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Anestezjologia intensywna terapia [journal]
- The borderline between legality and illegality of providing health services in anaesthesiology and intensive care units. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):1-3.
- The issue of penal and legal protection of the intensive care unit physician within the context of patient's consent to treatment. Part II: unconscious patient. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):55-9.
Cultural changes in Western societies, as well as the rapid development of medical technology during the last quarter of a century, have led to many changes in the relationship between a physician and a patient. During this period, the patient's consent to treatment has proven to be an essential component of any decision relating to the patient's health. The patient's will component, as an essential element of the legality of the treatment process, is also reflected in the Polish legislation. The correct interpretation of the legal regulations and the role the patient's will plays in the therapeutic decision-making process within the Intensive Care Unit (ICU) requires the consideration of both the good of the patient and the physician's safety in terms of his criminal responsibility. Clinical experience indicates that the physicians' decisions result in the choice of the best treatment strategy for a patient only if they are based on current medical knowledge and an assessment of therapeutic opportunities. The good of the patient must be the sole objective of the physician's actions, and as a result of the current state of medical knowledge and the medical prognosis, all the conditions of the legal safety of a physician taking decisions must be met. In this paper, the authors have set out how to obtain consent (substantive consent) to treat an unconscious patient in the ICU in light of the current Polish law, as well as a physician's daily practice. The solutions proposed in the text of the publication are aimed at increasing the legal safety of the ICU physicians when making key decisions relating to the strategy of the treatment of ICU patients.
- The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):50-4.
In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code.
- Prognostic scoring systems for mortality in intensive care units - the APACHE model. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):46-9.
The search for a tool enabling predicting morbidity and mortality among intensive care patients had been going on for years. 30 years ago it resulted in designing severity scoring systems which offer an objective quantification of illness severity of the patients admitted to ICU. APACHE (Acute Physiology and Chronic Health Evaluation Score). The most recently released version of APACHE IV, not only allow assessing patients on admission but also enable predicting risk of death during hospitalization. Severity scoring systems like APACHE IV is very useful but complicated and time consuming also. Their use without computer software is virtually impossible.
- Psychological reactions in family members of patients hospitalised in intensive care units. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):42-5.
The environment of the intensive care unit (ICU) is burdensome to a patient and the patient's family. There is a higher risk of depression, anxiety and stress-related disorders in the ICU patients' family members. In relatives of critically ill patients, the cluster of adverse psychological reactions, such as: anxiety, acute stress disorder, posttraumatic stress disorder, depression and complicated grief, is called post-intensive care syndrome - family (PICS-F). These complications may affect the relatives' ability to perform the role of a caregiver and it can also hinder their daily functioning. Apart from negative psychological consequences experienced after a loved one's stay in the ICU, there are also some positive changes observed in patient's relatives called posttraumatic growth. In this review, the psychological repercussions in the ICU patient's family and the means to prevent their undesirable responses are discussed.
- Renaissance of supraclavicular brachial plexus block. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):37-41.
Due to frequent complications, especially pneumothorax, supraclavicular brachial plexus block became less popular. Ultrasonography is a very powerful tool in modern medicine and a real milestone in regional anaesthesia. Ultrasound- guided supraclavicular brachial plexus block reduces the probability of major complications occurrence (like pneumothorax, Horner's syndrome, phrenic nerve palsy). In this review we present the usefulness of ultrasonographic imaging and how to perform efficient ultrasound-guided blockade safely.
- Hepatic encephalopathy in the course of alcoholic liver disease - treatment options in the intensive care unit. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):34-6.
Hepatic encephalopathy occurs as a complication of alcoholic liver disease may require methods of dialysis available in intensive care units. There is described the case of a 27-year-old patient with jaundice and hepatic encephalopathy with long history of alcohol dependence and substance abuse. The patient was successfully treated using liver dialysis method (Prometheus® system). Basing on this case it is possible to conclude that use of dialysis liver with Prometheus® may be beneficial in patients with severe course of alcoholic liver disease.
- Intrathecal morphine increases the incidence of urinary retention in orthopaedic patients under spinal anaesthesia. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):29-33.
Morphine injected into the subarachnoid space enhances the analgesic effects of spinal anaesthesia, improving the patient's comfort in the postoperative period. However, it is likely to be associated with adverse side effects that reduce patient satisfaction, e.g., urine retention. The aim of the present study was to evaluate the incidence of urine retention in patients receiving spinal anaesthesia combined with intrathecal morphine.The postoperative course of 30 patients undergoing orthopaedic surgical procedures was analysed. Patients were divided into two groups: the control group (BSH; 16 individuals anaesthetised with a 0.5% hyperbaric solution of bupivacaine) and the experimental group (BSH + MF; 14 individuals anaesthetised with a 0.5% hyperbaric solution of bupivacaine with the addition of 0.2 mg morphine). The following parameters were analysed: duration of anaesthesia, time to miction, time to urgency and need to introduce a urinary catheter.There were no statistically significant differences in the duration of anaesthesia, incidence of hypogastric discomfort/difficulties in urination, time to hypogastric discomfort or duration of discomfort. Patients receiving intrathecal morphine were characterised by longer time to miction, higher incidence of urinary catheterisation and longer time between anaesthesia and urinary catheterisation.Patients receiving spinal anaesthesia with a 0.5% hyperbaric solution of bupivacaine combined with intrathecal morphine were demonstrated to have a higher incidence of urinary catheterisation, longer time to urinary catheterisation and longer time to miction compared to patients receiving only local anaesthetics.
- Intraoperative awareness during general anaesthesia: results of the observational survey. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):23-8.
Intraoperative awareness is a rare but extremely unfavourable phenomenon affecting 0.1-0.2% of patients who undergo surgery under general anaesthesia. The event exposes patients to stress and its remote, severe outcomes. The aim of the present study was to determine the incidence of intraoperative awareness in patients undergoing general anaesthesia.Methods: The observational questionnaire-based study was carried out in patients treated in one centre during a period of 8 months. Anaesthesia depth was monitored clinically using measurements of end-tidal concentration of volatile anaesthetic agent. After anaesthesia, accounts of patients regarding possible intraoperative awareness were analysed. Awareness was defined as recall events are confirmed or have a high likelihood of occuring in the intraoperative period.Data from 199 patients were analysed. None of them experienced awareness during general anaesthesia (category A). Possible intraoperative awareness was observed in one patient (0.5%) (category B), and 17 patients (8.5%) experienced intraoperative dreaming.The incidence of intraoperative awareness in our study was low. The intraoperative monitoring including clinical analysis of anaesthetized patient as well as measurement of end-tidal concentration of volatile anaesthetic agent seems to be sufficient for prevention of episodes of awareness during general anaesthesia.
- Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jan-Mar; 46(1):17-22.
Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15-20 minutes compared to 15-30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.30 patients aged 30-70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.