Baska A, Sporysz-Janiec K, Figura M
… +2 more, Andruszkiewicz P, Zawadka M
Anaesthesiol Intensive Ther
· 2024 · PMID 39917976
·
Full text
Brain ultrasonography has emerged as a valuable diagnostic and monitoring tool in intensive care, complementing other point-of-care techniques. Transcranial colour-coded duplex (TCCD) offers a rapid, non-invasive, repeat...Brain ultrasonography has emerged as a valuable diagnostic and monitoring tool in intensive care, complementing other point-of-care techniques. Transcranial colour-coded duplex (TCCD) offers a rapid, non-invasive, repeatable, and cost-effective bedside me-thod that has gained significant interest among intensivists. TCCD enables visualisation of the circle of Willis and adjacent cerebral arteries, supporting its use in various critical scenarios, including vasospasm following subarachnoid haemorrhage, elevated intracranial pressure, hydrocephalus, acute ischaemic stroke, cerebral circulatory arrest, and certain intracranial haematomas. This manuscript aims to equip intensivists with foundational knowledge to integrate TCCD effectively into their diagnostic arsenal, covering essential Doppler physics, transcranial insonation techniques, and clinical applications of TCCD within intensive care settings.
Anaesthesiol Intensive Ther
· 2024 · PMID 39917971
·
Full text
INTRODUCTION: Visualisation and separate blockade of the four primary constituent nerves (radial, median, ulnar, musculocutaneous) increases the success rate of ultrasound-guided brachial plexus block at the axillary lev...INTRODUCTION: Visualisation and separate blockade of the four primary constituent nerves (radial, median, ulnar, musculocutaneous) increases the success rate of ultrasound-guided brachial plexus block at the axillary level. However, the upper limb is still positioned as if performing the landmark-oriented approach described by Winnie, with the shoulder and elbow at 90o. Thus, we aimed to find the optimum arm position for visualisation of the brachial plexus at the axilla using ultrasound. MATERIAL AND METHODS: After the Institutional Ethics Committee's approval, this prospective observational study was conducted on 36 consenting individuals more than 18 years of age. The ultrasound probe was placed on a short axis at the intersection of the pectoralis major muscle and the biceps brachii muscle, with just enough probe pressure to cause light compression of veins. Each arm was placed in three different positions - shoulder at 90º and elbow at 90º, shoulder at 90º and elbow at 0º, and shoulder at 120º and elbow at 90º - in which the nerves were assessed using a six-point visibility scale. The path of each nerve was traced down for confirmation. Distance from the skin to axillary artery, skin to individual nerves, and artery to nerves was measured. RESULTS: Visibility scores of the individual nerves and the distances measured in the three positions were comparable ( P > 0.05). The skin artery and skin nerve distances were the shortest in the 120/90 position, and the radial nerve was more often located in this position. CONCLUSIONS: Arm position with 120º shoulder and 90º elbow had favourable results. Further studies will confirm its clinical utility and block success rate.
Sadovyi V, Kuchyn I, Bielka K
… +3 more, Horoshko V, Sazhyn D, Sokolova L
Anaesthesiol Intensive Ther
· 2024 · PMID 39917970
·
Full text
BACKGROUND: Damage to the trachea, although rare, is a serious complication in anesthesiology and intensive care. The main mechanism of such injury is a direct mechanical action associated with excessive pressure in the...BACKGROUND: Damage to the trachea, although rare, is a serious complication in anesthesiology and intensive care. The main mechanism of such injury is a direct mechanical action associated with excessive pressure in the cuff of the endotracheal tube (ETT). The aim of the study was to evaluate the actual pressure in the cuffs during surgical interventions, correlate this measure with the subjective assessment of the anesthesiologist, and compare different methods of inflating the ETT cuff. METHODS: Ninety patients were randomly divided into two equal groups. In the study group, the "minimum leakage" technique was used to inflate the cuff. In the control group, the adequacy of pressure was determined by palpation of the cuff balloon. In both groups, the actual pressure was then measured using a mechanical manometer connected to the cuff. RESULTS: The average ETT cuff pressure was 30.4 ± 4.9 cmH 2 O (2.98 ± 0.48 kPa) in the study group and 68.9 ± 23.3 cmH 2 O (6.75 ± 2.28 kPa) in the control group. The pressure in the ETT cuffs was within the standard safe range (i.e. 20-30 cmH 2 O) in 2/45 (4.4%) and 23/45 (51.1%) patients in the control and the study group, respectively. CONCLUSIONS: In the majority of cases, the pressure achieved via evaluation by the me-thod of palpation of the control cuff was not adequate. Among various non-mechanical methods of measuring and controlling pressure in the cuff of the intubation tube, the minimum occlusion volume technique deserves attention.
Anaesthesiol Intensive Ther
· 2024 · PMID 39917969
·
Full text
PURPOSE: Mivacurium is a short-acting, non-depolarising neuromuscular blocking agent that provides adequate vocal cord myorelaxation during transoral laser microsurgery. This study aimed to determine the optimal dose of...PURPOSE: Mivacurium is a short-acting, non-depolarising neuromuscular blocking agent that provides adequate vocal cord myorelaxation during transoral laser microsurgery. This study aimed to determine the optimal dose of mivacurium by comparing the infusion rate delivered via a closed-loop target-controlled infusion system. METHODS: A prospective, randomized clinical trial was conducted on 60 patients undergoing laser-assisted laryngeal microsurgery for vocal cord tumours. All patients received an induction mivacurium dose of 0.2 mg kg -1 and were randomized to 3 groups, namely C1, C2 and C3, each receiving infusion rates of 6 μg kg -1 min -1 , 7 μg kg -1 min -1 , 8 μg kg -1 min -1 , respectively. Neuromuscular monitoring and pharmacodynamic para-meters of mivacurium were recorded. RESULTS: No cases of airway spasms, blood pressure or heart rate fluctuations were observed. Three patients had skin redness at the injection site. The onset time, no- response time, and recovery index (RI) of mivacurium did not differ significantly among the groups. However, additional mivacurium doses were needed for 15 patients in C1, 10 patients in C2, and 3 patients in C3 ( P 5.68 min was correlated with reduced mivacurium supplementation, and it was associated with no-response time and total mivacurium dose. The recovery index of all patients was also positively correlated with total mivacurium dosage ( p < 0.0001, r = 0.7838). CONCLUSIONS: A mivacurium infusion rate of 8 μg kg -1 min -1 offered the most favourable surgical field condition with no involuntary vocal cord movements, less need for supplementary doses, and fewer adverse reactions in laser-assisted laryngeal microsurgery.
Semenko N, Kuchyn I, Frank M
… +3 more, Bielka K, Milokhov D, Korshun O
Anaesthesiol Intensive Ther
· 2024 · PMID 39917968
·
Full text
BACKGROUND: The effect of both propofol and sevoflurane on bupivacaine cardiac toxi-city has not been conclusively defined. The goal of this study was to investigate the effects of propofol vs sevoflurane general anesthe...BACKGROUND: The effect of both propofol and sevoflurane on bupivacaine cardiac toxi-city has not been conclusively defined. The goal of this study was to investigate the effects of propofol vs sevoflurane general anesthesia (GA) on bupivacaine-induced arrhyth-mias. MATERIAL AND METHODS: Ten rabbits were randomized to two groups: propofol- or sevoflurane-based GA. At the maintenance stage of anesthesia heart rate and QRS/QT durations were recorded as "baseline" and an intravenous (i.v.) bupivacaine 0.25% infusion at the rate of 1.0 mg kg -1 min -1 was initiated. Blood samples were obtained when predefined electrocardiographic (ECG) changes were observed and when the heart rate (HR) reached 75%, 50%, and 25% of the baseline and 0 bpm. RESULTS: The mean time to first predefined ECG changes was 131 ± 25.02 s for the propofol group and 223 ± 34.11 s for the sevoflurane group ( P = 0.001). Time of progression of bradycardia in both groups was evaluated as a percentage of the initial HR for the understanding of the dynamics of changes during the local anesthetic systemic toxicity (LAST). The 25% HR time was shorter for the propofol group (480 ± 117 vs. 673 ± 146 s, P = 0.05). Time to asystole was shorter in the propofol group (110.7 ± 22.22 vs. 226.6 ± 98.61 s, P = 0.047). Mean serum bupivacaine concentration was lower for the propofol group during the occurrence of the first ECG changes (2.542 ± 1.415 vs. 6.997 ± 2.197 mg mL -1 , P = 0.005) and asystole (110.7 ± 22.22 vs. 226.6 ± 98.61 mg mL -1 , P = 0.047). CONCLUSIONS: It seems that sevoflurane-, but not propofol-based anesthesia reduces the risk of LAST during GA combined with peripheral nerve blocks. Sevoflurane-based anesthesia may protect the myocardium from the toxic effects of bupivacaine.
Putowski Z, Miłobędzka M, Kisiołek M
… +4 more, Szczeklik W, Jaeschke R, Puc P, Szczeklik K
Anaesthesiol Intensive Ther
· 2024 · PMID 39917967
·
Full text
The requirement for preoperative dental assessment (PDA) to prevent periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) seems to be a common practice at least in some orthopaedic centres. There are...The requirement for preoperative dental assessment (PDA) to prevent periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) seems to be a common practice at least in some orthopaedic centres. There are few studies which have examined this intervention. Routine referral of patients for routine PDA increases costs and potentially prolongs the time to the procedure. In order to investigate the effect of PDA on the frequency of PJI after TJA, we conducted a systematic review with meta-analysis of observational studies including adult patients undergoing TJA. The search for eligible studies was performed across MEDLINE, EMBASE, Web of Science, and Google Scholar databases. The intervention group consisted of patients who had undergone PDA, while the control group consisted of patients without PDA. The main outcome was the presence of PJI. In addition to traditional meta-analysis, a Bayesian analysis and trial sequential analysis were performed. The analysis included five observational studies. Considering PJI as an outcome, the total risk of bias was assessed as serious. A total of 23 175 patients were included in those studies, of whom 12 324 had a PDA. There was no effect of PDA versus no PDA on the incidence of PJI (OR 0.86, 95% CI: 0.50-1.49; I² = 42%). Bayesian analysis showed that the posterior probability of PDA reducing the frequency of PJI was 69.1%. Thus it was concluded that, in patients undergoing TJA, it remains unknown whether PDA influences the occurrence of postoperative PJI. There is insufficient evidence to support performing this intervention routinely. The health care systems and individual organisations will likely need to make decisions on continuation of such programmes on the basis of this limited amount of information.
El Sersi MH, Zaki MSM, Elnaggar SS
… +1 more, Mahrose R
Anaesthesiol Intensive Ther
· 2023 · PMID 38084575
·
Full text
INTRODUCTION: Paediatric male circumcision is a painful surgical procedure, which is usually carried out under general anaesthesia. Regional analgesic techniques, including dorsal penile nerve block (DPNB) and caudal ner...INTRODUCTION: Paediatric male circumcision is a painful surgical procedure, which is usually carried out under general anaesthesia. Regional analgesic techniques, including dorsal penile nerve block (DPNB) and caudal nerve block (CNB), are superior to opioid and non-opioid systemic analgesia for postoperative pain control after circumcision. MATERIAL AND METHODS: The purpose of our study was to compare the efficacy, duration of postoperative analgesia, and complications of DPNB, CNB, and the combination of 2 blocks. Eighty-one male patients aged from 3 to 12 years scheduled for circumcision were distributed into 3 groups, each consisting of 27 patients; group 1 (DPNB group), group 2 (CNB group), and group 3 for combined blockade. This study compared the 3 groups in terms of intraoperative vital signs: heart rate and blood pressure, postoperative Wong-Baker score, and complications (nausea, vomiting, pruritus, urinary retention, and constipation). RESULTS: The intraoperative haemodynamics did not differ between the 3 groups of the study. There is significant difference in the Wong-Baker scale postoperatively at 1, 3, and 24 hours, being significantly less in the CNB group and combined blockade group than in the DPNB group, but there was no significant difference between the CNB group and the combined blockade group. The incidence of complications showed no significant intergroup difference, except for urinary retention being lower with DPNB. CONCLUSIONS: Both caudal and combined blockade were superior to DPNB for intraoperative and postoperative analgesia after circumcision. CNB and combined blockade was associated with significantly higher incidence of urinary retention compared to DPNB. Also, there was no additional benefit to the analgesic efficacy from combining both blocks.
Bielka K, Kuchyn I, Frank M
… +6 more, Sirenko I, Kashchii U, Yurovich A, Fomina H, Lisnyy I, Semenko N
Anaesthesiol Intensive Ther
· 2023 · PMID 38084574
·
Full text
INTRODUCTION: The Russian invasion of Ukraine has caused huge damage to all medical infrastructure and impairs patient safety. The aim of our study was to assess the impact of implementation of the WHO Surgical Safety Ch...INTRODUCTION: The Russian invasion of Ukraine has caused huge damage to all medical infrastructure and impairs patient safety. The aim of our study was to assess the impact of implementation of the WHO Surgical Safety Checklist and Anesthesia Equipment Checklist on patient outcomes and adherence to safety standards in low-resource settings, affected by an ongoing war. MATERIAL AND METHODS: A prospective multicenter study was conducted in 6 large Ukrainian hospitals. The study was conducted in two phases: a control period, lasting five months, followed by a study period, when the two checklists (the WHO Surgical Safety Checklist and Anesthetic Equipment Checklist) were introduced in the designated operating rooms. The primary outcomes were any major complications, including death, during 30 days after surgery. RESULTS: A total of 2237 surgical procedures were recorded - 1178 in the control group and 1059 in the intervention group. Major postoperative complications occurred in 82 (6.9%) patients in the control group and in 25 (2.4%) in the study group (OR = 0.32 [0.19-0.52], P < 0.001). The effect on the incidence of specific postoperative complications was statistically significant for the "surgical infection" (1.5% vs. 0.1%; OR = 0.31 [0.1-0.8], P = 0.01) and "reoperation" (1.7% vs. 0.5%; OR = 0.32 [0.1-0.8], P = 0.01) cate-gories as well as for the 30-day mortality (1.3% vs. 0.3%; OR = 0.35 [0.1-0.9], P = 0.03). Better adherence to basic WHO surgical safety recommendations was observed for every check mentioned in the WHO Surgical Safety Checklist ( P < 0.05). CONCLUSIONS: The WHO Surgical Safety Checklist and the Anesthesia Equipment Checklist improve patient outcomes in war-affected low-resource settings.
Anaesthesiol Intensive Ther
· 2023 · PMID 38084573
·
Full text
INTRODUCTION: In a randomized clinical study, we investigated the effectiveness of nasal lignocaine spray and swabs in treating postdural puncture headache (PDPH) after spinal anesthesia. MATERIAL AND METHODS: Group S pa...INTRODUCTION: In a randomized clinical study, we investigated the effectiveness of nasal lignocaine spray and swabs in treating postdural puncture headache (PDPH) after spinal anesthesia. MATERIAL AND METHODS: Group S patients received two puffs of lignocaine 10% spray in both nostrils followed by cotton soaked in normal saline, and group B patients received two puffs of saline spray in both nostrils followed by a cotton swab soaked in lignocaine 2%. Patients were assessed before the procedure and 30 minutes, 60 minutes, 2 h, 24 h, 48 h, and 72 h after the procedure for pain relief with the help of a visual analogue scale (VAS). Hemodynamic parameters and adverse effects were also recorded. Normally distributed continuous variables were expressed as mean (95% confidence interval) whereas non-normally distributed variables were expressed as median (IQR). Repeated measures analysis of variance was used to compare the VAS score at different time points between test and control groups. The difference in means between the two groups was compared using the independent sample t -test. The paired t-test was used to compare the changes in clinical and laboratory variables. RESULTS: At each time point, the mean VAS score for pain was substantially different between the two groups. Moreover, until the second hour, the VAS score was significantly lower in group S than in group B. No significant intervention-related adverse effect was observed in either group. CONCLUSIONS: Without any noticeable side effects, lignocaine 10% spray is more successful in treating PDPH after spinal anesthesia, particularly in the first two hours.
Anaesthesiol Intensive Ther
· 2023 · PMID 38084572
·
Full text
INTRODUCTION: Transversus abdominis plane (TAP) has been mentioned as having bene-ficial effects on chronic pain after hernioplasty. This study assessed the effects of TAP block on acute and persistent postoperative pain...INTRODUCTION: Transversus abdominis plane (TAP) has been mentioned as having bene-ficial effects on chronic pain after hernioplasty. This study assessed the effects of TAP block on acute and persistent postoperative pain after inguinal hernia surgery, with or without buprenorphine. MATERIAL AND METHODS: 64 patients were allocated to group R ( n = 32) and received 20 mL of 0.25% ropivacaine for TAP block; group RB ( n = 32) received 20 mL of 0.25% ropivacaine containing 300 µg of buprenorphine for TAP block. The primary outcome was the analgesic and antihyperalgesic effect of buprenorphine. The duration of analgesia, analgesic consumption, postoperative pain scores at rest and sitting up to 48 hours, and the effect on wound hyperalgesia were evaluated. Secondary outcomes included the incidence of side effects and complications. RESULTS: The median (IQR) duration of analgesia in group R was 386.5 (37.25) minutes vs. 868 (41.3) minutes in the RB group. Median pain scores on sitting were found to be significantly better in group RB than in group R at 6, 12, and 24 hours ( P < 0.001). The wound hyperalgesia index showed a significant difference between groups ( P < 0.001). The incidence of persistent postoperative pain was 6.25% in the R group, as compared to 0% in the RB group. Otherwise, the patients did not have any further complications associated with the block. CONCLUSIONS: The results demonstrated that TAP block with buprenorphine reduced acute postoperative pain severity, but we did not find a difference between groups in persistent pain.