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Anestezjologia intensywna terapia [journal]
- Interaction between transplant coordinator and non-heart-beating donor family members. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):49-51.
Thanks to continuous advances in transplantology in Poland, over 1000 patients a year are given a chance for new life or improvement of its quality. The number of identified brain-dead donors increases every year, so is the number of transplanted organs. Unfortunately, despite the substantially improved transplantation system in Poland, the number of patients awaiting organ transplants is markedly higher than the number of donors and still many patients die before the transplantation is possible. In recent years, the worldwide attempts have been made to increase the number of donors to help the largest possible group of patients with end-stage organ failure. One of the options is to re-start non-heart-beating donation. The contact with the family of a potential non-heart-beating donor is crucial for identification, donation and transplantation of organs. Conversations of transplant coordinators with patients' relatives and their information regarding the patient's opinion about organ donation are extremely important for the entire transplantation process.
- Consent to eventual treatment in the intensive care unit expressed within the consent form for elective anaesthesia and surgery. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):44-8.
In contemporary clinical practice, the issue of requesting patient consent to perform therapeutic treatment plays an important role. The conscious consent of a patient as an expression of one's will greatly strengthens the legality of medical procedures performed by a physician, regardless of the medical field. However, obtaining consent to treatment in the intensive care unit (ICU) often poses enormous difficulties in daily clinical work, and has in recent decades been the cause of much dispute between doctors and lawyers. The correct interpretation of the provisions under the relevant laws determines the safety and comfort of the medical practice in the ICU. This study compared the current rules of normative acts of Polish common law relating to medical practice in intensive care units and issued on the basis of the judgments of the common court of law over the past ten years. On the basis of those provisions, the authors conclude that the patient should be informed by the anaesthesiologist during the visit as to the possibility of postoperative therapy in the ICU. The extent of such information depends on the likelihood of having treatment in the ICU. The consent of the patient for hospitalisation in the ICU should be mandatory in the case of treatments which are very likely to necessitate such hospitalisation. This concerns especially cardiac surgery, neurosurgery and treatments for patients with a significant burden of disease. The authors of this study propose that an information and consent form to undergo treatment in the intensive care unit should be included within the anaesthesia consent form.
- Inadvertent intraoperative hypothermia. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):38-43.
Inadvertent perioperative hypothermia complicates a large percentage of surgical procedures and is related to multiple factors. Strictly regulated in normal conditions (± 0.2°C), the core body temperature of an anaesthetised patient may fall by as much as 6°C, while a 2°C decrease is very common. This is due to a combination of anaesthesia-related impairment of the central thermoregulatory control and a cool operating room temperature, which, when superimposed on insufficient insulation and a failure to actively warm the patient, may result in profound temperature disturbances. As a result, prolonged wound healing, increased risk of wound infection, a higher rate of cardiac morbidity, and greater intraoperative blood loss and postoperative blood transfusion requirements may occur. The reasons for this are said to include underlying changes in microcirculation, coagulation, immunology and an increase in the duration of action of most anaesthesia medications. As effective methods have been available for a number of years now, it is currently indicated to maintain intraoperative normothermia in order to minimise procedure-related risk and improve patient comfort.
- Complications after using the Airtraq laryngoscope for a predicted difficult intubation. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):35-7.
Although standard management of an expected difficult intubation is based on fibre-optic techniques, the application of optical laryngoscopes such as Airtraq is gaining widespread acceptance. We here describe a case where an intubation attempt with the Airtraq laryngoscope was not only unsuccessful, but negatively influenced subsequent use of a flexible fibroscopic approach.
- Deep snow immersion suffocation--the deadly threat. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):33-4.
This report presents the case of non-avalanche-related snow immersion death in the Tatra Mountains, which meets all the criteria of this rare phenomenon. The causes and mechanism of deep snow immersion suffocation as well as prevention strategies are discussed.
- Haddad syndrome. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):30-2.
Haddad syndrome is a rare genetically conditioned disease. We present a female newborn with congenital central hypoventilation syndrome associated with Hirschprung's disease. The infant is mechanically ventilated and parentally fed in a home setting. The diagnosis has been confirmed by the presence of 20/26 PHOX2B genetic mutation.
- Perioperative prognostic factors in patients with ruptured abdominal aortic aneurysms treated in the intensive care unit. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):25-9.
The incidence of abdominal aortic aneurysm has been estimated at 20-40 cases per 100,000 per annum. The disease is often asymptomatic; in many cases, its first symptom is shock caused by a ruptured aneurysm. The aim of the present study was to assess retrospectively the selected perioperative factors in patients hospitalised in the intensive care unit (ICU) after repair of ruptured abdominal aortic aneurysm.Analysis involved medical records of patients after repair of ruptured abdominal aortic aneurysm treated in ICU in the years 2009-2010. Patients were divided into two groups: group I - survivors who were discharged from ICU and group II - non-survivors. Demographic factors, intraoperative data, vital parameters, laboratory results and severity of patient's state on admission to ICU were analysed.Analysis of laboratory results on admission to ICU showed lower values of pH and HCO(3)(-) concentrations as well as higher international normalised ratio (INR) and activated partial thromboplastin time (APTT) in group II. Mean intraoperative diuresis differed between the groups; in group I - 303 mL and in group II - 155 mL. Mean diuresis on ICU day 1 was higher in group I compared to group II, i.e. 20.87 and 11.27 mL kg b.w.-1, respectively. APACHE II, SAPS II, MODS and SOFA point values were higher in group I than in group II.Markers of impaired homeostasis, such as pH, HCO(3)(-) concentration, INR and APTT assessed on admission to ICU can be relevant prognostic factors in patients after repair of ruptured abdominal aortic aneurysm. Monitoring of diuresis during surgery and on day 1 of ICU treatment was a sensitive risk marker for acute kidney injury. Multiple organ failure scales such as APACHE II, MODS, SOFA and SAPS II were reliable prognostic tools to be used in the early period of ICU treatment.
- A randomised comparison between Cobra PLA and classic laryngeal mask airway and laryngeal tube during mechanical ventilation for general anaesthesia. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):20-4.
The aim of this study was to compare ventilation parameters during mechanical ventilation using Laryngeal Mask Airway (LMA), Laryngeal Tube (LT), and Peri-Laryngeal Airway Cobra (PLA).In a prospective, randomised controlled trial, 90 patients undergoing general anaesthesia for elective surgery were divided into three subgroups. The settings of controlled ventilation were: oxygen 50%, air 50%, sevoflurane 1.5-2.0%, TV 7 mL kg(-1), RR 10 breath min(-1), inspiratory/expiratory ratio 1:2 and FGF 3 L min(-1). The number of attempts, time taken to insert the device, airway pressure (peak airway pressure, plateau airway pressure), air leak (inspiratory and expiratory volume difference), and dynamic compliance were measured. The timepoints for collecting data were after successful insertion of the device, and after ten, 20, 30 and 50 mins of ventilation. The presence of visible blood traces, patients' assessment of their throat soreness, dysphonia and dysphagia were noted postoperatively.The success rates at first insertion were 90% and 80% and 90%, while time for insertion was 5 sec and 21.94 sec and 5.24 sec in the Cobra PLA, LMA and LT groups respectively. Ventilation pressures during procedure were highest in the LT group, where compliance was lowest compared to the Cobra PLA and LMA groups. The air leak was similar in all the groups. 30% vs. 40% vs. 10% of devices had positive blood traces; 20% vs. 40% vs. 30% of patients suffered from a sore throat; and 30% vs. 30% and 30% of patients suffered from dysphagia in the Cobra PLA, LMA and LT groups respectively.The differences were small, but Cobra PLA seemed to be slightly superior in terms of the measured parameters.
- The impact of colloid infusion prior to spinal anaesthesia for caesarean section on the condition of a newborn--a comparison of balanced and unbalanced hydroxyethyl starch 130/0.4. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):14-9.
Fluid therapy is the most commonly used treatment to prevent hypotension associated with spinal anaesthesia. The aim of this study was to test the hypothesis that a balanced solution of 6% hydroxyethyl starch will have a more beneficial impact on the condition of newborns at birth than an unbalanced 6% solution of HES.The study participants included 51 healthy parturients undergoing elective caesarean section with spinal anaesthesia. Patients received a transfusion of 500 mL of unbalanced 6% HES (Voluven) or balanced 6% HES (Tetraspan) prior to anaesthesia. The condition of the newborn was assessed using the Apgar score, and the acid-base balances of venous and arterial umbilical cord blood were also measured.The incidence of hypotension after spinal anaesthesia was 80% in Group A and 76.9% in Group B (P = 1.0). There were no differences between the two groups in the total doses of ephedrine and no differences between treatment groups in Apgar scores. Also, no differences in acid-base balance parameters (pH, H(+), pCO(2), pO(2), HCO(3)(-), BE) were found.A balanced 6% solution of hydroxyethyl starch (HES 130/0.42) did not significantly influence the condition of the newborns at birth or the acid-base and electrolyte concentration of newborns compared to an unbalanced solution of 6% hydroxyethyl starch (HES 130/0.4).
- Complications in patients treated with plasmapheresis in the intensive care unit. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jan-Mar; 45(1):7-13.
Plasmapheresis is one of the methods of extracorporeal blood purification involving the removal of inflammatory mediators and antibodies. The procedure is used in a variety of conditions, including autoimmune diseases. The aim of the present study was to analyse the incidence of plasmapheresis-related complications in patients treated in the intensive care unit (ICU).The analysis involved 370 plasmapheresis procedures in 54 patients. The data were collected from patients' medical records, including procedure protocols.The most common diseases treated with plasmapheresis included: myasthenia gravis (33.3%), Guillain-Barre syndrome (14%), Lyell's syndrome (9.3%), systemic lupus erythematosus (7.4%), and thrombotic thromcytopenic purpura (7.4%). The adverse side effects observed most frequently during plasma filtration were: fall in arterial blood pressure (8.4% of all procedures), arrhythmias (3.5%), sensations of cold with temporarily elevated temperature and paresthesias (1.1%, each). In most cases the symptoms were mild and transient. Severe and life-threatening episodes, i.e. shock, fall in arterial blood pressure requiring pressor amines, persistent arrhythmias and haemolysis, developed in 2.16% of procedures.Plasmapheresis can be considered a relatively safe method of treatment of ICU patients. Continuous observation and proper monitoring of patients provided by highly trained medical personnel are essential for its safety.