Mika S, Gola W, Gil-Mika M
… +2 more, Wilk M, Misiołek H
Anaesthesiol Intensive Ther
· 2024 · PMID 38741438
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Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as im...Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as impenetrable by ultrasound. Only during the recent several years has the approach to the use of such tool in clinical daily routines changed dramatically to offer so-called point-of-care ultrasonography (POCUS). Both vertical and horizontal artefacts became valuable sources of information about the patient's clinical condition, assisting therefore the medical practitioner in differential diagnosis and monitoring of the patient. What is important is that the information is delivered in real time, and the procedure itself is non-invasive. The next stage marking the progress made in this area of diagnostic imaging is the development of arti-ficial intelligence (AI) based on machine learning algorithms. This article is intended to present the available, innovative solutions of the ultrasound systems, including Smart B-line technology, to ensure automatic identification process, as well as interpretation of B-lines in the given lung area of the examined patient. The article sums up the state of the art in ultrasound artefacts and AI applied in POCUS.
Bedi V, Debbarma S, Sharma S
… +3 more, Navaria R, Jhawer A, Choudhary S
Anaesthesiol Intensive Ther
· 2023 · PMID 38282504
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INTRODUCTION: Epidural volume extension is technique aiming to mitigate spinal anaesthesia induced hypotension, by reducing the dose of local anaesthetics. The present study was executed to determine the effect of epidur...INTRODUCTION: Epidural volume extension is technique aiming to mitigate spinal anaesthesia induced hypotension, by reducing the dose of local anaesthetics. The present study was executed to determine the effect of epidural volume extension subarachnoid block with 0.5% hyperbaric bupivacaine in patients undergoing proximal femoral nailing (PFN) regarding characteristics of sensory-motor block and postoperative analgesia. MATERIAL AND METHODS: In this prospective, double-blind trial conducted from October 2021 to April 2022, 105 adult patients scheduled to undergo PFN were randomised into groups: control (C), 10 mL NS (E1), and 20 mL NS (E2), to receive 10 mg hyperbaric bupivacaine intrathecally plus additional epidural volume extension with 10 and 20 mL normal saline in groups E1 and E2, respectively. The primary outcome measured was the duration of postoperative analgesia. The secondary outcomes measured included onset of sensory- motor block and duration of sensory block. P < 0.05 was considered statistically significant. RESULTS: A significantly longer duration of postoperative analgesia was noted in patients receiving 10 and 20 mL epidural volume extension (365.09 ± 101.83 and 330.06 ± 35.22 vs. 265.77 ± 38.01 min in the control group, P < 0.01). Patients who received any epidural volume extension with either 10 or 20 mL had significantly quicker onset of sensory and motor block as well as prolonged duration of sensory block. No significant difference in duration of postoperative analgesia, and onset and duration of block was observed between patients receiving either 10 or 20 mL epidural volume extension. CONCLUSIONS: Epidural volume extension significantly shortened the onset of sensory-motor block and increased the duration of sensory block and postoperative analgesia in patients undergoing PFN under subarachnoid block; however, no such difference was observed between 10 and 20 mL epidural volume extension.
Abdelhamid B, Ayman E, Nabil T
… +2 more, Hamimy WI, El-Monem Morsy MA
Anaesthesiol Intensive Ther
· 2023 · PMID 38282503
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INTRODUCTION: There is a lack of clarity regarding the ideal local anaesthetic volume for modified thoracolumbar interfascial plane (mTLIP) block. This study was designed to investigate the analgesic efficacy of two diff...INTRODUCTION: There is a lack of clarity regarding the ideal local anaesthetic volume for modified thoracolumbar interfascial plane (mTLIP) block. This study was designed to investigate the analgesic efficacy of two different volumes of bupivacaine 0.25% (20 mL, and 10 mL) for ultrasound-guided mTLIP block in patients undergoing lumbar spine surgeries. MATERIAL AND METHODS: A total of 80 patients received single shot of bilateral mTLIP block at the mid- level of the operative intervention and were randomly allocated into one of the two groups to receive either 10 or 20 mL 0.25% bupivacaine on each side. Total morphine consumption in the first 24 hours postoperative was set as the primary outcome. Time to first rescue analgesia and Numeric Rating Scale (NRS) were set as secondary outcomes. RESULTS: There was no significant difference in the primary outcome: 6.20 ± 2.18 mg (10 mL Group) vs. 5 ± 0.00 mg (20 mL Group), P = 0.056. The time of first request of rescue morphine was significantly shorter in 10 mL Group (7.80 ± 3.98 hours) as compared to the 20 mL Group (13.23 ± 3.00 hours), P < 0.001. NRS at rest and movement in all time measurements was significantly higher in 10 mL Group. CONCLUSIONS: Bilateral mTLIP block using 40 mL of 0.25% bupivacaine (20 mL on each side) increased the postoperative total analgesic duration for lumbar spine surgeries, and was associated with a lower postoperative pain scores compared to 20 mL of 0.25% bupivacaine (10 mL on each side). CLINICAL TRIAL REGISTRATION ID: The study was registered at clinicaltrials.gov (ID: NCT05276908) before patient's enrolment.
Kurup MT, Sarkar S, Verma R
… +7 more, Bhatia R, Khanna P, Maitra S, Anand R, Ray BR, Singh AK, Deepak KK
Anaesthesiol Intensive Ther
· 2023 · PMID 38282502
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INTRODUCTION: Neuroinflammation, neuronal cytotoxicity, and apoptosis due to exposure to anaesthetic agents are often implicated in postoperative cognitive dysfunction (POCD). Lidocaine and dexmedetomidine have been show...INTRODUCTION: Neuroinflammation, neuronal cytotoxicity, and apoptosis due to exposure to anaesthetic agents are often implicated in postoperative cognitive dysfunction (POCD). Lidocaine and dexmedetomidine have been shown to suppress the neuron-specific markers of inflammation, and we aimed to compare their neuroprotective efficacy in elderly patients. MATERIAL AND METHODS: This prospective randomized control study compared the incidence of POCD in ASA I/II patients aged 60 to 80 years without any history of substance abuse or any disorder affecting cognition. Dexmedetomidine and lidocaine were administered intraoperatively, and their effects on POCD were correlated with serum levels of IL-1, IL-6, TNF-a, amyloid-β, and S100 on postoperative day 3. POCD was assessed by the Stroop test, Trail making test-B, Porteus Maze test, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) on the day before surgery and the third postoperative day, along with blood samples. RESULTS: Demographic parameters, anaesthesia duration, exposure to anaesthetic gases, intraoperative opioid use, and blood transfusion were similar in the lidocaine ( n = 31) and dexmedetomidine ( n = 29) groups. The incidence of POCD was 29.03% in the lidocaine group and 24.1% in the dexmedetomidine group ( P = 0.77). On postoperative day 3, IL-1 levels increased by 449% with lidocaine and 202% with dexmedetomidine ( P = 0.03). TNF-a, IL-6, and S-100β levels increased similarly in both groups. There was no significant correlation between percentage changes in neuropsychological tests and biomarkers. CONCLUSIONS: There was no significant difference in the incidence of POCD, but dexmedetomidine had a better anti-inflammatory effect in terms of lesser rise of postoperative IL-1 compared to lidocaine.
Singh GP, Kuthiala G, Shrivastava A
… +2 more, Gupta D, Mehta R
Anaesthesiol Intensive Ther
· 2023 · PMID 38282501
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INTRODUCTION: The present study was carried out to evaluate the efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for adult male pati...INTRODUCTION: The present study was carried out to evaluate the efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for adult male patients undergoing unilateral inguinal hernia surgery. MATERIAL AND METHODS: Sixty ASA I-III adult male patients > 18 years old, scheduled for unilateral inguinal hernia surgery were randomly allocated into 2 groups of 30 patients each. In Group A ( n = 30) the patients received ultrasound-guided nerve block (ilioinguinal, iliohypogastric, and genitofemoral), and in Group B ( n = 30) the patients received unilateral subarachnoid block. The primary outcome was to assess postoperative analgesic efficacy (visual analogue scale [VAS] scores at rest and during coughing/ambulation). The secondary outcomes were time to first rescue analgesia with morphine, the total dose of morphine used as rescue analgesia, urinary retention, time to first micturition, time to first unassisted walking, and time to discharge from the surgical recovery room. RESULTS: The mean pain scores at 1, 2, 4, and 6 hours during rest and during coughing/ambulation were significantly lower in Group A when compared to patients in Group B ( P < 0.001). There was no requirement for rescue analgesic opioids in Group A ( P < 0.001). Mean time to first micturition and mobilization occurred earlier in Group A, leading to early discharge from the recovery room ( P < 0.001). No major side effects were observed in any of the study groups. CONCLUSIONS: Ultrasound-guided triple nerve block technique can be used as a sole anaesthetic technique for inguinal hernia surgery because it not only provides optimal anaesthesia intra-operatively but also has a favourable analgesic and opioid-sparing efficacy in the early postoperative period with minimal adverse effects.
Sultan SS, Deabes AA, Elewa GEM
… +1 more, Alansary AM
Anaesthesiol Intensive Ther
· 2023 · PMID 38282500
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INTRODUCTION: Oral domperidone is a prokinetic drug that enhances gastric emptying, which has a positive effect in decreasing gastric residual volume (GRV), subsequently decreasing the risk of pulmonary aspiration. This...INTRODUCTION: Oral domperidone is a prokinetic drug that enhances gastric emptying, which has a positive effect in decreasing gastric residual volume (GRV), subsequently decreasing the risk of pulmonary aspiration. This study aimed to assess the effect of preoperative oral domperidone on gastric residual volume, detected by ultrasound for patients undergoing elective surgery under general anesthesia. MATERIAL AND METHODS: This randomized double-blinded controlled placebo trial was conducted in 40 patients who were randomly assigned to two equal groups: the domperidone group (D) ( n = 20): patients received 400 mL of apple juice as a clear fluid, two hours preoperatively, and an oral domperidone 10 mg tablet; and the placebo group (P) ( n = 20): patients received 400 mL of apple juice as a clear fluid two hours preoperatively with a placebo tablet. Gastric residual volume detected by ultrasound was the primary outcome and postoperative nausea and vomiting (PONV) was the secondary outcome. RESULTS: There was no statistically significant difference in the mean gastric residual volume detected by ultrasound between groups after 1 hour ( P > 0.05). However, the mean gastric residual volume detected by ultrasound after 2 hours was statistically significantly lower with domperidone (55.95 ± 6.72 mL) than with the placebo group (70.22 ± 13.00 mL) ( P < 0.05). There was no statistically significant difference between groups regarding PONV, with a P -value > 0.05. CONCLUSIONS: Preoperative oral domperidone intake was effective in decreasing the GRV measured by ultrasound.
Kutnik P, Bierut M, Rypulak E
… +9 more, Trwoga A, Wróblewska K, Marzęda P, Kośmider K, Kamieniak M, Pająk A, Wolanin N, Gębska-Wolińska M, Borys M
Anaesthesiol Intensive Ther
· 2023 · PMID 38282499
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INTRODUCTION: Enhanced recovery after surgery (ERAS) is a modern approach to perioperative management. This study aimed to evaluate compliance with certain aspects of the ERAS protocol in malnourished and properly nouris...INTRODUCTION: Enhanced recovery after surgery (ERAS) is a modern approach to perioperative management. This study aimed to evaluate compliance with certain aspects of the ERAS protocol in malnourished and properly nourished patients undergoing elective surgery. MATERIAL AND METHODS: A questionnaire study was conducted among 197 patients undergoing elective surgery at the university hospital. We divided patients into two groups according to nutritional status. RESULTS: The study's results showed that 67 patients (34%) lost weight before admission (the weight-loss group). Twenty-five participants (37%) in the weight-loss group and 15 patients (12%) in the preserved-weight group underwent surgery due to cancer ( P < 0.001). More patients in the weight loss group (45 of 67) than in the preserved-weight group (40 of 129, P < 0.001) limited their food intake a week before the surgery. The preserved-weight group participants were mobilized earlier than the weight-loss group ( P = 0.04). The median number of hours since drinking their last fluids and eating their last meals before the surgery were 12.2 hours and 25.4 hours for both groups, respectively. Only eight patients received preoperative carbohydrate loading. We found higher serum protein concentrations in the preserved-weight group (7.10 [0.5] vs. 6.92 [0.71], P = 0.023); however, white blood cell count was higher in the weight-loss group (7.85 (2.28) vs.7.10 (0.50), P = 0.04). Both groups were highly satisfied with their hospital treatments. CONCLUSIONS: Our study revealed relatively high malnutrition in patients undergoing elective surgery. As a standard of perioperative care in the studied centre, the ERAS protocol implementation level is low.
Putowski Z, Czok M, Polok K
… +9 more, Guidet B, Jung C, Bruno RR, de Lange D, Leaver S, Moreno R, Wernly B, Flaatten H, Szczeklik W
Anaesthesiol Intensive Ther
· 2023 · PMID 38282498
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INTRODUCTION: The Sequential Organ Failure Assessment (SOFA) score is the sum of 6 components, each representing one organ system with dysfunction classified on a 4-point scale. In research, usually by default, the total...INTRODUCTION: The Sequential Organ Failure Assessment (SOFA) score is the sum of 6 components, each representing one organ system with dysfunction classified on a 4-point scale. In research, usually by default, the total SOFA score is taken into account, but it may not reflect the severity of the condition of the individual organs. Often, these values are expected to predict mortality. MATERIAL AND METHODS: In this study, we reanalysed 2 cohorts of critically ill elderly patients to explore the distribution of SOFA subscores and to assess the between-group differences. Both cohorts were adjusted to maintain similarity in terms of age and the primary cause of admission (respiratory cause). RESULTS: In total, 910 (non-COVID-19 cohort) and 551 patients (COVID-19 cohort) were included in the analysis. Both cohorts were similar in terms of the total SOFA score (median 5 vs. 5 points); however, the groups differed significantly in 4/6 SOFA subscores (respiratory, neurological, cardiovascular, and coagulation subscores). Moreover, the cohorts had different fractions of organ failures (defined as a SOFA subscore ≥ 3). CONCLUSIONS: This analysis revealed significant differences in SOFA subscores between the COVID-19 and non-COVID-19 respiratory cohorts, highlighting the importance of considering individual organ dysfunction rather than relying solely on the total SOFA score when reporting organ dysfunction in clinical research.
Nešković N, Drenjančević D, Kvolik S
… +3 more, Škiljić S, Budrovac D, Drenjančević IH
Anaesthesiol Intensive Ther
· 2023 · PMID 38282497
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INTRODUCTION: Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differe...INTRODUCTION: Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients. MATERIAL AND METHODS: A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days. RESULTS: Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes. CONCLUSIONS: PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.
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
· 2024 · PMID 39917980
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INTRODUCTION: Perioperative stress and exposure to anesthetics may trigger alterations in cognition. In this study, a group of women underwent neuropsychological evaluation to measure the influence of inhalational and in...INTRODUCTION: Perioperative stress and exposure to anesthetics may trigger alterations in cognition. In this study, a group of women underwent neuropsychological evaluation to measure the influence of inhalational and intravenous anesthesia on linguistic performance, in the context of the perioperative inflammatory response and duration. MATERIAL AND METHODS: Patients undergoing elective gynecological laparoscopic operations were randomly assigned to receive either propofol-based anesthesia (PBA) or sevoflurane-based anesthesia (SBA). The Vocabulary subtest of the Polish version of the Wechsler Adult Intelligence Scale-Revised, Łatysz test [ŁT, subtests: correct words (CW) and all words (AW)], and Word Fluency Test [WFT subtest letters: F, A, S, and categories: animals (An), fruits (Fr), vegetables (Ve)] were applied before and 24 h after anesthesia. Leukocyte count and smear as well as C-reactive protein were analyzed in the same time period. Duration of anesthesia was recorded. RESULTS: Sixty-one patients were included in the study (PBA: 29, SBA: 32). The comparison of the pre- and postoperative difference in results between the PBA and SBA groups showed a significant difference in one test (WFT-A). A postoperative increase in the results occurred in more scales in the SBA group (ŁT-CW, ŁT-AW, WFT-A, and WFT-Ve) than in the PBA group (ŁT-AW). There were single correlations between the inflammatory markers and the results of linguistic tests. The duration of anesthesia did not influence the results of linguistic tests. CONCLUSIONS: The linguistic performance in the perioperative period was stable, with increases noted in several of the tested domains, predominantly in the SBA group.
Marković D, Šurbatović M, Milisavljević D
… +3 more, Marjanović V, Kovačević T, Stanković M
Anaesthesiol Intensive Ther
· 2024 · PMID 39917979
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INTRODUCTION: Among the numerous scores for difficult intubation assessment, there is no single score that is specific for laryngeal surgery. The parameters identified by this research will provide a foundation for devel...INTRODUCTION: Among the numerous scores for difficult intubation assessment, there is no single score that is specific for laryngeal surgery. The parameters identified by this research will provide a foundation for developing a new score for preoperative airway assessment specific for laryngeal surgery. MATERIAL AND METHODS: This prospective pilot clinical study included 50 patients over 18 scheduled for microscopic laryngeal surgery. The following anesthesiological and surgical parameters were analyzed: flexible laryngoscopy, general and clinical data, inter-incisor gap (IIG), modified Mallampati score (MMP), S-lux, thyromental distance, sternomental distance, mandibular measurements, etc. Difficult intubation was defined according to the Intubation Difficulty Scale (IDS), and the patients were divided into difficult (DI) and normal (NI) intubation. RESULTS: According to the IDS scale, 17 (34%) intubations were characterized as difficult. Patients in the DI group were male ( P = 0.033) and had apnea during sleep ( P = 0.021). Other statistically significant parameters were IIG below 4 cm, reclination, neck girth, and MMP. Flexible laryngoscopy showed a high statistical significance of P = 0.0001. These parameters have an AUC of 0.955, with χ 2 = 43.268, P < 0.0001. CONCLUSIONS: The combination of the statistically significant parameters shows excellent accuracy in laryngeal surgery. This combination can form a basis to develop a preoperative airway assessment score specific to laryngeal surgery.
Anaesthesiol Intensive Ther
· 2024 · PMID 39917978
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INTRODUCTION: Data concerning anaesthesia for endourology are rare, and options for it are numerous. Thus, identifying the optimal anaesthesia regimen remains challenging. With this study we aimed to provide the means fo...INTRODUCTION: Data concerning anaesthesia for endourology are rare, and options for it are numerous. Thus, identifying the optimal anaesthesia regimen remains challenging. With this study we aimed to provide the means for selecting optimal anaesthesia for endourology procedures. MATERIAL AND METHODS: This was a randomised, open-label, controlled study conducted in a single tertiary hospital. Inclusion criteria: American Society of Anesthesiologists (ASA) physical status/risk category I-III, and scheduled surgery time < 60 minutes. Exclusion criteria: contraindications or lack of consent for one of the anaesthesia types, intellectual disabilities, pregnancy, breastfeeding, and refusal to participate. The participants were divided into 3 groups: G1, spinal anaesthesia (SPA) with bupivacaine; G2, SPA with prilocaine; G3, total intravenous anaesthesia (TIVA) with remifentanil and propofol. The primary outcome measure was time to ambulation, while the secondary outcome measures included perioperative hypotension. The results are presented as mean ± SD or median [IQR]. RESULTS: In total, 117 patients completed the study. The time to ambulation (minutes) was significantly different between all groups: 187.95 ± 49.82, 161.05 ± 46.28, and 129.14 ± 63.75 min, for G1, G2 and G3, respectively. The mean arterial pressure drop from baseline during the procedure was most pronounced in G3 (35% [30-44], P < 0.001) and lowest in G2 (18% [12-27], P < 0.001 vs. G3, NS vs. bupivacaine). Machine-learning models were trained and demonstrated satisfactory performance in predicting the time spent in recovery. CONCLUSIONS: In the context of endourological surgery, the time required for ambulation was shortest when using TIVA, while SPA with hyperbaric prilocaine provides the closest approximation to optimal anaesthesia.
Anaesthesiol Intensive Ther
· 2024 · PMID 39917977
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INTRODUCTION: Multidrug-resistant organism (MRO) bacteraemia is associated with significant mortality. A limited number of studies have examined the relationship between MRO colonisation and subsequent bacteraemia in cri...INTRODUCTION: Multidrug-resistant organism (MRO) bacteraemia is associated with significant mortality. A limited number of studies have examined the relationship between MRO colonisation and subsequent bacteraemia in critically ill patients. MATERIAL AND METHODS: All patients with a positive surveillance swab result and a positive blood culture result for MROs admitted to the Westmead intensive care unit (ICU) between 1 January 2014 and 31 March 2019 had their results matched with ICU data extracted from the ICU database and analysed for the risk of bacteraemia among swab positive patients. RESULTS: There were 3,878 (2,388 males, 1,490 females) assessable admissions during the period. The median APACHE II (Acute Physiology and Chronic Health Evaluation) score was 17. A total of 9,681 swab results were collected from 3,878 patients. Of the 3,878 patients, 818 were positive for MROs, and 3,060 were negative. Thirty-two swab positive patients (3.9%) tested positive for MROs in the blood culture, and 16 (0.52%) in the swab negative group had MROs in their blood cultures. This difference was statistically significant (adjusted [adj] OR 6.33; 95% CI: 3.40-11.76). The swab positive group was also associated with a significantly higher positive blood culture with orga-nisms other than MROs than the swab negatives (11.1% and 6.2%, respectively, adj OR 1.37; 95% CI: 1.04-1.82). The overall mortality was higher in swab positive compared to swab negative patients (20.7% vs. 13.1%, P < 0.001). The overall prevalence of MRO colonisation was 21% in our cohort. CONCLUSIONS: The risk of MRO bacteraemia was higher among patients with a positive surveillance swab result for the organism compared to those with a negative swab, but this was not associated with higher mortality in that group.