Dear colleagues,
In this issue of the Greek e-journal of Perioperative Medicine the first article of Massa E, et al answers vital questions concerning urgent readmissions to the ICU. It emphasizes that although a lot of efforts are being made to reduce them, these adverse events still exist. It provides also evidence, from current published literature, that readmitted patients to the ICU have a much poorer prognosis and higher mortality rates compared with other hospitalized patients.
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Patients discharging the Intensive Care Unit (ICU) still need a high level of care because of the severity of their disease. In fact, they have an increased risk for readmission to the ICU. Moreover, urgent readmissions to the ICU are a widely used tool to assessment the quality of Health Care services. Although a lot of efforts are being made to reduce them, these adverse events still exist. It is noted that readmitted patients to the ICU have a much poorer prognosis, as its mortality rates are six times higher, and also have eleven times higher probability to die in hospital compared with other hospitalized patients.
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The concept of sustainability in anesthesia, referred as "Environmentally Sustainable Anesthesia", can be characterized by the safe perioperative management of equipment and medicines by the anesthesiologist, without harming the environment. Τhe term "Green Anesthesia" also relates to the priority to environmental sustainability even if the economic factor comes second, but in essence, sustainable and green anesthesia refer to common actions and practices. The problem of environmental impacts from anesthesiology practice arises when managing chemical agents to ensure the proper conditions for safe anesthesia administration, by pharmaceutical means and special techniques. The main problem is the Inhaled agents (Ν2Ο and volatile anesthetics), as part of them is released into the atmosphere by forming Wasted Anesthetic Gases (WAGs). It begins in the operating room and ends into the atmosphere. Atmosphere is essential for life on earth.
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Induction of anesthesia can be accomplished with intravenous or inhalational anesthetic agents, which have both desired and side effects. The aim of this study was to record, investigate and compare the hemodynamic profile of five different induction anesthetic agents in patients undergoing major vascular surgery. One hundred and fifty patients, who were scheduled for major vascular surgery, were randomly assigned into five groups according to the anesthetic agent that was used for anesthesia induction. The five agents used for anesthesia induction were: propofol [2mg/kg], thiopental [3mg/kg], etomidate [0.3mg/kg], midazolam [0.2mg/kg] and diazepam [0.3mg/kg]. Before induction of anesthesia patients were administered Ringer lactate to replace volume deficit due to preoperative fasting. Besides standard intraoperative monitoring, an arterial catheter and a pulmonary artery catheter were placed in all patients before anesthesia induction.
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