ΕΙΚΟΝΑ 1. Θεραπευτική προσέγγιση της  ενδοκράνιας υπέρτασης

(Τροποποίηση από Robba C, Citerio G. Focus on brain injury. Intensive Care Med 2017)

Αντιμετώπιση ενδοκράνιας υπέρτασης

Intracranial hypertension (IH) is currently managed in the intensive care unit with a combined medical – surgical approach. Progress in monitoring and in understanding pathophysiological mechanisms of IH could change current management in the intensive care unit, enabling targeted interventions that could ultimately improve outcomes. The prevention of secondary brain damage from raised intracranial pressure (ICP) is the central focus ...

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Figure 3. TCD SBP(Vs), DBP (Vd) and MBP (Vmean) values according to patients positions

*p < 0,05 TCD: Transcranial doppler, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, MBP: Mean blood pressure

Systemic and cerebral effects of the head-down and head-up positions in ischemic heart patients under anesthesia

In cardiac surgery, head-down and head-up positions are used to control cardiac filling pressure and for cardiac exposure. Even though benefits of head positioning are not clear, they can also bring some risks. Understanding physiological consequences of positioning can help avoiding serious adverse events and complications. In this prospective study we investigated the effect of head-down and head-up position upon ...

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Workload during a complex ICU monitoring task: the effect of level of patient’s sedation level and repetion of the task

Patient care in Intensive Care Units is characterized by high demanding tasks, which leads in daily high workload. The aim of the study is to evaluate the effect of patient’s sedation level to workload for the certain task. It also examines whether workload lowers over time, as an effect of the experience gained by the repetition of the task. NASA- ...

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Anesthesiology considerations during maxillofacial surgery in a child with Noonan’s syndrome: A Case Report

Noonan syndrome (NS) is an autosomal dominant disorder characterized by anatomic and pathophysiologic abnormalities.Anesthetic management in these cases has many challenges regarding airway management and cardiovascular stability.We present a case report of a 11-year-old male child who was scheduled for maxillofacial surgery under general anesthesia.

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A case of persistent bronchospasm after anesthesia induction

We report a case of persistent bronchospasm after anesthesia induction. The case refers to an elective surgery of an ulcerous formation in the intergluteal cleft. Bronchospasm is not an unusual event in the immediate intubation period, especially in patients with respiratory disease, but in most cases resolves uneventfully. In this patient, despite thorough treatment in the operation room, ausculatory findings ...

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Within diversity (of publications), we gain.

The vast advance in medical knowledge forces us to super specializations. Yet, as we get to know better the tree, we might lose the perspective of the forest. Team work and more specifically, diversity teams, keep us in touch with the different aspects of knowledge. And although diversity has potential to disrupt group functioning, in reality, in both in behavioral and psychological science and in business arena, diverse teams are proven smarter1-2.

A publication is a reflection of team work towards the same direction. Thus, if working in a team with different specialists give you another perspective of your expertise field, then keeping in touch with a wide range of their work (publications) could also have the same effect.

The present issue represents the inaugural work of the new editorial team of the journal. Based on the aforementioned concept, the articles selected (mostly presentations of original studies) cover a wide area of interests.

The only review included is focused on intracranial hypertension (ICH). Although the subject is present in more than 17000 publications in PubMed database3, the research still continues. New monitoring techniques as pupillometry4, ultrasound measured optic nerve sheath5 and near infrared spectroscopy6 are suggested as alternatives to ‘classical’ invasive techniques. Transcranial pulsatility7 index and substance-Ps’8 role is yet to be defined; new therapies for conditions like refractory idiopathic ICH9 are tested. As we wait for the results of the new trials, Schizodimos et all, summarize the already know facts about the management of ICH.

In the next article, Özler et all. present the results of a study examining the effects of head down and head up positions in patients undergoing elective Coronary Artery By-pass Grafting (CABG) surgery after anesthesia induction. The study comes as an addition to the recently published trials about cerebral hemodynamics in healthy subjects under different conditions10-11.

The following study focus in workload in Intensive Care Unit (ICU). Even though several reports investigate the relation between high workload with administrative problems or adverse effects12-13, Aslanidis et all, use a different percpective as they choose NASA –TLX workload index to assess the effects of the repetition (familiarization) of a complex monitoring task.

Kolonia et al. cover a completely different theme, as they focus on the anesthetic considerations and potential problems of a patient with Noonan’s syndrome. These patients have facial, cardiovascular and skeletal abnormalities which may cause severe perioperative problems. The whole anesthetic management should consider all the above anomalies and be designed to prevent further complications14.

The final article is a “crisis during anesthesia”-related case. While clinician worldwide try to establish a method to predict such adverse effects15, reporting of single cases such as Stergiouda et al. presents, only add the collective database.

For the Editorial Board

Mouloudi E.
Papagiannopoulou P.
Aslanidis T.

 

References

  1. Why diverse teams are smarter. Harvard Business Review 2014. Available from: https://hbr.org/2016/11/why-diverse-teams-are-smarter (accessed 10/10/2017).
  2. Galinsky A, Todd A, Homan A, et al. Maximizing the Gains and Minimizing the Pains of Diversity Perspect Psych Sci 2015, Vol. 10(6) 742 –748
  3. National Library of Medicine (US). PubMed [Internet] Intracranial hypertension-results by year. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=intracranial+hypertension (accessed 10/10/2017)
  4. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT03304314, Multifocal Chromatic Pupilloperimetry in Patients with Pseudotumor Cerebri and Healthy Subjects; 2017 Okt 10 [cited 2017 Okt 10]; [about 4 screens]. Available from: https://clinicaltrials.gov/ct2/show/NCT03304314?recrs=ab&cond=Intracranial+Hypertension&draw=2&rank=30
  5. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT02361671, Optic Nerve Sheath Diameter in Patients with Intracranial Pathology; 2017 Okt 10 [cited 2017 Okt 10]; [about 4 screens]. Available from:https://clinicaltrials.gov/ct2/show/NCT02361671?recrs=ab&cond=Intracranial+Hypertension&draw=2&rank=15
  6. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT02950181, Descriptive Analysis of Near Infrared Spectroscopy in Critically Ill and Injured Pediatric and Neonatal Patients (NIRSCI); 2017 Okt 10 [cited 2017 Okt 10]; [about 6 screens]. Available from: https://clinicaltrials.gov/ct2/show/NCT02950181?recrs=ab&cond=Intracranial+Hypertension&draw=2&rank=27
  7. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT03144219, Transcranial Doppler Pulsatility Index as a Marker of Impaired Cerebral Compliance; 2017 Okt 10 [cited 2017 Okt 10]; [about 6 screens]. Available from:     https://clinicaltrials.gov/ct2/show/NCT03144219?recrs=ab&cond=Intracranial+Hypertension&draw=2&rank=9
  8. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT03035838, Importance of Substance P in Intracranial Pressure Elevation Following Traumatic Brain Injury (NK1); 2017 Okt 10 [cited 2017 Okt 10]; [about 6 screens]. Available from: https://clinicaltrials.gov/ct2/show/NCT03035838?recrs=ab&cond=Intracranial+Hypertension&draw=2&rank=22
  9. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT02143258, Stenting of Venous Sinus Stenosis for Medically Refractory Idiopathic Intracranial Hypertension; 2017 Okt 10 [cited 2017 Okt 10]; [about 6 screens]. Available from: https://clinicaltrials.gov/ct2/show/NCT02143258?recrs=ab&cond=Intracranial+Hypertension&draw=2&rank=1
  10. Kurazumi T, Ogawa Y, Yanagida R, et al. Dynamic Cerebral autoregulation during the combination of mild hypercapnia and cephalad fluid shift. Aerosp Med Hum Perform. 2017;88(9):819-826.
  11. Laurie SS, Vizzeri G, Taibbi G, et al. Effects of short-term mild hypercapnia during head-down tilt on intracranial pressure and ocular structures in health human subjects. Physiol Rep. 2017;5(11). pii: e13302y
  12. Oliveira AC, Garcia PC, Nogueira LS. Nursing workload and occurrence of adverse events in intensive care: a systematic review. Rev Esc Enferm USP. 2016;50(4):683-694
  13. Serafim CTR, Dell’Acqua MCQ, Castro MCNE, et al. Severity and workload related to adverse events in the ICU. Rev Bras Enferm. 2017;70(5):942-948.
  14. Bajwa SJ, Gupta S, Kaur J, et al. Anesthetic considerations and difficult airway management in a case of Noonan syndrome. Saudi J Anaesth. 2011; 5(3):345-7.
  15. Subramanyam R, Yeramaneni S, Hossain MM, et al. Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia: Development and Validation of a Risk Prediction Tool. Anesth Analg. 2016;122(5):1578-85.
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