Samara E, Tzoumas L, Tzoumas K
… +2 more, Tzimas P, Papadopoulos G
Anaesthesiol Intensive Ther
· 2023 · PMID 37587880
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BACKGROUND: Regional anaesthesia and analgesia present many advantages. Related complications are few and have been fully described. Information on regional anaesthesia malpractice is lacking in Greece. The objectives of...BACKGROUND: Regional anaesthesia and analgesia present many advantages. Related complications are few and have been fully described. Information on regional anaesthesia malpractice is lacking in Greece. The objectives of the analysis were to highlight areas of high litigation risk and report the financial impact of claims. METHODS: Published judicial decisions of criminal, civil, administrative and disciplinary content, from 1995 to 2020, were searched in the legal information banks. The court decisions were analysed by an expert in collaboration with the lawyers of the investigation. RESULTS: A total of 26 court decisions related to complications from regional anaesthesia were found involving 10 cases, which comprised: 8 convictions, 1 referral of the case for a new expert opinion and 1 acquittal. In 6 cases the medical negligence involved complications after epidural anaesthesia and in 2 after subarachnoid anaesthesia. In 1 case there was collective liability of the anaesthesiologist and the obstetrician for negligent homicide and in 7 cases liability of the anaesthesiologist for bodily injuries. The duration of the litigation was 5-16 years. CONCLUSIONS: Analysis of court cases made it possible to identify the causes that led to complications during regional anaesthesia. Informed consent, non-traumatic technique, careful patient selection, adherence to safety rules, and early diagnosis and treatment of complications are essential to avoid permanent injury.
Saracoglu A, Saracoglu K, Sorbello M
… +2 more, Çakmak G, Greif R
Anaesthesiol Intensive Ther
· 2023 · PMID 37587879
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BACKGROUND: Guidelines and consensus statements recommend the use of videola-ryngoscopes (VLs) in airway management of patients with COVID-19. However, there is a lack of knowledge about which types of videolaryngoscopes...BACKGROUND: Guidelines and consensus statements recommend the use of videola-ryngoscopes (VLs) in airway management of patients with COVID-19. However, there is a lack of knowledge about which types of videolaryngoscopes are used, differences of use between countries, and how the COVID-19 pandemic influenced their use. The primary aim of this before-and-after cross-sectional survey study was to assess the frequency of the use of videolaryngoscopy in the operation theatres in different countries. Also, the preferred characteristics of videolaryngoscopes were assessed. METHODS: With Ethics Committee approval, a questionnaire was distributed among anaes-thesiologists through the European Airway Management Society's network in 2019 before and in 2021 during the COVID-19 pandemic. Responses to the questions were analysed and presented as descriptive statistics. RESULTS: We reached out to 791 anaesthesiologists; 155 (19.5%) returned the first questionnaire, and 91 (11.5%) returned the second survey. Videolaryngoscopes were used in 24.1% of cases before COVID-19 and in 43.1% after the pandemic ( P < 0.001). We revealed that the availability of videolaryngoscopes increased to 100% in all centres during the pandemic. Routine use of videolaryngoscopes in all cases increased from 12.5% to 38.9%. The type of videolaryngoscope and the blade preference did not change during this period ( P = 1.000). CONCLUSIONS: This survey reflects that the COVID-19 pandemic significantly increased the availability and use of videolaryngoscopes in operating theatres, and that more anaesthesiologists now use them routinely in all cases. The preferred type of VL or blade did not change during the pandemic.
Bd V, Goyal S, Sharma A
… +4 more, Kothari N, Kaloria N, Sethi P, Bhatia P
Anaesthesiol Intensive Ther
· 2023 · PMID 37409840
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BACKGROUND: Paediatric patients are a population with a high level of anxiety. The prevention of perioperative stress in a frightened child is important to render the child calm and cooperative for smoother induction. In...BACKGROUND: Paediatric patients are a population with a high level of anxiety. The prevention of perioperative stress in a frightened child is important to render the child calm and cooperative for smoother induction. Intranasal premedication is easy and safe, and the drug is rapidly absorbed into the systemic circulation, ensuring early onset of sedation in children and good effectiveness. METHODS: 150 patients in the age group 2-4 years, ASA class I, undergoing elective surgical procedures were enrolled. The patients were randomly divided into 3 groups: a DM group (receiving intranasal dexmedetomidine 1 µg kg -1 and midazolam 0.12 mg kg -1 ), a DK group (receiving intranasal dexmedetomidine 1 µg kg -1 and keta-mine 2 mg kg -1 ), and an MK group (receiving intranasal midazolam 0.12 mg kg -1 and ketamine 2 mg kg -1 ). After 30 minutes of administration of the drugs, the patients were assessed for parent separation anxiety, sedation, ease of IV cannulation, and mask acceptance. RESULTS: The comparison among the 3 groups showed a statistically significant difference for ease of IV cannulation and mask acceptance at 30 minutes, with a P -value of 0.010 with CI of 0.0-0.02, and P -value 0.007 with CI 0.0-0.02, respectively. The parent separation anxiety and sedation score at 30 minutes was statistically insignificant with a P -value of 0.82 with CI of 0.03-0.14 and P -value 0.631 with CI of 0.38-0.58, respectively. CONCLUSIONS: The combination of midazolam and ketamine had a better clinical profile for premedication as compared to other combination drugs used in our study in terms of IV cannulation and acceptance of masks with a comparable decrease in separation anxiety from parents and adequate sedation.
Drzymalski DM, Dahlawi M, Hall RR
… +2 more, Ranjan S, Best CL
Anaesthesiol Intensive Ther
· 2023 · PMID 37409839
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BACKGROUND: Music is a low-cost intervention that can improve patient satisfaction. METHODS: This was a prospective, randomised, controlled trial conducted at an urban tertiary care academic medical centre in the United...BACKGROUND: Music is a low-cost intervention that can improve patient satisfaction. METHODS: This was a prospective, randomised, controlled trial conducted at an urban tertiary care academic medical centre in the United States. Nulliparous women 18-50 years old with a healthy singleton pregnancy at ≥ 37 weeks gestational age undergoing elective caesarean delivery under neuraxial anaesthesia were randomised to the music group (Mozart sonatas) or control group (no music). Mozart sonatas were broadcast to the music group immediately prior to patient entry and maintained throughout the procedure. The primary outcome was patient satisfaction using the Maternal Satisfaction Scale for Caesarean Section (MSSCS). Secondary outcomes were changes in anxiety pre- and post-operatively and post-operative mean arterial pressure (MAP). Student's t-test, the Wilcoxon rank sum test, and the c2 test were used where appropriate for statistical analyses. RESULTS: 27 parturients were evaluated for participation between 2018 and 2019, and 22 enrolled. The final study subject number was 20 due to two withdrawals. There were no clinically meaningful differences in baseline demographics, vital signs, and anxiety. The mean (SD) total patient satisfaction for music vs. control was 116 (16) vs. 120 (22), mean difference 4 (95% CI: -14.0 to 22.0), P = 0.645. The mean (SD) change in anxiety with music vs. control was 2.7 (2.7) vs. 2.5 (2.6), mean difference -0.4 (95% CI: -4.0 to 3.2), P = 0.827. The median (IQR) post-operative MAP with music vs. control was 77.7 (73.7-85.3) vs. 77.3 (72.0-87.3), P = 0.678. CONCLUSIONS: The use of Mozart sonatas did not result in improvements in patient satis-faction, anxiety or MAP in parturients undergoing elective caesarean delivery.
Anaesthesiol Intensive Ther
· 2023 · PMID 37409838
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BACKGROUND: Children usually need sedation or even anaesthesia for magnetic resonance imaging (MRI) studies. As there is no universally accepted method for this purpose we undertook a prospective, randomised comparison o...BACKGROUND: Children usually need sedation or even anaesthesia for magnetic resonance imaging (MRI) studies. As there is no universally accepted method for this purpose we undertook a prospective, randomised comparison of propofol and dexmedetomidine in children aged 1 to 10 years. METHODS: After Institutional Board approval and parents' informed consent 64 ASA status I or II children scheduled for MRI scan were enrolled. Patients were premedicated with intravenous (IV) midazolam (0.1 mg kg -1 ) and ketamine (1 mg kg -1 ) and randomised to propofol (P) or dexmedetomidine (D) group. A propofol bolus of 1 mg kg -1 followed by infusion of 4 mg kg -1 h -1 , or dexmedetomidine 1 µg kg -1 followed by 2 µg kg -1 h-1 infusion were used. Heart rate, SpO 2 and non-invasive blood pressure were monitored and recorded at 5 min intervals. Results were compared by means of standard statistical methods. RESULTS: Both dexmedetomidine and propofol after premedication with ketamine and midazolam are suitable for MRI sedation, although propofol use results in shorter recovery time. Less interventions are needed when dexmedetomidine is used.
Zawadka M, Andruszkiewicz P, Gola W
… +2 more, Wong A, Czuczwar M
Anaesthesiol Intensive Ther
· 2023 · PMID 37409836
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Ultrasonography is becoming an essential part of the management of critically ill patients. There has been a sufficient body of evidence to support the incorporation of point-of-care ultrasound (POCUS) in anaesthesia and...Ultrasonography is becoming an essential part of the management of critically ill patients. There has been a sufficient body of evidence to support the incorporation of point-of-care ultrasound (POCUS) in anaesthesia and intensive care medicine training programme. Recently the European Society of Intensive Care Medicine reco-gnized POCUS as an essential skill for European Intensive Care Medicine specialists and updated Competency Based Training in Intensive Care (CoBaTrICe). Following European training standards, the Ultrasound and Echocardiography Committee of the Polish Society of Anaesthesiology and Intensive Therapy issued this Position Statement for recommendations for the accreditation process in POCUS in Poland.
Díaz-Bohada L, Segura-Salguero JC, Aristizabal-Mayor JD
… +3 more, Miranda-Pineda N, Perea-Bello AH, Wąsowicz M
Anaesthesiol Intensive Ther
· 2023 · PMID 37409833
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BACKGROUND: The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high whil...BACKGROUND: The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high while the quality of life (QoL) after VATS remains unknown. We hypothesised that patients with ESPB would have a low incidence of acute and CNP and would report a good QoL up to three months after VATS. METHODS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. RESULTS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. CONCLUSIONS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively.
Kumar A, Joshi A, Parikh B
… +2 more, Tiwari N, Ramamurthy RH
Anaesthesiol Intensive Ther
· 2023 · PMID 37306273
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INTRODUCTION: Pulmonary complications such as acute respiratory distress syndrome and refractory respiratory failure have been major causes of morbidity and mortality after cardiac surgery in children. Patients are usual...INTRODUCTION: Pulmonary complications such as acute respiratory distress syndrome and refractory respiratory failure have been major causes of morbidity and mortality after cardiac surgery in children. Patients are usually transitioned to either high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO) as "salvage therapy" when the maximal medical management and controlled mechanical ventilation (CMV) become ineffective. MATERIAL AND METHODS: A retrospective review of paediatric patients who underwent congenital heart surgery and developed cardiorespiratory failure during their stay in a paediatric cardiac ICU, refractory to maximal CMV, was performed in the study. The outcomes assessed were respiratory variables such as SpO 2 , RR, oxygenation index (OI), P/F ratio, and ABG parameters in CMV and HFOV as predictors of survival. RESULTS: Twenty-four children with cardiorespiratory failure were candidates for a transition to either HFOV ( n = 15) or VA ECMO ( n = 9) for refractory hypoxaemia; of these 24 patients, 13 (54.16%) survived. PaO2 showed a significant improvement in the survivors (P = 0.03). Improvement in the PaO 2 /FiO 2 (P/F ratio) after initiation of HFOV was associated with survival ( P < 0.001). pH, PaCO 2 , HCO 3 , FiO 2 , Paw, RR/Amp, SpO 2 , and OI also showed improvements in survivors but these were not statistically significant. The HFOV survivors had longer mechanical ventilation and ICU stay than non-survivors ( P = 0.13). CONCLUSIONS: HFOV was associated with improved gas exchange for paediatric patients who developed post-cardiac surgery refractory respiratory failure. HFOV can be considered as rescue therapy where ECMO has major financial implications.
Anaesthesiol Intensive Ther
· 2023 · PMID 37306272
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INTRODUCTION: Despite the recent use of serratus anterior plane (SAP) and pectoral nerve (PECS) blocks for pain management following breast surgery, there are insufficient data comparing their analgesic benefits. This st...INTRODUCTION: Despite the recent use of serratus anterior plane (SAP) and pectoral nerve (PECS) blocks for pain management following breast surgery, there are insufficient data comparing their analgesic benefits. This study aimed to compare the quality of analgesia for PECS and SAP blocks in patients having modified radical mastectomy (MRM). MATERIAL AND METHODS: This trial enrolled 50 adult female patients scheduled for MRM under anaesthesia. Patients were randomly allocated to two groups. After induction of anaesthesia, 25 patients received US-guided PECS II block, and 25 patients received US-guided SAP block. The primary outcome was the time to first analgesic request. Secondary outcomes included the total analgesic consumption and postoperative pain during the first 24 hours as well as the total time to perform the block, surgeon satisfaction, haemodynamic parameters, and postoperative nausea and vomiting. RESULTS: Time to first analgesic request was significantly longer in the SAP group than in the PECS II block group (95% CI: 90.2-574.5, P = 0.009). The SAP block significantly lowered the total analgesics consumption, the 24 hours patient's need for analgesia, and the VAS scores immediately, as well as at 2, 8, 20, 22, and 24 hours postoperatively ( P < 0.005). Although it required a longer preparation time than PECS II block, the SAP block had comparable surgeons' satisfaction, haemodynamic parameters, and post-operative nausea and vomiting to PECS II block. CONCLUSIONS: Following MRM, US-guided SAP block provided a delayed time to first rescue analgesia with better acute pain control and lower total analgesic consumption compared to the PECS II block.
Paredes S, Torres VH, Chaves-Cardona H
… +3 more, Matus M, Porter S, Renew JR
Anaesthesiol Intensive Ther
· 2023 · PMID 37306271
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INTRODUCTION: Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study inv...INTRODUCTION: Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study investigates neuromuscular blocking antagonists in this population when undergoing subsequent non-cardiac surgery. MATERIAL AND METHODS: A retrospective review was performed for the period 2015-2019 across our health care enterprise. Patients with previous orthotopic heart transplant and subsequent non-cardiac surgery were identified. A total of 185 patients were found, 67 receiving neostigmine (NEO) and 118 receiving sugammadex (SGX). Information of patient characteristics, prior heart transplant, and subsequent non-cardiac surgery was collected. Our primary outcome was the incidence of bradycardia (heart rate < 60 bpm) and/or hypotension (mean blood pressure (MAP) < 65 mmHg) following neuromuscular blockade reversal. Secondary outcomes included need of intra-operative inotropic agents, arrhythmia, cardiac arrest, hospital length of stay (hLOS), ICU admission, and death within 30 postoperative days. RESULTS: In unadjusted analysis, no significant differences were found between the two groups in change in heart rate [0 (-26, 14) vs. 1 (-19, 10), P = 0.59], change in MAP [0 (-22, 28) vs. 0 (-40, 47), P = 0.96], hLOS [2 days (1, 72) vs. 2 (0, 161), P = 0.92], or intraoperative hypotension [4 (6.0%) vs. 5 (4.2%), OR = 0.70, P = 0.60] for NEO and SGX respectively. After multivariable analysis, the results were similar for change in heart rate ( P = 0.59) and MAP ( P = 0.90). CONCLUSIONS: No significant differences in the incidence of bradycardia and hypotension were found in the NEO versus SGX groups. NEO and SGX may have similar safety profiles in patients with prior heart transplant undergoing non-cardiac surgery.
Prabhakaran AT, Vanalal D, Soni K
… +6 more, Baidya D, Aggarwal R, Binu H, Gamanagatti S, Dehran M, Trikha A
Anaesthesiol Intensive Ther
· 2023 · PMID 37306270
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BACKGROUND: Two extubation methods are commonly used in the intensive care unit (ICU): the traditional method with endotracheal suctioning and the positive- pressure method without suctioning. Better physiological outcom...BACKGROUND: Two extubation methods are commonly used in the intensive care unit (ICU): the traditional method with endotracheal suctioning and the positive- pressure method without suctioning. Better physiological outcomes were found in lab studies using the latter, as the air passing between the endotracheal tube and the larynx pushes out the collected subglottic secretions, which can be suctioned. METHODS: 70 mechanically ventilated patients in a tertiary ICU were randomised into 2 groups of 35 patients each. At the end of the spontaneous breathing trial (SBT), the positive pressure extubation (PPE) group was given a pressure support of 15 cm H 2 O and a positive end expiratory pressure of 10 cm H 2 O for 5 minutes while the other group (traditional extubation - TE) was extubated directly. We compared the lung ultrasound scores (LUS), chest X-ray findings, alveolar arterial oxygen gradient changes, adverse clinical events, ICU-free days and reintubation rates between the two groups. RESULTS: Median LUS at the end of the SBT was similar between the two groups. However, the median post-extubation LUS at 30 minutes, 6 hours, 24 hours in the PPE group [5 (4-8) ( P = 0.04), 5 (3-8) ( P = 0.02), 4 (3-7) ( P = 0.02), respectively] were significantly lower compared to the TE group [6 (6-8), 6 (5-7.5), 6 (5-7.5), respectively]. There was a persistent lowering of the scores even at the end of 24 hours in the PPE group, while the percentage of patients without adverse clinical events was significantly higher (80% vs. 57.14%, P = 0.04). CONCLUSIONS: The study shows that positive pressure extubation is a safe procedure which improves aeration and reduces adverse events.
Anaesthesiol Intensive Ther
· 2023 · PMID 37306269
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INTRODUCTION: Our previous study revealed racial differences in the tracheal length of cardiac paediatric patients between Germany and Japan. The current study was conducted in two stages, aiming to determine whether the...INTRODUCTION: Our previous study revealed racial differences in the tracheal length of cardiac paediatric patients between Germany and Japan. The current study was conducted in two stages, aiming to determine whether the tracheal length differs between cardiac and non-cardiac paediatric patients and whether the results could also be generalised to adults. MATERIAL AND METHODS: The first stage was a retrospective observational evaluation of 335 cardiac and 275 non-cardiac paediatric patients in Japan. The tracheal length, the distance between the vocal cords and carina tracheae, was measured on preoperative chest radiographs taken in the supine position. The second stage was a validation process including 308 Japanese patients. Endotracheal intubation was performed based on the results of the first-stage investigation. RESULTS: It was revealed that the tracheal length ranged from 7 to 11% of the body height in both the cardiac and non-cardiac Japanese paediatric patients. None of 308 Japanese paediatric and adult patients underwent single-lung intubation after the endotracheal tube was inserted at a depth of 7% of the body height at the vocal-cord level, corresponding to the minimum tracheal length for Japanese patients. The distance between the endotracheal tube tip and carina tracheae on postoperative chest radiographs was generally less than 4% of the body height across all paediatric and adult Japanese patients. CONCLUSIONS: The current study demonstrated that endotracheal intubation avoiding single-lung intubation can be achieved by inserting endotracheal tubes to the minimum tracheal length for a specific ethnic group at the vocal-cord level in paediatric patients, including neonates and premature infants, as well as adults.