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Anestezjologia intensywna terapia [journal]
- Psychological principles in regard to the interview with the deceased donor's family. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):200-207.
The purpose of this article is to present the most important rules of the interview process with the family of a patient who has been diagnosed with brain death. Based on data from the literature and their own clinical experience, the authors also describe the psychological mechanisms that make contact with the family of a potential donor particularly difficult. The paper also discusses successive stages in the process of building contact with the family from the perspective of the dual advocacy approach that, in the light of recent data from the literature, can significantly increase the likelihood of the family's acceptance of organ donation, offering both the specific theoretical foundations as well as the strict principles in regard to the interview. The article contains practical suggestions for dealing with difficulties that can arise at all stages of contact with the family: making contact, providing information, providing information about brain death and talking with the family about organ donation from a deceased relative.
- Coagulation management in epidural steroid injection. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):195-199.
The objective of this study was to review all published articles in the English language literature about the coagulation management of epidural corticosteroid injections (ESI) in humans. ESI are among the most commonly used procedures to manage chronic spinal pain, yet there is no conclusive review on the coagulation management of this popular procedure. We searched for reports using MEDLINE and EMBASE with the terms 'epidural and steroids', 'corticosteroids' or 'glucocorticosteroids', 'coagulation', and 'haematoma' up to and including the year 2012. Reports were also located through references of articles. We conclude that even though epidural steroid injection is one of the most used techniques in treating radicular pain, correct management of coagulation is necessary.
- The right to information. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):180-194.
The right to self-determination, including the decision on treatment, is affirmed in modern societies. Therefore, the fundamental condition of legal procedures is informed consent of a patient or an authorised person. However, to make the consent legally effective, some conditions have to be met; of these, the provision of comprehensive medical information is of the utmost importance. Thus, a patient is entitled to necessary information provided by a physician. The correlate of this right is the obligation to disclose information which must be fulfilled by a medical practitioner. The aim of this review is to examine this obligation in terms of determining the range of subjects authorised to provide information, the scope of subject information or a set of data, and the manner and time in which it should be given. Moreover, this article discusses regulations which permit limitations of information disclosure, i.e. the patient's entitlement to renounce the right to information, and therapeutic privilege. The disquisition regards achievements of legal doctrine and judicature, from the angle of which all the legal solutions and doubts arising are presented.
- Symptoms of hypovolemic shock during the induction of general anaesthesia in a patient with large vascular malformation - an adverse effect of propofol and sevoflurane? [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):175-179.
enous malformations are the second most common congenital vessel anomaly. In our hospital, we conduct up to 30 sclerotherapies with 1-3% aethoxysclerol annually in children of all ages. The procedure is invasive and painful and therefore requires general anaesthesia.A 16-year-old girl underwent sclerotherapy of a vast vascular malformation of her left leg, pelvis, abdominal cavity and thorax. After induction of general anaesthesia and positioning for the procedure, she presented with hypotonic shock with sinus tachycardia and sudden decrease in her ETCO₂. Her skin became pale and cold. The venous malformation became distended. The incident was caused by redistribution of the blood to the malformation, which is believed to have been triggered by the volatile anaesthetic. After discontinuation of the sevoflurane, modification of anaesthesia and the administration of ephedrine and fluids, hypotonia was successfully treated. The patient's state was stabilised, her clinical measurements returned to normal, and the procedure was continued. Her later course was uneventful. Blood gas analysis in post-anaesthesia care unit revealed mild, compensated metabolic acidosis. No electrolyte abnormalities were present.Volatile anaesthetics and propofol decrease the systemic vascular resistance and cause vasodilatation. Our patient presented with hypotonic shock due to the redistribution of blood to the dilated venous malformation, which developed after the use of standard concentration of sevoflurane. Intravenous anaesthetics were administered during induction and might have increased that effect. Although we found no similar reports, we believe that patients with vast venous malformations can experience such complications after the use of volatile anaesthetics, especially in high concentrations.
- Hyperglycaemia and ketosis in a non-diabetic patient - an unusual cause of delayed recovery. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):171-174.
We report a case of hyperglycaemia and ketosis developing in a non-diabetic patient who underwent a neurosurgical procedure under general anaesthesia. A 52-year-old non-diabetic female patient underwent excision of acoustic neuroma under general anaesthesia. Pancreatic function was not disturbed and she received a single dose of dexamethasone (8 mg) and paracetamol (1 g). Delayed recovery from anaesthesia occurred. On investigation, she was found to have hyperglycaemia and ketosis. She was further managed on the line of diabetic ketoacidosis. After 24 hours, when blood glucose had normalised and ketosis abated, she could be weaned from mechanical ventilation and extubated. The patient did not receive any drugs known to cause such a condition. To the best of our knowledge, hyperglycaemia and ketosis developing in a non-diabetic patient causing delayed recovery and extubation is here reported for the first time.
- The effectiveness of the APACHE II, SAPS II and SOFA prognostic scoring systems in patients with haematological malignancies in the intensive care unit. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):166-170.
Cancer-related mortality remains the second most common cause of death in Poland. In many cases, the occurrence of treatment-related complications requires admission to the intensive care unit (ICU). The aim of this study was to assess the clinical application of the APACHE II, SAPS II and SOFA scales to evaluate the risk of death in patients with haematological malignancies treated in the ICU.This study's analysis included 99 patients, who were each assigned to one of the following two groups: surviving patients who were discharged from the ICU (n = 24); and patients who died in the ICU (n = 75). Analysis was performed using demographic, clinical and laboratory data obtained during the patient's admission to the ICU and also during the first 24 hours of intensive therapy. Patient assessment was performed using the APACHE II, SAPS II and SOFA scoring systems as well as other clinical variables.Univariate logistic regression identified the following risk factors of death in patients with haematological malignancies: systolic (P = 0.006), diastolic (P = 0.01) and mean arterial pressure values (P = 0.009); occurrence of acute kidney injury; neutrophil (P = 0.009) and platelet count in the peripheral blood (P = 0.001); and the SAPS II (P = 0.00005), SOFA (P = 0.00009) and APACHE II (P = 0.0007) scores. SAPS II score was the only independent risk factor of patient death in multivariate analysis (P = 0.0004; unitary OR 1.052 [95% CI: 1.022-1.082]).Of all the applied patient assessment scales, only the SAPS II score was found to be useful in subjects with haematological malignancies hospitalised in the ICU.
- Radiofrequency neurotomy for the treatment of chronic pain: interference with implantable medical devices. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):162-165.
Radiofrequency is widely used in the treatment of chronic pain for its efficacy and low incidence of side effects and complications. Despite this, it is commonly believed that this kind of treatment could interfere with medical implantable devices. Potential interference between implanted devices such as pacemakers, defibrillators and spinal cord stimulators and the radiofrequency of neurotomy is an important concern for physicians caring for patients with these devices.A retrospective study was conducted on 30 radiofrequency-treated patients, collected in five years out of more than 1,000 patients treated. Our cohort was selected due to the presence of implanted medical devices. Treatments include the radiofrequency neurotomy of the lumbar facet joints, intervertebral discs, sacroiliac joint and peripheral nerves.Out of 30 patients and 68 treatments, global radiofrequency ablation was considered safe, due to the absence of any problem during or after the procedure. In particular, procedures were never interrupted because of electrical interference with the implanted devices or for problems attributable to an aberrant activation of them. Neurological and physical exam did not show any alteration after the procedure.There are several theoretical concerns about radiofrequency treatments in patients with implantable electrical medical devices. However, there is no experimental evidence of electrical interference with the implanted devices. Our long experience strongly suggests that by following simple precautions, patients can benefit from radiofrequency pain-relieving procedures without any adverse events.
- The prevalence of burnout syndrome in Polish anaesthesiologists. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):155-161.
Burnout syndrome is a psychological response to chronic work-related stress characterized by low enthusiasm towards the job, high psychological exhaustion, indolence and guilt. Being a medical doctor, both in Poland and in other countries, is one of the most stressful occupations and anaesthesiology is considered one of the most stressful specializations, which justify carrying out of the study on Polish anaesthesiologists. The aim of the study was to determine the prevalence of burnout syndrome in Polish anaesthesiologists METHODS: Non-randomized cross-sectional study was carried out and data were gathered through a self-administrated questionnaire. The sample consisted of 373 Polish anaesthesiologists, 57.6% were women and 42.4% were men. A 66% response rate was achieved. The Burnout Syndrome was measured by the Spanish Burnout Inventory.The prevalence burnout risk was almost 70%. The percentage of participants who indicated very high levels of burnout was 18%; 5.9% of whom fell into profile 2 considered to be clinical. The instrument applied was reliable with Cronbach's alphas exceeding 0.70.The sample is characterized by high burnout risk with 5.9% of clinical cases. Participation in prevention programs is recommended.
- Prognostic value of serum galactomannan in mixed ICU patients: a retrospective observational study. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):145-154.
Little is known about serum galactomannan (GM) testing in (mostly non-neutropenic) mixed intensive care unit (ICU) patients. The aim of this study was to look for the incidence of invasive aspergillosis (IA) in critically ill patients, to validate previously reported GM thresholds, and to evaluate the prognostic value of GM.This was a retrospective study of 474 GM samples in 160 patients from the start of January 2003 until the start of February 2004. GM tests were ordered because of a clinical suspicion of IA or on a regular basis in immune compromised patients. The number of samples per patient was 3 ± 2.6. We used the criteria of the European Organisation for Research and Treatment of Cancer (EORTC) to define proven IA, probable IA, and possible IA. The number of positive samples, with GM optical density (OD) > 0.5 was 230 (48.5%).In our study population, five (3%) patients had proven IA, 11 (7%) had probable, 27 (17.5%) had possible, and 116 (72.5%) had no IA. We could not identify a GM threshold for IA with analysis of receiver operating characteristics (ROC) curves: with a sensitivity of (56.3%, 50%, 50%, 37.5%), specificity (38.2%, 67.5%, 68.8%, 72.9%), NPV (88.7%, 91.8%, 92.5%, 91.3%) and PPV (9.2%, 12.9%, 15.1%, 13.3%) for a cut-off of OD > 0.5, > 0.8, > 1.1 and > 1.5 respectively. IA was associated with high mortality of 87.5% and 100% in patients with probable and proven IA respectively. Patients with IA had a significant increase of GM during their stay (GMdelta 0.7 ± 1.5 vs -0.2 ± 1.5, P = 0.027). The overall ICU mortality was 41.9% and the hospital mortality was 58.1%. Patients who died in the ICU and in the hospital had higher APACHE- -II, SAPS-II and SOFA scores (P < 0.0001) and also a significant increase in GM during their stay with 0.27 ± 1.26 (ICU non-survivors) and 0.11 ± 1.55 (hospital non-survivors) compared to a decrease in GM -0.43 ± 1.7 (P = 0.004) and -0.48 ± 1.51 (P = 0.017) in ICU and hospital survivors respectively. Non-survivors also had higher mean GM values but this was not statistically significant. There was a trend towards higher GM values in patients treated with piperacillin/tazobactam (n = 34), but this did not reach statistical significance. Neutropenic patients (n = 31) showed an increase in GM during their stay 0.32 ± 1.3 vs a decrease with -0.43 ± 1.7 in non-neutropenic patients (P = 0.07). Patients on total parenteral nutrition (n = 125) had higher maximal GM levels (1.55 ± 1.94 vs 0.88 ± 1.25, P = 0.058). Patients who were mechanically ventilated had significantly higher mean (P = 0.038) and maximal (P = 0.007) GM levels.We found a high incidence of proven and probable IA in a group of mixed ICU patients (10%) and the presence of IA was associated with a high mortality. The serum GM antigen detection test may not be useful in the diagnosis of IA in mixed ICU patients, according to the results of the ROC analysis. We could not define a useful threshold.
- Non-word reading test vs anaesthesia. How do anaesthetised patients decode the contents without referring to the meaning? [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):139-144.
The aim of this study was to examine the phonological functioning (reading speed and accuracy) of hospital patients under general anaesthesia administered during colonoscopy.In this study the 'Łatysz' non-word reading test was used to measure the impact of selected anaesthetics on the phonological aspect of language processing (defined as decoding without referring to the meaning) in a group of 22 anaesthetised patients compared to 23 non-anaesthetised patients from university clinics.Compared to the preoperative performance, a decrease in reading accuracy and reading speed was observed only in the Anaesthesia Group - AG (in the subjects aged ≥ 35 years) 1.5 h after the administration of anaesthetics. Postoperatively, the AG were significantly slower and less accurate than the Control Group - CG - after 1.5 h. After 3 h, the AG had regained their baseline values both in reading accuracy and reading speed. During the last assessment session, the AG pronounced 82% of the words correctly, while the CG pronounced 74% correctly. Moreover, subjects aged ≥ 35 years performed worse than younger subjects in their reading accuracy and speed.The patients who underwent colonoscopy under general anaesthesia manifested impaired phonological functioning shortly after the procedure, both in the speed and accuracy of reading non-words. However, the accuracy problems subsided relatively quickly.