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Anestezjologia intensywna terapia [journal]
- Ultrasound in critical care. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):177-81.
Ultrasound has been revolutionising our specialty. The introduction of new, portable machines and goal-directed protocols has led many anaesthetists to use this diagnostic tool in their daily practice. Immediate, bedside ultrasound diagnosis of many life-threatening emergencies (pneumothorax, cardiac tamponade, or internal haemorrhage) enables not only the institution of proper treatment, but also the monitoring of its effectiveness. Ultrasound guided invasive procedures (such as vascular cannulations, toraco- and pericardiocentesis) have superseded the old anatomical landmarks-based techniques due to a greater safety margin. In order to perform a credible ultrasound examination, a proper level of competence is required. In this review article, the authors present various critical ultrasound applications.
- Methods of central vascular access for haemodialysis. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):171-6.
The basic form of renal replacement therapy is haemodialysis. The duration and efficacy of this treatment depends on well-functioning vascular access. Short-term or long-term catheters are used if the arterial-venous fistula placement is not possible or not indicated. According to the recommendations of the NKF DOQI (National Kidney Foundation Disease Outcomes Quality Initiative), the first choice of access is the right internal jugular vein, and the next are the left internal jugular, femoral and subclavian vein. In this article, we present approaches to the abovementioned veins for haemodialysis cathether insertion as well as catheter tip positioning in the venous system to prevent serious complications.
- Ventilator-associated lung injury. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):164-70.
Mechanical ventilation of disease-affected lungs, as well as being an inadequate mode of ventilation for initially healthy lungs, can cause significant changes in their structure and function. In order to differentiate these processes, two terms are used: ventilator-associated lung injury (VALI) and ventilator-induced lung injury (VILI). In both cases, lung injury primarily results from differences in transpulmonary pressure - a consequence of an imbalance between lung stress and strain. This paper focuses on changes in lung structure and function due to this imbalance. Moreover, in this context, barotrauma, volutrauma and atelectrauma are interpreted, and the importance of signal transduction as a process inducing local and systemic inflammatory responses (biotrauma), is determined. None of the assessed methods of reducing VALI and VILI has been found to be entirely satisfactory, yet studies evaluating oscillatory ventilation, liquid ventilation, early ECMO, super-protective ventilation or noisy ventilation and administration of certain drugs are under way. Low tidal volume ventilation and adequately adjusted PEEP appear to be the best preventive measures of mechanical ventilation in any setting, including the operating theatre. Furthermore, this paper highlights the advances in VILI/VALI prevention resulting from better understanding of pathophysiological phenomena.
- Perioperative management of cardiac surgery patients who are at the risk of acute kidney injury. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):155-63.
Acute kidney injury is one of the most frequent and clinically important of all postoperative complications in cardiac surgery. It is estimated that almost half of subjects suffer from a deterioration of kidney function after a cardio-pulmonary by-pass. Renal insufficiency impacts upon the outcome in terms of an increase in postoperative morbidity and mortality, and a decrease in quality of life. Recently, a modified and unified classification of cardio-renal syndrome has been devised, which takes into account bilateral association between the heart and the kidneys. Because acute decompensation in heart function leads to acute kidney damage, therefore cardiac surgery-associated acute kidney injury may be recognised as a type 1 cardio-renal syndrome from a pathophysiological point of view. This paper aims to review the current data on the diagnosis of acute kidney injury and preventive strategies that can be implemented in cardiac surgery perioperative care.
- The Clarus Video System stylet for awake intubation in a very difficult urgent intubation. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):153-4.
Awake fibreoptic intubation (AFI) is a standard method of airway management in a case of anticipated difficult intubation. It is usually performed using flexible fibroscopes. In this report, we describe the case of a 42 year-old female patient who suffered from congenital disease producing severe deformation of the head, face, neck and chest. In this case, the AFI procedure was performed successfully using a rigid intubation stylet: the Clarus Video System. One of the advantages of rigid stylets is that they are very easy to use, and in the hands of anaesthesiologists not very familiar with fibroscope intubation, they can be an alternative to flexible fibroscopes in AFI procedures.
- Labour epidural analgesia in Poland in 2009 - a survey. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):149-52.
Labour analgesia in most developed countries is funded by the state, available to every woman in labour, and plays an important role in the everyday activities of most anaesthetists. This paper presents the second part of an Obstetric Anaesthesia Survey which was conducted in 2009. The first part of the Survey, relating to anaesthesia for caesarean sections, was published in 2010.The author sent out 432 questionnaires containing questions about hospital size and location, staffing levels and numbers of deliveries per year. There were also questions regarding regional and other pain relief methods used in labour, ways of administration, drugs used and monitoring of patients.The response rate was 24%. Around 45% of responding hospitals had only 1-3 deliveries per year, which makes it difficult to provide separate obstetric anaesthetic cover. Only ten hospitals (11%) employed an anaesthetist for the labour ward. Epidural analgesia was used in 55% of hospitals but only 20% provided the service for 24 hours per day and free of charge. Entonox was used very occasionally, but the most common means of pain relief was pethidine injection. There were marked differences in the medication used for labour epidurals, with 18% of units using high concentrations of local anaesthetics which could result in motor block. Despite a lack of regulations in Polish law and a lack of proper training in 50% of units, midwives were looking after the patients with established labour epidural which could create medico-legal consequences. There was also a marked variation in the parameters monitored during labour analgesia.Epidural labour analgesia was offered for 24 hours per day and free of charge in only 20% of hospitals. Without public pressure it will be difficult to get more funding from the National Health Fund (NFZ) to enable other hospitals, especially those with small obstetric units, to introduce regional labour analgesia. Although the 2009 guidelines addressed most of the issues regarding the conduct of epidural labour analgesia, changes need to be made in Polish law to allow midwives to be appropriately trained to look after parturients with regional labour analgesia.
- Anaesthetic management for endovascular treatment of unruptured intracranial aneurysms. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):145-8.
Endovascular techniques for treatment of intracranial aneurysms are increasingly commonly applied. In general, the procedures are short, require general anaesthesia and complete immobilisation of patients. The aim of the present study was to assess the usefulness of general anaesthesia with propofol and laryngeal mask airway for endovascular management of intracranial aneurysms based on analysis of haemodynamic stability.The study encompassed 26 patients undergoing endovascular treatment of intracranial aneurysms. The mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), end-tidal CO₂(E(T)CO₂) and haemoglobin saturation with oxygen (SpO₂ ) were determined at eight measurement points: T₁ - before anaesthesia induction, T₂ - after induction, T₃ - after LMA insertion, T₄ - during arteriography, T₅ - during "coiling" , T₆ - at completion of propofol infusion, T₇ - before LMA removal, T₈ - after LMA removal.MAP and HR were found significantly reduced between T₂ and T₁ . To maintain BIS within the range of 40-60, the following propofol infusion rates (in mg kg b.w.⁻¹ h⁻¹ ) were required: T₂ - 4.5 ± 0.3; T₃ - 4.6 ± 0.7; T₄ - 4.5 ± 0.8 and T₅ - 4.4 ± 0.6. E T CO₂ and SpO₂ were not demonstrated to be changed. The mean duration of anaesthesia and of recovery was 64.3 ± 21.8 and 8.9 ± 4.8 min, respectively.General anaesthesia with propofol and LMA ensures suitable conditions for endovascular treatment of intracranial aneurysms.
- New generation pulse oximetry in the assessment of peripheral perfusion during general anaesthesia - a comparison between propofol and desflurane. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):138-44.
A pulse oximeter is a standard device for perioperative monitoring. It is well known that the early detection of tissue hypoxia is of great importance. It has been made easier due to a new generation pulse oximetry device from Masimo. This enables measurements of the peripheral perfusion index (PI) in real time. It has been found that volatile anaesthetics such as sevoflurane and desflurane increase the perfusion index. As we know, no data is available about perfusion index during propofol/remifentanil total intravenous anaesthesia.ASA I and II class women scheduled for elective gynaecological surgery were eligible for the study. Patients were divided into two groups: group P receiving propofol/remifentanil intravenous anaesthesia and group D receiving desflurane/fentanyl general anaesthesia. PI was noted before anaesthesia, after remifentanil/fentanyl injection, after endotracheal intubation, at the beginning of surgery, during the procedure at ten minute intervals, at the end of the procedure, after awakening, after extubation and before discharge to the ward.Eighty-three patients were enrolled to the study. In both groups, PI increased significantly from the start to the end of surgery. There was a significant correlation between PI and end-tidal desflurane concentration (r = 0.807; P = 0.001). No correlation was found between propofol or remifentanil concentrations and PI.Both intravenous propofol/remifentanil and desflurane/fentanyl general anaesthesia increase peripheral perfusion. An increase in end-tidal desflurane concentration raises peripheral perfusion.
- Objective assessment of pain-related stress in mechanically ventilated newborns based on skin conductance fluctuations. [Journal Article]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):134-7.
In the process of intensive care, neonates are exposed to stress and pain related to the repeated therapeutic- diagnostic procedures. The aim of this study was the objective assessment of stress intensity pain while performing selected procedures in neonates in the intensive care unit.32 neonates, with a mean body mass of 2,495 g, intubated and mechanically ventilated, and who underwent sedation and analgesia were qualified to the study. A stress reaction to suctioning from endotracheal tube and capillary blood taking for blood gas analysis was evaluated. For the pain stress evaluation, the conductance fluctuation method was used.0.20 oscillations per second during the mechanical ventilation were obtained; during the suctioning, the number of oscillations increased to 0.33. With finger tip puncture, the number of oscillations was 0.35. The mean values obtained in the cases of suctioning and puncture differed significantly from the ones obtained at mechanical ventilation (P < 0.001) and did not differ between one another (P = 0.558). The oscillation proportion ≥ 0.33 s-1 was the lowest during the ventilation and it was significantly different (P < 0.001) from the values obtained at suctioning and finger tip puncture. There were no significant differences between these values.The measurement of conductivity of the skin as an objective tool to measure pain and discomfort during invasive procedures in neonatal intensive care shows that, despite the use of sedation and analgesia, neonates experience discomfort associated with the selected performance of therapeutic and diagnostic procedures.
- The consensus statement of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy on general anaesthesia in children under 3 years of age. [Journal Article, Research Support, Non-U.S. Gov't]
- Anaesthesiol Intensive Ther 2013 Jul-Sep; 45(3):119-33.