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Anestezjologia intensywna terapia [journal]
- Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Sep 24.
Surveys have demonstrated a lack of physician awareness of IAH/ACS and wide variations in management of these conditions, with many intensive care units (ICUs) reporting that they do not measure intra-abdominal pressure (IAP). We sought to determine the association between publication of the 2006/2007 World Society of the Abdominal Compartment Syndrome (WSACS) IAH/ACS Consensus Definitions/Clinical Management Guidelines, IAP measurement practices, and IAH/ACS clinical awareness and management.The WSACS Executive Committee created an interactive online survey with 53 questions, accessible from November 2006 until December 2008. The survey was endorsed by the WSACS, the European Society of Intensive Care Medicine (ESICM), the European Critical Care Research Network (ECCRN), and the Society of Critical Care Medicine (SCCM). A link to the survey was emailed to all members of the supporting societies as well as to all the members of the Belgian Intensive Care Society (SIZ). Participants of the 3rd World Congress on Abdominal Compartment Syndrome meeting (March 2007, Antwerp, Belgium) were also asked to complete the questionnaire. No reminders were sent. Based on 13 knowledge questions an overall score was calculated (expressed as percentage). : RESULTS: A total of 2244 of the approximately 10,000 clinicians sent the survey responded (response rate, 22.4%). Most of the 2244 respondents (79.2%) completing the survey were physicians or physicians in training and the majority were residing in North America (53.0%). The majority of responders (85%) were familiar with IAP/IAH/ACS, but only 28% were aware of the WSACS consensus definitions for IAH/ACS. Three quarters of respondents considered the cut-off for IAH to be at least 15 mmHg, and nearly two thirds believed the cut-off for ACS was higher than the currently suggested consensus definition (20 mmHg). In 67.8% of respondents, organ dysfunction was only considered a problem with IAP of 20 mmHg or higher. IAP was measured most frequently via the bladder (91.9%), but the majority reported that they instilled volumes well above the current guidelines. Surgical decompression was frequently used to treat IAH/ACS, whereas medical management was only attempted by about half of the respondents. Decisions to decompress the abdomen were predominantly based on the severity of IAP elevation and presence of organ dysfunction (74.4%). Overall knowledge scores were low (43 ± 15%), respondents that were aware of the WSACS had a better score compared to those who were not (49.6% vs. 38.6%, p<0.001). : : CONCLUSIONS: This survey showed that although most responding clinicians claim to be familiar with IAH and ACS, knowledge of published consensus definitions, measurement techniques, and clinical management are inadequate.
- Local anaesthesia for ‘awake intubation’ using the TruView PCD video laryngoscope. [Letter]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):210-1.
- Central venous catheter in a morbidly obese patient--a sequence of mistakes and coincidences leading to the patient being exposed to the risk of severe complications. [Letter]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):208-9.
- Sympathetic nerve blocks for the management of postherpetic neuralgia - 19 years of Pain Clinic experience. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Sep 24.
- Psychological principles in regard to the interview with the deceased donor's family. [Journal Article]
- Anaesthesiol Intensive Ther 2014 Jul-Aug; 46(3):200-7.
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):195-9.
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):180-94.
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):175-9.
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):171-4.
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.