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Anestezjologia intensywna terapia [journal]
- The procedure for death notification--"In Person, In Time…". [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):241-3.
Informing of a patient's death is difficult for physicians as well as patient's families. Breaking bad news is part of clinical experience of physicians and existential experience of patient's close relatives. The professional manner of death notification may effectively reduce the level of stress and other negative emotions in both parties involved. Special information procedures defining cardinal rules of professional death notification have been devised to help physicians in this process. One of them, created in the United States in the 1990s, is the communication protocol - "In Person, In Time" - Recommended Procedures for Death Notification", discussed in the present paper.
- Use of dexmedetomidine in the adult intensive care unit. [Journal Article, Research Support, Non-U.S. Gov't]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):235-40.
Sedation and analgesia, which are universally used in intensive care units (ICUs), provide patients with comfort and safety. The current trends aim at light sedation; the objective is to ensure the minimal sedation level for improving patients' autonomy and enabling the professional staff to assess the patients' neurological status and cognitive functions. Reports in the literature have indicated that a sedative or an entire sedation procedure can affect cognitive processes, the duration of mechanical ventilation and treatment outcomes in critically ill patients. At present, special attention is given to post-sedation delirium. Although sedatives differ in their uptake points, which can influence the quality of sedation, their common characteristic is substantial impairment of cognitive functions, memory and respiration. Alpha 2-adrenergic receptor agonists, which comprise a novel group of agents, are used frequently for sedation. One of these medications is dexmedetomidine, which is designed to sedate adult ICU patients who exhibit a score ≥ -3 according to the Richmond Agitation-Sedation Scale. Recent studies comparing the use of dexmedetomidine and the other sedative agents that are most commonly administered in ICUs demonstrated that the former largely fulfils the expectations of intensivists.
- Acid-base disorder analysis during diabetic ketoacidosis using the Stewart approach--a case report. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):230-4.
This case report presents a 49 year-old female with type 1 diabetes admitted to the intensive care unit with acute respiratory failure and severe diabetic ketoacidosis with an initial measurement of blood glucose level of 1,200 mg L⁻¹, pH 6.78, serum HCO₃ ⁻ 3.2 mmoL L⁻¹ and BE -31.2 mmoL L⁻¹. Analysis of the blood gasometric parameters with the Stewart approach and the traditional Henderson-Hasselbalch concept enabled the discovery of metabolic acidosis caused by unidentified anions (mainly ketons). A treatment protocol with intensive fluid management with 0.9% NaCl, intensive intravenous insulin therapy, and potassium supplementation was administered. Analysis of the gasometric parameters after 12 hours of treatment according to the Stewart approach compared to the Henderson-Hasselbalch concept disclosed that metabolic acidosis caused by the unidentified anions has resolved almost completely and been replaced by metabolic hyperchloremic acidosis. The hyperchloremic acidosis was caused by the intensive fluid resuscitation with 0.9% NaCl, which contains a high chloride load, exceeding the chloride levels observed in human serum. Fluid management with balanced fluids other than saline was continued, together with intravenous insulin infusion, potassium supplementation, and 5% glucose administration. Analysis of this case study revealed the advantages of the Stewart approach to acid base abnormalities compared to the traditional Henderson-Hasselbalch concept. The Stewart approach allows the diagnosis of the exact causes of severe life-threatening metabolic acidosis and the appropriate modification of the therapeutic mangement of patients with diabetic ketoacidosis.
- The substantial impact of ultrasound-guided regional anaesthesia on the clinical practice of peripheral nerve blocks. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):223-9.
Ultrasound-guided (US-guided) regional anaesthesia has gained worldwide popularity in recent years owing to the benefits the method offers to patients. The 1st Department of Anaesthesiology and Intensive Care of Warsaw Medical University was one of the first centres in Poland to employ US-guided peripheral nerve blocks (PNB) on a routine basis. The technique was incorporated into the institution's clinical practice from 2007. The purpose of this study was to retrospectively assess changes in the clinical practice of US-guided versus non US-guided PNBs over six years of experience with the technique.Retrospective analysis assessing the prevalence of PNB methods, local anaesthetic (LA) injection techniques (i.e. single injection vs. multiple), LA volumes used, success rates and the incidence of complications.This study included 4,066 PNBs performed between January 2006 and June 2012. The results showed systematic growth in the prevalence of US-guided blocks in the total number of PNBs, from 8.6% in 2007 up to 53.3% in 2012. The mean LA volume used in PNB was significantly lower in US-guided blocks compared to traditional PNB techniques (respectively, 21.83 mL vs. 31.41 mL, P < 0.05) without a decrease in the success rate (respectively, 76% vs. 74%, P > 0.05). A shift in the prevailing block technique from single injection to multiple injections was observed, regardless of the nerve location technique employed (from 29% up to 84% of PNBs performed using multiple injection technique).The use of ultrasound optimizes the technique of peripheral blocks and the amount of local anaesthetic used. Ultrasonography does not affect the safety of peripheral blocks.
- Long-term totally implantable venous access port systems--one center experience. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):215-22.
Implantable venous access ports are essential for patients requiring chronic venous access. The aim of this study was to determine securities, risks of complications and patients' satisfaction with using a port system.Between April 2008 and May 2013, 220 consecutive patients (mean age: 53 ± 12 years; 155 female) were enrolled into this observational, single-centre study. 65 patients who received a port system were asked to complete a questionnaire with the aim of evaluating the patient's satisfaction and quality of life.First vena subclavia and later internal jugular were the most frequently used for venous access. Among serious complications, three cases (1.5%) of pneumothorax were observed. Technical difficulties of cannulation were observed in 12 cases (5.6%). In the late period, functional complications, defined as 'easy injection, impossible aspiration' at port access, affected more than 25% of the patients.Implantation of vascular ports is a safe procedure, and serious complications are rare. In the evaluated group, complications connected with the complete functioning of ports were observed. Among responders, more than 90% of patients reported high overall satisfaction.
- Effect of sevoflurane on cerebral perfusion pressure in patients with internal hydrocephalus. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):211-4.
Due to its confirmed neuroprotective properties, sevoflurane is one of a few anaesthetics used for neuroanaesthesia. Its effects on the cerebral and systemic circulations may be of particular importance in patientswith intracranial pathology. This study aimed to evaluate the effect of sevoflurane at concentrations lower than 1 MAC on cerebral perfusion pressure (CPP) in patients with internal hydrocephalus.The study was conducted on14 patients with internal hydrocephalus, who underwent ventriculo-peritoneal shunt implantation. After inserting the catheter into the lateral cerebral ventricle, sevoflurane, at 1.1 and 2.2 vol%, was initiated at two successive 15-minute intervals. The intracranial pressure (ICP) was continuously measured; special attention was focused on the values prior to and at the end of each observation period. The following parameters were monitored: mean arterial pressure (MAP), CPP, heart rate, end-tidal CO₂ concentration, core body temperature, and the inspiratory and end-expiratory concentrations of sevoflurane.The HR and MAP decreased during successive observation intervals compared to baseline values. Likewise, the CPP decreased from 75.6 ± 2.8 mm Hg to 72.2 ± 2.6 mm Hg to 70.2 ± 0.8 mm Hg. The baseline value for ICP was 16.3 ± 0.6 mm Hg and increased to 17.7 ± 0.8 and 18.9 ± 0.5 mm Hg during the next observation periods.Sevoflurane administered ata concentration below 1MAC to patients with internal hydrocephalus increases the ICP and decreases the MAP, which leads to adecrease in CPP. The CPP decrease is more dependent on depressing the systemic circulatory system than an increased ICP.
- Ferritin in dialysis-related arthropathy: could it be a possible biochemical indicator of articular chronic pain? [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):205-10.
The aim of our study was to evaluate laboratory data behaviour in two dialysis populations, with and without dialysis-related arthropathy and pain.We produced an elaboration of more than 160,000 items of biochemical data of 25 dialysis-related arthropathy patients with chronic articular pain, and 25 patients asymptomatic for joint pain and arthropathy. The pain visual analogue scale (VAS) was employed for pain intensity determination.The serum level of β-2 microglobulin was similar in the two groups of patients, while ferritin values were significantly higher in symptomatic patients. We excluded the possibility that the ferritin difference between the two groups was due to different iron storage and to an inflammatory profile. Furthermore, the pain VAS mean value was higher in patients who had higher ferritin and pain than in asymptomatic patients.It is important to underline that the higher value of ferritin in patients with chronic pain due to dialysis- -related arthropathy could represent a new stimulus for a deeper investigation of this indicator, setting a periodic revelation of pain intensity.
- Intraoperative awareness--comparison of its incidence in women undergoing general anaesthesia for caesarean section and for gynaecological procedures. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):200-4.
Intraoperative awareness (IA) is diagnosed when patients can recall their surroundings or an event related to the surgery that occurred while they were under general anaesthesia. The female gender and Caesarean section are considered to be contributing factors. The aim of the present study was to analyse the frequency of IA in patients undergoing general anaesthesia either for Caesarean section or gynaecological procedures.ASA I and II women were included into the study. Patients were randomly allocated to 4 groups: A, B and C included patients qualified for elective gynaecological surgery, and group D comprised Caesarean section patients. Premedication was not given. Group A received total intravenous anaesthesia with TCI, and groups B, C and D received balanced anaesthesia. The depth of anaesthesia was monitored with an AEP monitor. Blinded structured interviews were conducted 2 hours after anaesthesia and on postoperative days 7 and 30.337 patients were enrolled into the study. 45 patients reported diverse sensations connected to the anaesthesia (Group A - 7 patients, B - 9 patients, C - 2 patients, D - 28 patients). There were mainly dream sensations, but IA was present in 3 cases. In all of the cases, IA was recognised during the first interview. One episode of awareness appeared in group B, and the other two appeared in group D. One Caesarean section was complicated by intraoperative haemorrhage. The patient from group B had similar sensations during previous anaesthesia. Two women enrolled in the study reported awareness in the past, which did not occur this time.Awareness during general anaesthesia occurs occasionally. The frequency of occurrence in a group of patients undergoing general anaesthesia for uncomplicated Caesarean section is not higher than for other procedures. The anaesthesia for Caesarean section, as well as for other procedures, may be accompanied by pleasant dreams.
- Guidelines for system and anaesthesia organisation in short stay surgery (ambulatory anaesthesia, anaesthesia in day case surgery). [Journal Article]
- Anaesthesiol Intensive Ther 2013 Oct-Dec; 45(4):190-9.