Gade S, Kalbande JV, Vijapurkar SK
… +2 more, Dey S, Agrawal N
Anaesthesiol Intensive Ther
· 2025 Jul · PMID 40696858
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INTRODUCTION: Dexmedetomidine is administered intravenously, intrathecally, and intramuscularly to enhance the effect of subarachnoid anesthesia. In this study, we investigated the effect of intranasal dexmedetomidine on...INTRODUCTION: Dexmedetomidine is administered intravenously, intrathecally, and intramuscularly to enhance the effect of subarachnoid anesthesia. In this study, we investigated the effect of intranasal dexmedetomidine on the characteristics of spinal anesthesia. MATERIAL AND METHODS: In this double-blinded randomized control study, 60 patients undergoing orthopedic surgery under spinal anesthesia were allocated to two groups. Group A received intranasal dexmedetomidine 1 μg kg 20 minutes (min) before the subarachnoid block. Group B received intranasal normal saline 20 min before the subarachnoid block. Time for the onset of sensory and motor blockade, two-segment regression time, and request of first rescue analgesia were noted. Sedation scores using the Ramsay Sedation Scale (RSS), adverse effect and hemodynamic parameters were assessed. RESULTS: The onset of sensory block and motor block did not differ significantly between the groups. However, two-segment regression time was significantly longer in Group A than in Group B (113.17 ± 14.11 min vs. 94.13 ± 9.59 min, respectively; < 0.001), and the time for first rescue analgesia was significantly longer in Group A than in Group B (3.97 ± 1.56 min vs. 2.56 ± 0.76 min, respectively; < 0.001). The overall mean heart rate and mean arterial pressure were comparable between the two groups with stable hemodynamics. The visual analogue scale score in Group A was low (P < 0.001). Intraoperatively, at 30 min and 60 min, the change in RSS score was found to be statistically significant ( < 0.001). CONCLUSIONS: Intranasal dexmedetomidine prolongs the effect of subarachnoid anesthesia, provides stable hemodynamics with arousable sedation, and offers a noninvasive, better-tolerated alternative compared to other invasive routes of administration.
Anaesthesiol Intensive Ther
· 2025 Jul · PMID 40696857
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INTRODUCTION: Evaluation of ultrasound (US)-guided disc block used to diagnose discogenic pain, as described in case reports. The study aimed to ascertain the noninferiority of US-guided lumbar disc block to conventional...INTRODUCTION: Evaluation of ultrasound (US)-guided disc block used to diagnose discogenic pain, as described in case reports. The study aimed to ascertain the noninferiority of US-guided lumbar disc block to conventional discography in the diagnosis of discogenic low back pain (DLBP). MATERIAL AND METHODS: The reports of 418 patients undergoing lumbar fusion for DLBP were stratified into a US group receiving US-guided lumbar disc block and a control group receiving fluoroscopy (FL)-assistant discography via a propensity-score matched method in a 1 : 1 ratio. The primary endpoint was the confirmatory rate defined as the rate of clinical success following surgery measured by a numerical pain rating scale score ≤ 2 and an Oswestry Disability Index score ≤ 15 at the 1-month follow-up point. Secondary outcomes included needle insertions until contrast given, procedure time, radiation dosages and adverse events. RESULTS: The confirmatory rates for disc block and discography were 71.8% and 73.2% (difference = -1.3%, 95% confidence interval [CI]: -9.9%, 7.2%, = 0.353). The lower bound of 95% CI did not cross the noninferiority margin of 10%. There were fewer needle insertions (median 2, IQR: 1-3 vs. 5, IQR: 4-6, < 0.001), shorter procedure times (8.94 ± 2.28 vs. 16.13 ± 3.39 min, < 0.001) and lower radiation dosage (1689.56 ± 898.54 vs. 8293.50 ± 1039.09 μGy m , < 0.001) in the US group than the control group. No serious adverse events were observed. CONCLUSIONS: US-guided lumbar disc block was not inferior to conventional discography as a diagnostic modality in the evaluation of DLBP being considered for surgery. Given that the sonographic method provided advantages in terms of facilitation of needle insertion, reduced procedure time, and attenuated radiation exposure, it might be an alternative option for surgery decision making.
Leone A, Brombach T, Etingold J
… +4 more, Manall P, Carbone F, Colamaria A, Spetzger U
Anaesthesiol Intensive Ther
· 2025 Jul · PMID 40696856
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INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH), a severe form of hemorrhagic stroke, poses significant diagnostic and management challenges, particularly in predicting and managing cerebral vasospasm and delayed...INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH), a severe form of hemorrhagic stroke, poses significant diagnostic and management challenges, particularly in predicting and managing cerebral vasospasm and delayed cerebral ischemia. This study explores the predictive value of near-infrared spectroscopy (NIRS) in high-grade aSAH patients. MATERIAL AND METHODS: This observational study included 16 high-grade aSAH patients treated at a single institution from June 2020 to November 2023. Neuromonitoring incorporated daily transcranial Doppler and continuous NIRS, alongside routine computed tomography perfusion. The primary endpoint was the occurrence of major cerebral vasospasms detected by digital subtraction angiography preceded by a decrease in regional oxygen saturation as indicated by NIRS. RESULTS: Among the participants, vasospasms were most prevalent in the internal carotid artery (56.3%), followed by the middle cerebral artery (50%). NIRS detected alterations in 43.8% of the cohort, with 25% occurring before vasospasm onset. A correlation between early NIRS alterations and specific vasospasm locations was identified. CONCLUSIONS: Conclusions: While NIRS shows potential for continuous, non-invasive monitoring of cerebral oxygenation, its utility in predicting vasospasms is limited. The findings underscore the importance of integrating NIRS with other neuromonitoring modalities to enhance predictive accuracy and patient management in aSAH. Large-scale studies are necessary to establish protocols and intervention thresholds.
Anaesthesiol Intensive Ther
· 2025 Jul · PMID 40696855
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The use of volatile anesthetics as an alternative sedation modality in the intensive care unit (ICU) has gained traction over the last several years. Volatile agents such as sevoflurane and isoflurane possess favorable p...The use of volatile anesthetics as an alternative sedation modality in the intensive care unit (ICU) has gained traction over the last several years. Volatile agents such as sevoflurane and isoflurane possess favorable pharmacokinetic and pharmacodynamic properties that make them suitable choices for titration of sedation in patients requiring mechanical ventilation. Several studies have continued to demonstrate their efficacy and safety particularly when assessing wake-up times and times to extubation in contrast to various intravenous sedatives. Leveraging the pharmacodynamic properties of the volatile agents may also be beneficial in certain disease states. As there are devices currently available to enable delivery of volatile anesthetics to patients in the ICU, ongoing studies exist to determine how to best use this sedation modality. This review outlines the recent evidence and discusses perspectives on volatile-based sedation for critically ill patients.
Rękas-Dudziak AR, Rojek J, Blacha A
… +3 more, Pruszynska-Oszmałek E, Kołodziejski P, Matuła P
Anaesthesiol Intensive Ther
· 2025 Jun · PMID 40530445
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INTRODUCTION: The pentraxins are a superfamily of proteins characterized by the presence of a pentraxin domain at the C-terminal. One of them is pentraxin 3 (PTX3), which is of great interest to scientists, primarily due...INTRODUCTION: The pentraxins are a superfamily of proteins characterized by the presence of a pentraxin domain at the C-terminal. One of them is pentraxin 3 (PTX3), which is of great interest to scientists, primarily due to its function as an endogenous modulator of the inflammatory response. Local inflammation is a common phenomenon during various types of surgery and procedures, and its causes, among others, are local ischemia or tissue irritation. One such procedure is carotid plaque removal by carotid endarterectomy (CEA), which is performed to reduce the risk of stroke. MATERIAL AND METHODS: The purpose of this study was to investigate the effect of CEA on PTX3 concentration and the relationship between cognitive functions and the duration of brain ischemia in patients. We evaluated the relationships using blood collected from patients undergoing CEA, the Mini-Mental State Examination (MMSE) questionnaire, and commercially available ELISA tests. RESULTS: Results: We found that the concentration of PTX3 increased after surgery (from 0.59 ± 0.11 to 1.29 ± 0.29 ng mL; < 0.01). Also, a decrease in the MMSE score was observed 24 hours after the procedure ( < 0.01). However, just one month after the procedure, it significantly increased compared to the day of admission to the hospital ( < 0.01). Our results did not demonstrate any interactions between the tested parameters. It can be concluded that neither the changes in PTX3 concentration following the procedure nor the timing of these changes directly contribute to the temporary deterioration of cognitive functions observed after CEA. CONCLUSIONS: PTX3 increases independently of the duration of cerebral hypoxemia/ hypercapnia after clamping the carotid artery. This rise is an inflammatory marker that occurs independently within the central nervous system.
Shorbagy MS, Mahrose R, Kasem AA
… +2 more, Ali YA, Abdelaziz SH
Anaesthesiol Intensive Ther
· 2025 Jun · PMID 40524639
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INTRODUCTION: Sedative premedication may hold notable significance in pediatric patients undergoing diagnostic and interventional cardiac catheterization, as it minimizes anxiety, facilitates parental separation, and all...INTRODUCTION: Sedative premedication may hold notable significance in pediatric patients undergoing diagnostic and interventional cardiac catheterization, as it minimizes anxiety, facilitates parental separation, and allows for the acceptance of inhalational induction. The intranasal route is a reliable method for administering sedatives as pre- medication in pediatric patients. This study compared and evaluated the sedative effects of intranasal dexmedetomidine versus intranasal midazolam as premedication in pediatric patients undergoing transcatheter closure of ventricular septal defects. MATERIAL AND METHODS: This prospective, randomized, double-blind study included 40 pediatric patients aged 3 to 6 years scheduled for transcatheter perimembranous VSD closure under general anesthesia. The subjects were randomly assigned to receive either intranasal midazolam at 0.2 mg kg body mass or intranasal dexmedetomidine at 0.5 μg kg body mass. The primary outcome measured was the effect of preoperative sedatives on the Ramsay sedation score. Secondary outcomes included the child-parent separation score, child emergence agitation level, effects on hemodynamics, and oxygen saturation. RESULTS: This study included 40 individuals with similar demographic profiles and comparable duration of the procedure ( = 0.152) in both groups. No statistically significant differences were detected in the Ramsay sedation score ( = 0.582), child-parent separation score ( = 1.000) 20 minutes after drug administration, or postoperative child emergence agitation level ( = 0.351). No statistically significant difference was observed in terms of blood pressure, heart rate and oxygen saturation between the two groups. CONCLUSIONS: Pediatric patients were successfully and effectively sedated with both intranasal dexmedetomidine and intranasal midazolam, with stable hemodynamics and oxygen saturation.
Anaesthesiol Intensive Ther
· 2025 Jun · PMID 40524638
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INTRODUCTION: The healthcare system is one of the areas most affected by the COVID-19 pandemic in Poland. This resulted in a higher occurrence of medical errors at diffe-rent stages of diagnosis and patient treatment. Th...INTRODUCTION: The healthcare system is one of the areas most affected by the COVID-19 pandemic in Poland. This resulted in a higher occurrence of medical errors at diffe-rent stages of diagnosis and patient treatment. This study aimed to determine how the COVID-19 pandemic affected the number and type of medical errors in Poland and the type of medical facility where the irregularity occurred. MATERIAL AND METHODS: We reviewed inquiries into the correctness of medical proceedings related to COVID-19; these were received by our department from prosecutor's offices throughout Poland during the pandemic and after its end: from the beginning of January 2020 to the end of December 2023. During the examined period (48 months), the department received a total of 4,483 inquiries, i.e. approximately 4.5 per day (approximately 1,000 working days). Of these, 293 were related to the COVID-19 pandemic (6.54%) and were further analyzed according to the selected criteria. Inquiries regarding "COVID" cases concerned all aspects of medical procedures, all medical professions, and all healthcare entities. RESULTS: A clear correlation was found: most inquiries raising doubts about the correctness of medical procedures were received during the peaks (waves) of the pandemic: autumn 2020, spring 2021, late autumn 2021, and winter 2021/2022. CONCLUSIONS: Despite the introduction of legal regulations intended to decriminalize consequences of medical errors related to the COVID-19 pandemic, such cases were still submitted to prosecutors' offices; prosecutors initiated proceedings and then commissioned expert opinions on the correctness of the medical procedure.
Khajavi M, Kazeroni R, Ramezani R
… +3 more, Biderafsh A, Kianpour P, Neishaboury M
Anaesthesiol Intensive Ther
· 2025 May · PMID 40458052
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INTRODUCTION: Maintaining control over the airway is critical during general anesthesia induction, particularly in patients with anticipated difficult airways. Video laryngoscopy with various devices has emerged as a val...INTRODUCTION: Maintaining control over the airway is critical during general anesthesia induction, particularly in patients with anticipated difficult airways. Video laryngoscopy with various devices has emerged as a valuable tool in such scenarios and has shown promising performance. This study aimed to evaluate glottic visualization and the first attempt success rate of tracheal intubation of GlideScope and Sanyar video laryngo- scopes in adult patients with predicted difficult intubation. MATERIAL AND METHODS: A randomized, controlled, two-armed, parallel clinical trial was conducted, in adult patients with anticipated difficult intubation undergoing elective surgery under general anesthesia. Participants were randomly assigned to either the GlideScope or Sanyar group. The primary outcome was the success rate of intubation in the first attempt at laryngoscopy, and secondary outcomes were the duration of intubation, glottic visualization, blood pressure and heart rate after intubation. RESULTS: A total of 93 patients were included in the analysis, with 46 in the S group and 47 in the G group. The S group demonstrated a significantly higher first-attempt success rate of tracheal intubation (93.4% vs. 85.2%; = 0.002) and shorter intubation time (29.28 ± 8.00 seconds vs. 42.73 ± 15.50 seconds; = 0.0001) compared to the G group. Glottic visualization and hemodynamic changes did not significantly differ between the two groups. CONCLUSIONS: The Sanyar video laryngoscope exhibited superior efficacy in terms of first-attempt tracheal intubation success and shorter intubation time compared to the GlideScope in adult patients with predicted difficult airways. These findings suggest that the Sanyar video laryngoscope may serve as a valuable alternative in challenging intubation scenarios.
Barud M, Turek B, Dąbrowski W
… +1 more, Siwicka D
Anaesthesiol Intensive Ther
· 2025 May · PMID 40420612
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Robotic surgery has become increasingly popular over the last 30 years. This technique is particularly attractive due to its minimally invasive nature, high precision compared to open and laparoscopic techniques, less po...Robotic surgery has become increasingly popular over the last 30 years. This technique is particularly attractive due to its minimally invasive nature, high precision compared to open and laparoscopic techniques, less postoperative pain, shorter hospital stay for patients, and faster recovery. For an anesthesiologist, robot-assisted operations involve numerous challenges resulting from the surgical technique. The most important problems during anesthesia include changes in physiology resulting from the development of pneumoperitoneum and a steep Trendelenburg position. This review discusses problems that may be encountered by an anesthesiologist performing anesthesia during robotic surgery.
Reysner T, Kowalski G, Reysner M
… +3 more, Lapaj L, Daroszewski P, Wieczorowska-Tobis K
Anaesthesiol Intensive Ther
· 2025 May · PMID 40420611
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INTRODUCTION: This study evaluated the efficacy of ultrasound-guided erector spinae plane block (ESPB) and pericapsular nerve group (PENG) block under spinal anesthesia for postoperative analgesia in elderly patients und...INTRODUCTION: This study evaluated the efficacy of ultrasound-guided erector spinae plane block (ESPB) and pericapsular nerve group (PENG) block under spinal anesthesia for postoperative analgesia in elderly patients undergoing total hip arthroplasty. MATERIAL AND METHODS: In this randomized, controlled, double-blind study, 90 elderly patients (aged 67-89 years, ASA II and III), scheduled for total hip arthroplasty under spinal anesthesia were randomly allocated to three groups: PENG block ( = 30), ESPB ( = 30), and Control group ( = 30). Ultrasound-guided blocks were administered using 20 mL of 0.2% ropivacaine. The primary outcome was total opioid consumption over 48 hours. 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: Opioid consumption within 48 hours was significantly lower in both the PENG (3.5 ± 4.0) and ESPB (3.4 ± 3.8) groups compared to the Control group (16.07 ± 3.8 ), with P < 0.001, and no significant difference between PENG and ESPB groups ( = 1.0). Time to first rescue analgesia was longer in the PENG (12.3 ± 3.2) and ESPB (11.2 ± 2.9) groups relative to the Control group (4.2 ± 1.1), < 0.001. Pain scores remained consistently lower in both intervention groups at all time points compared to the Control group. Quadriceps strength was lower in the PENG group at 6 hours postoperatively compared to ESPB. NLR and PLR values were lower in both block groups than in the Control group. CONCLUSIONS: Ultrasound-guided PENG and ESPB are effective for postoperative analgesia in elderly patients undergoing total hip arthroplasty, significantly reducing opioid requirements and enhancing recovery quality.
Czok MZ, Cierniak A, Skupnik W
… +8 more, Pasieka P, Białka S, Garus M, Kościuczuk U, Milecki J, Topolińska M, Putowski Z, Szczeklik W
Anaesthesiol Intensive Ther
· 2025 May · PMID 40420609
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INTRODUCTION: The evaluation of postoperative convalescence requires a patient-reported quality of recovery. One of the tools that facilitate such evaluation is the Quality of Recovery-15 (QoR-15) questionnaire. Even tho...INTRODUCTION: The evaluation of postoperative convalescence requires a patient-reported quality of recovery. One of the tools that facilitate such evaluation is the Quality of Recovery-15 (QoR-15) questionnaire. Even though it has been validated in several languages, a Polish version of the questionnaire has not been available until now. MATERIAL AND METHODS: The study was conducted in 5 Polish hospitals from 22 January 2023 to 7 May 2023. Patients aged over 18 years undergoing a surgical procedure with planned general anaesthesia were considered eligible for the study. The participants completed the translated QoR-15 questionnaire twice: before surgery and on day 1 after surgery. 20% of patients were asked to complete the questionnaire twice after surgery in order to establish the test-retest reliability. Visual Analogue Scale results were obtained at each time point. Comprehensive data regarding patients' clinical characte-ristics, surgical procedure and postoperative complications were obtained from medical records. RESULTS: 342 patients (52.6% females) successfully completed both preoperative and postoperative questionnaires. The Cronbach's a values for preoperative and postoperative questionnaires were 0.85 and 0.86, respectively. Test-retest reliability indicated by the intraclass correlation coefficient was 0.91 (95% CI: 0.85 to 0.94, < 0.01). Cohen's effect size was 0.78 (95% CI: 0.62 to 0.93) with a standardized response mean of -0.65 (95% CI: -0.75 to -0.54). CONCLUSIONS: The Polish version of the QoR-15 questionnaire is a reliable and effective tool for assessing the quality of recovery reported by patients after surgery and general anaesthesia.
Piwowarczyk P, Szczukocka M, Uchacz A
… +4 more, Kutnik P, Czarnik T, Czuczwar M, Borys M
Anaesthesiol Intensive Ther
· 2025 Apr · PMID 40237531
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INTRODUCTION: Unfractionated heparin (UFH) is the traditional anticoagulant of choice in critically ill COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO). Nadroparin, a low molecular weight heparin,...INTRODUCTION: Unfractionated heparin (UFH) is the traditional anticoagulant of choice in critically ill COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO). Nadroparin, a low molecular weight heparin, potentially offers advantages such as predictable pharmacokinetics and reduced bleeding risks compared to UFH, with complex pharmacokinetics, influencing activated partial thromboplastin and causing substantial haemorrhagic risks. Bleeding, the most common adverse event during ECMO, is associated by many with increased activated partial thromboplastin time. MATERIAL AND METHODS: This retrospective, bicentric analysis involved 38 consecutive ECMO-supported COVID-19 patients from two Polish hospitals. The study compared 27 patients receiving UFH and 11 patients treated with 5700 IU of nadroparin administered subcutaneously twice daily. Thrombotic and haemorrhagic complications were assessed to determine the safety and feasibility of each anticoagulant. RESULTS: Resistance to flow throughout the therapy in the ECMO membrane oxygenator was significantly lower in the group anticoagulated with UFH (1.74 mmHg × minute × L [1.38-2.6] vs. 6.13 mmHg × minute × L [5.93-14.81]; < 0.001). However, the number of transfused red blood cell packs in the aforementioned group was significantly greater (10 units [5-17] vs. 4 units [2-8]; = 0.027), and the haemoglobin level after ECMO therapy was significantly lower (7.8 g dL [6.9-8.8] vs. 10.2 g dL [8.5-12.2]; = 0.003). Moreover, there was a higher number of life-threatening events in the UFH group. CONCLUSIONS: UFH anticoagulation may provide better flow optimization in the oxygenator, but the risk of life-threatening bleeding may increase. The present findings need to be fully elucidated in prospective studies on a larger critically ill population supported with respiratory ECMO.
Paprocka-Lipińska A, Damps M, Barsow S
… +1 more, Kosiba B
Anaesthesiol Intensive Ther
· 2025 Apr · PMID 40237530
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INTRODUCTION: The purpose of this survey was to investigate the opinions on futile therapy among anaesthesiologists and residents in anaesthesiology and intensive therapy as well as to determine the frequency of the futi...INTRODUCTION: The purpose of this survey was to investigate the opinions on futile therapy among anaesthesiologists and residents in anaesthesiology and intensive therapy as well as to determine the frequency of the futile therapy protocol being used. Additionally, the survey aimed to determine the factors responsible for futile therapy being still practised in intensive care units (ICUs). MATERIAL AND METHODS: The authors developed a questionnaire for the purpose of the study. In addition to questions about professional status, gender, age, seniority, and place of work, questions regarding aspects of futile therapy in the context of medical decision-making were included in the study tool. A question was also asked about whether the COVID-19 pandemic might have influenced the perception of futile therapy. The survey was conducted using the computer-assisted web interview (CAWI) technique. The questionnaires were completed in an online form between May and October 2023. RESULTS: The study group consisted of 488 respondents including anaesthesiologists and residents in anaesthesiology and intensive therapy. About 80% of the respondents were anaesthesiologists, with an average ICU experience of about 15 years. The vast majority of anaesthesiologists ( = 458) were of the opinion that the decisions on intensive care limits should be subject to legal regulations. CONCLUSIONS: Polish anaesthesiologists recognise the need to regulate the decision-making process as part of the legal system while not perceiving a need for their decisions to be subject to authorization by hospital ethics committees. Respondents also note the need to educate the public on the subject of end-of-life care.