22.04-31.07). Pain was evaluated using Numeric Rating Scale (NRS) at 1, 2, 6, 12, and 24 hours after surgery, with no significant differences between the groups (P = 0.325). CONCLUSIONS: Both bilateral QLB and ESP block provided effective postoperative analgesia in patients undergoing LRP. No statistically significant differences were observed between groups in terms of opioid consumption and pain scores during the first 24 hours. However, this trial was not designed or powered to establish equivalence or non-inferiority, and therefore such conclusions cannot be drawn.
Somri M, Somri F, Gaitini L
… +4 more, Safadi A, Abd El Azim A, Mafra I, Gómez-Ríos MÁ
Anaesthesiol Intensive Ther
· 2025 Sep · PMID 41039946
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INTRODUCTION: Second-generation supraglottic airway devices, such as the laryngeal tube suction disposable (LTS-D) and i-gel, are widely used in pediatric anesthesia due to advantages such as improved sealing and gastric...INTRODUCTION: Second-generation supraglottic airway devices, such as the laryngeal tube suction disposable (LTS-D) and i-gel, are widely used in pediatric anesthesia due to advantages such as improved sealing and gastric drainage. This randomized controlled trial compared the efficacy and safety of the LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia. MATERIAL AND METHODS: Eighty ASA I children aged 2-8 years (12-25 kg), scheduled for short elective surgical procedures, were randomized to the LTS-D (n = 40) or i-gel (n = 40) group. Primary outcomes were oxygen saturation (SpO₂) and end-tidal CO₂ (EtCO₂). Secondary outcomes included insertion time, oropharyngeal leak pressure, fiberoptic view, tidal volumes (Vt), and adverse events. RESULTS: Both devices maintained comparable oxygenation. Mean EtCO₂ was slightly higher in the i-gel group, with a mean difference of 2.56 mmHg (95% CI: 1.86-3.26; P < 0.001). The i-gel had significantly faster insertion times (24.53 ± 2.00 s vs. 31.20 ± 1.95 s; P < 0.001) and superior fiberoptic visualization (optimal grades in 99% vs. 70%; P < 0.001). The LTS-D showed higher oropharyngeal leak pressures (37.63 ± 3.71 cmH₂O vs. 24.43 ± 1.72 cmH₂O; P < 0.001). Vt and adverse event rates were similar, with no severe complications reported (P = 0.65). CONCLUSIONS: Both the LTS-D and i-gel are safe and effective for airway management in non-paralyzed children undergoing short procedures. The i-gel enables faster insertion and better anatomical positioning, while the LTS-D offers higher leak pressures, making it preferable when a better seal is needed. Device choice should be guided by clinical context and patient characteristics.
Aszkiełowicz A, Kapłan C, Kapica P
… +1 more, Marszałek R
Anaesthesiol Intensive Ther
· 2025 Oct · PMID 41039945
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Remimazolam is a novel, ultra-short-acting benzodiazepine that has emerged as a promising agent in modern anesthetic and intensive care practice. This review pre-sents a detailed analysis of its pharmacokinetic and pharm...Remimazolam is a novel, ultra-short-acting benzodiazepine that has emerged as a promising agent in modern anesthetic and intensive care practice. This review pre-sents a detailed analysis of its pharmacokinetic and pharmacodynamic properties, clinical efficacy, and safety profile across various patient populations and procedural contexts. The drug's rapid metabolism by plasma esterases, minimal reliance on hepatic or renal function, and availability of a reversal agent (flumazenil) distinguish it from traditional sedatives such as propofol and midazolam. Clinical data support its utility in procedural sedation, general anesthesia, and ICU sedation, particularly in elderly and hemodynamically unstable patients. Pediatric applications are discussed, highlighting the early evidence and dosing considerations. The review also compares remimazolam with other agents such as propofol and dexmedetomidine, underlining its advantages in cardiovascular stability and recovery profiles. While current results are encouraging, the article emphasizes the need for further research to establish standardized protocols and explore its long-term safety, especially in vulnerable populations.
Doroba O, Czupryniak L, Sanfilippo F
… +2 more, Andruszkiewicz P, Zawadka M
Anaesthesiol Intensive Ther
· 2025 Sep · PMID 40995652
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An increasing number of patients treated with novel antidiabetic drugs, including glucagon-like-peptide-1 receptor agonists (GLP-1RA), dual glucose-dependent insulinotropic polypeptide receptor agonists and sodium-glucos...An increasing number of patients treated with novel antidiabetic drugs, including glucagon-like-peptide-1 receptor agonists (GLP-1RA), dual glucose-dependent insulinotropic polypeptide receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors, are presenting in the perioperative period. GLP-1RAs are known to delay gastric emptying, although current data remain preliminary and somewhat conflicting. SGLT2 inhibitors may be associated with euglycemic ketoacidosis in the perioperative period. To assess residual gastric content, gastric ultrasound may serve as a valuable tool in stratifying aspiration risk. Various recommendations are available for the perioperative management of patients on GLP-1RAs or SGLT2 inhibitors. These are based largely on expert opinion and multi-society consensus. This review aims to summarise the key perioperative considerations related to these drug classes and to familiarise practitioners with their pharmacological profiles. We highlight their potential adverse effects and present current recommendations from professional organisations to support safe and effective perioperative management.
de la Matta M, Bastón-Castiñeiras M, López-Herrera D
Anaesthesiol Intensive Ther
· 2025 Sep · PMID 40995651
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INTRODUCTION: The effect of modifying the end inspiratory pause (EIP) on the variations in the physiological dead space (VDphys) in patients undergoing robotic surgery ventilated under a tailored open lung approach has n...INTRODUCTION: The effect of modifying the end inspiratory pause (EIP) on the variations in the physiological dead space (VDphys) in patients undergoing robotic surgery ventilated under a tailored open lung approach has not been addressed before. MATERIAL AND METHODS: This prospective-paired study was carried out in a tertiary hospital. Following an alveolar recruitment manoeuvre (ARM) and the application of a tailored open-lung positive end-expiratory pressure (PEEPOL), participants consecutively received three EIP levels (30%, 40%, and 10%). The sequence was repeated after pneumoperitoneum and the Trendelenburg position and following a second ARM for patients with suspected lung collapse based on an Air test. RESULTS: Eighteen adult subjects were included. The use of an EIP of 10% was asso-ciated with a higher VDphys, both before pneumoperitoneum: 210 mL (IQR 200-237) vs. 197 mL (IQR 173-217) and 196.8 (IQR 185-218) with EIP 30% and 40%, respectively ( < 0.001 and = 0.006) and after pneumoperitoneum: 212 mL (IQR 198-228) vs. 202 mL (IQR 181-213), = 0.001. The application of ARMs and PEEPOL led to a significant reduction in driving pressure [5 cmH₂O (IQR 5-6) vs. 7 cmH₂O (IQR 6-10), < 0.001], despite concurrent increases in PEEP [12 cmH₂O (IQR 10-13) vs. 5 cmH₂O, < 0.001] and plateau pressure [17 cmH₂O (IQR 16-19) vs. 12 cmH₂O (IQR 12-15)]. CONCLUSIONS: The use of an EIP of 30-40% compared to 10% in patients undergoing robotic surgery optimises lung mechanics and minimises ventilation inefficiencies both before and during the establishment of pneumoperitoneum and Trendelenburg positioning.
Kołacz M, Kosson D, Rzepliński R
… +4 more, Olczyk-Miiller K, Mieszczański P, Puchalska-Kowalczyk E, Cichowlas G
Anaesthesiol Intensive Ther
· 2025 Sep · PMID 40959973
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INTRODUCTION: Neuropathic pain (NP) arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system. Antidepressants (ADs) are recommended for the pharmacological treatment of NP. However...INTRODUCTION: Neuropathic pain (NP) arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system. Antidepressants (ADs) are recommended for the pharmacological treatment of NP. However, current guidelines do not specify how long ADs may be effective in NP treatment if the patient is benefiting from the therapy. MATERIAL AND METHODS: This was a retrospective cross-sectional study aiming to analyze the effectiveness of ADs in the treatment of NP by assessing the relationship between AD usage, the length of AD treatment and the intensity of pain in this group patients. Based on their pain intensity and length of treatment, the patients were divided into: three groups (NRS 0-3, NRS 4-6 and NRS ≥ 7), and six groups (< 1 month, 1-3 months, 3-6 months, 6-12 months, 1-2 years, 2-5 years, and > 5 years), respectively. RESULTS: The study was conducted on a database from 421 patients, 231 (54.86%) of whom took antidepressants. We found that AD treatment significantly reduces the likelihood of being in the NRS 7-10 group compared to the NRS 0-3 group (OR = 0.611, 95% CI: 0.37-1.0, = 0.05), and this reduction was observed up to 24 months of treatment (OR = 0.41, 95% CI: 0.22-0.75, < 0.004). CONCLUSIONS: Considering the limitations of the study, the use of ADs in NP therapy may have a significant impact on reducing the occurrence of severe pain up to 24 months of therapy and should be included in pharmacotherapy in this group of patients.
Reysner T, Wieczorowska-Tobis K, Kowalski G
… +3 more, Lapaj L, Daroszewski P, Reysner M
Anaesthesiol Intensive Ther
· 2025 Aug · PMID 40891793
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INTRODUCTION: Total knee arthroplasty (TKA) is associated with severe pain. We examined whether an ultrasound-guided, single-injection L2 erector spinae plane block could improve analgesia compared to an ultrasound-guide...INTRODUCTION: Total knee arthroplasty (TKA) is associated with severe pain. We examined whether an ultrasound-guided, single-injection L2 erector spinae plane block could improve analgesia compared to an ultrasound-guided iPACK (infiltration between the popliteal artery and capsule of the knee) block with adductor canal block (ACB) in patients undergoing TKA under spinal anesthesia. MATERIAL AND METHODS: Ninety patients aged 65-89 years of both sexes (ASA I-III) scheduled for TKA were randomly allocated to receive iPACK block (ropivacaine 0.2%, 20 mL) with ACB (ropivacaine 0.2%, 10 mL), lumbar erector spinae plane block (L-ESPB) (ropivacaine 0.2%, 20 mL on each side), or to the control group. The primary outcome was total opioid consumption. The secondary outcomes included pain scores, time to first rescue opioid analgesia, quadriceps muscle strength, neutrophil-to-lymphocyte ratio (NLR), and platelet- to-lymphocyte ratio (PLR). RESULTS: The total opioid consumption in 48 h was significantly lower in the iPACK+ACB group (mean ± SD) (3.0 ± 3.3) compared to L-ESPB (6.8 ± 3.8, = 0.0442) and the control group (18.2 ± 4.0, < 0.001). The time to first rescue opioid analgesia was longer in the iPACK+ACB (12.0 ± 1.9) compared to the L-ESPB (9.2 ± 1.9, < 0.001) group and the control group (4.3 ± 1.1, < 0.001). The pain scores, NLR, and PLR levels were significantly lower in the iPACK+ACB and L-ESPB groups than at all time points in the control group. CONCLUSIONS: The iPACK+ACB is more effective than L-ESPB in pain management following TKA. iPACK+ACB and the L-ESPB lowered total opioid consumption and prolonged time to first opioid analgesia. NLR and PLR levels did not differ between the groups.
Płotek W, Bekała A, Łuczak-Wawrzyniak J
… +7 more, Dudzińska-Rapczewska K, Gasińska-Błotniak M, Cybulski M, Kubik-Komar A, Kubera E, Wilczak M, Dąbrowski W
Anaesthesiol Intensive Ther
· 2025 Aug · PMID 40891792
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INTRODUCTION: The aim of the study was to evaluate the neurocognitive safety of two schemes of general anesthesia based on propofol or sevoflurane applied to patients undergoing laparoscopic gynecological operations, wit...INTRODUCTION: The aim of the study was to evaluate the neurocognitive safety of two schemes of general anesthesia based on propofol or sevoflurane applied to patients undergoing laparoscopic gynecological operations, with a special focus on the patients' age, American Society of Anesthesiologists (ASA) physical status/risk category I, II, or III, and levels of neuromarkers. MATERIAL AND METHODS: The Montreal Cognitive Assessment (MoCA) was chosen for cognitive assessment. The potential neuroinjury after anesthesia and operation was assessed with a set of neuromarkers: glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), tau protein (tau), and ubiquitin C-terminal hydrolase L1 (UCH-L1). The study was conducted on a group of women with no prior neurological or psychiatric diseases. RESULTS: A total of 61 patients (mean age 40.57 years) were included in the study (29 patients under propofol-based anesthesia [PBA], 32 patients under sevoflurane-based anesthesia [SBA]). The groups were demographically comparable. The patients in both groups exhibited a postoperative increase in the MoCA regardless of the type of anesthesia. The NFL and UCH-L1 levels increased significantly in both groups. The GFAP levels were significantly higher in the SBA group. Neither the age nor the increase in the neuromarkers influenced the patients' cognition. CONCLUSIONS: The types of anesthesia applied in the laparoscopic gynecological operations resulted in a cognitively safe outcome despite detectable alterations in the neuromarkers.
Kalina M, Stadlerová B, Astapenko D
… +3 more, Bílská M, Černý V, Škulec R
Anaesthesiol Intensive Ther
· 2025 Aug · PMID 40891790
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INTRODUCTION: Peripheral venous catheter (PVC) insertion is a common intervention, conventionally performed using visualization and palpation techniques. It has been reported that the first attempt success rate can be as...INTRODUCTION: Peripheral venous catheter (PVC) insertion is a common intervention, conventionally performed using visualization and palpation techniques. It has been reported that the first attempt success rate can be as low as 51%. Ultrasound guidance improves the overall success rate and the success rate of the first attempt. Therefore, we performed a randomized, prospective, clinical trial to compare two different techniques of PVC insertion in the setting of an operating theatre with a focus on the first attempt success rate. MATERIAL AND METHODS: This clinical trial allocated patients scheduled for elective surgery in general anaesthesia to undergo PVC cannulation with ultrasound guidance (Group A) or to undergo PVC cannulation without the use of ultrasound (Group B). RESULTS: A total of 613 adult patients were enrolled. The success of the first cannulation attempt was significantly higher in Group A compared to Group B (Group A: 90.6%, Group B: 84.5%, = 0.039). The overall success rate in both groups was 100%. The time needed to perform PVC cannulation was significantly lower in Group B than Group A (Group A: 406 ± 200 s, Group B: 301 ± 215 s, < 0.001). CONCLUSIONS: We found that ultrasound-guided PVC cannulation was associated with a higher first-attempt success rate than the conventional technique.
Anaesthesiol Intensive Ther
· 2025 Jul · PMID 40734644
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In Poland, epidural analgesia in labour is reimbursed from public funds by the National Health Fund, and yet many women are still unable to access it. The main factor limiting the accessibility of this procedure is the l...In Poland, epidural analgesia in labour is reimbursed from public funds by the National Health Fund, and yet many women are still unable to access it. The main factor limiting the accessibility of this procedure is the lack of an anaesthesiologist. Compared to other fields of medicine in which anaesthesiologists are involved, the needs of women giving birth are often marginalized and do not constitute a priority for the managers of medical entities. In 2022, 14% of births took place under analgesia, rising to 17% in 2023, and 23% in 2024. Despite the positive trend, still, on average, only one in four women can count on giving birth without unnecessary suffering. The aim of the article is to review the current legal ramifications of labour analgesia in terms of international, European, and Polish law.
Wasyluk W, Czop M, Wasyluk M
… +2 more, Janisz-Hezron J, Zwolak A
Anaesthesiol Intensive Ther
· 2025 Jul · PMID 40734643
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The obesity paradox, suggesting improved survival in obese individuals compared to those with normal weight, remains debated, particularly in sepsis. While it has been explored in clinical and experimental settings, conc...The obesity paradox, suggesting improved survival in obese individuals compared to those with normal weight, remains debated, particularly in sepsis. While it has been explored in clinical and experimental settings, conclusive evidence is lacking. This study systematically reviews and meta-analyses the relationship between obesity and survival in murine sepsis models. This systematic review and meta-analysis following PRISMA guidelines included studies from PubMed/Medline (up to January 31, 2025) comparing sepsis survival in obese and non-obese mice. All eligible murine studies were systema-tically reviewed, whereas only those employing diet induced obesity (DIO) and cecal ligation and puncture (CLP) were pooled in the meta-analysis and meta-regression. Twenty-one studies (38 survival experiments) met the criteria: CLP ( = 14), intraperitoneal lipopolysaccharide ( = 7), and other bacterial inoculation models ( = 17). Across all models, obesity increased survival in 10, decreased it in 9, and had no effect in 19 experiments. Quantitative synthesis of 10 CLP-DIO experiments (159 obese vs. 149 lean mice) showed no overall mortality difference ( = 0.391). Meta-regression explained 86% of heterogeneity: later highfat diet (HFD) initiation and longer feeding reduced mortality, whereas older age at sepsis induction increased mortality (all < 0.001). Across the studies, obesity exerted mixed effects; pooled analysis of CLP DIO experiments showed no survival benefit. Variability among studies was associated with time related factors: age at HFD initiation, feeding duration, and age at sepsis induction, highlighting the need to investigate these relationships and to develop a time point standardized CLP DIO sepsis model.