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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In 2014, the European Society of Cardiology and European Society of Anaesthesiology published guidelines on preoperative assessment and management of patients scheduled for non-cardiac surgery. Compliance with these guidelines has not been evaluated in Greece. The main objective was to evaluate the level of compliance with the published recommendations. A retrospective, observational study was designed. The status 1–4 who underwent scheduled non-cardiac surgery between February 2016 and April 2016 in five tertiary hospitals were reviewed. Patients treated in intensive care units were excluded. Primary outcomes were the rates of compliance with the published recommendations for preoperative testing, continuation or not of medication and overall compliance. The secondary outcome measure was the time required to perform unnecessary preoperative investigations. 3197 (63.8%) preoperative electrocardiograms, 522 (83.8%) cardiac ultrasonographic imaging procedures, and 55 (93.2%) non-invasive imaging stress tests should not have been performed. Only 101 (30.3%) and 4 (6%) patients who should or could have been evaluated by cardiac ultrasonography or a non-invasive stress test, respectively, underwent the recommended tests. None of the 1055 patients who should have discontinued angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for hypertension did so; 31 (53.4%) patients with known systolic heart failure were not taking these medications as recommended. Only 27.3% of patients were being managed exactly as recommended. The 2014 guidelines for preoperative management of non-cardiac surgery patients are not being followed appropriately by hospitals in Greece. Continue reading
The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system. Along with that, the effects of noise-induced stress in intensive care units, is well explored. This study explores the noise-induced acute electrodermal activity changes in adult critical care patients and to compare these changes with cardiovascular effects of the same stress (noise) stimulus. Skin conductance variability, noise level, selected hemodynamic and respiratory parameters were monitored during 4 hour routine daytime intensive care nursing and treatment in an adult Intensive Care Unit. Average ambient noise levels during the time window (4 min) before the stimulation were 54.33(2.65) dB for Group A and 55.65(3.31) dB, while the noise stimulation was on average for Group A 70.8 (1.98) dB, and for Group B: 71.31(3.31) dB. EDA changes to noise stimulus were more distinct than hemodynamic and respiratory parameters. Yet, a weak relation was found between all EDA parameters and the particular noise level changes. Noise-induce stress causes more distinct EDA changes when measured immediately post stimulus. In addition, sedation level seems to affect the intensity of these changes. However, further studies are needed in to order to reach a definite conclusion. Continue reading
The aim of this study was to determine how low and moderate levels of PEEP affect right ventricular structure and function.
The study involved 14 patients under mechanical ventilation (pressure controlled). To perform the study, we used transesophageal echocardiography (M-mode, two-dimensional,tissue Doppler) and 10 parameters were recorded. Measurements were performed initially with PEEP 0 cmΗ2Ο, then 10 minutes after applying PEEP 5cmΗ2Ο and 10 minutes after applying PEEP 10cmΗ2Ο.
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This is the first study in Greece that aims prehospital care by Emergency Medical Services staff and the factors that affecting it. In a prospective 5 month survey study , 13 EMTs recorded data (45 variables) about 1450 cases;1010 of which were included for further analysis. Six (6%) of the cases were characterized as super-emergencies, 46% non-emergent and 35% as emergent. Fourty five (45%) of the cases were recorded in the 15.00-23.00 shift. Geographical distribution of the calls is very different from the pre-located ambulance bases and varies with the type (non-urgent/ urgent) of the call. In 152 the characterization of the call was changed after arrival on the spot.
Continue readingAnesthesiologist always works around the oral and peri oral soft and hard tissue. Oral/nasal intubation might injure hard tissue or “knock out” the tooth. The present study was conducted among anesthetic specialist to assess the measures that they would take to manage an avulsed tooth that might occur during intubation & laryngoscopy. The present study involved 40 anesthetists working in private hospitals. They were asked to answer a questionnaire designed to evaluate the line of action that an anesthetist would follow in case of an iatrogenic tooth avulsion...
Continue readingThe aim of this study was to compare the level of sensory block in parturients with different body height, after spinal anesthesia with local anesthetic of fixed volume and consistence. This retrospective study was conducted on 107 women, which underwent caesarean section under spinal anesthesia. It was hypothesized that maternal height was not associated with level of sensory block. Parturients were divided into two groups, based on their body height. Group A (n=65) included those with height ≤165 cm and group B (n=42) those with height of ≥166 cm. Subarachnoid space was reached with a 25G needle through the L3-L4 spinal space. Then, ropivacaine 20mg and 10mcg fentanyl (in solution of 2.8 ml) was given...
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Increased IAP often coexists with sepsis in severely ill patients in the ICU, under mechanical ventilation and pharmaceutical support of the circulation with inotropes and vasoactive drugs. Both conditions have an unfavorable effect on the cardiovascular system. The purpose of this experimental study was to record the effect of increased intra-abdominal pressure on the cardiovascular system of pigs, with or without additional sepsis. Sixteen male pigs were randomly assigned in two groups A and B. In both groups, after induction to anesthesia and mechanical ventilation, the intra-abdominal pressure was increased to 25mmHg by helium insufflation in the peritoneal cavity, and that level of IAP was preserved until the end of the experiment. In Group A no other intervention apart from the increase in IAP was made, whereas in Group B, 60 minutes after the increase in IAP, 100μg/kg LPS were administered. Data were recorded after induction of anesthesia and initiation of mechanical ventilation (baseline measurement/measurement 0) and thereafter every 20 min after intra-abdominal pressure increase. The last measurement (measurement 9) was obtained immediately before release of pneumoperitoneum. Parameters measured or calculated included HR, BP(s,d,m), RVPs, PAP(s,d,m), PΑWP, CO, SV, SVR, PVR, SvO2, ETCO2. HR increased statistically significantly only in Group B, 60 minutes after the administration of LPS. BP (s, d, m) presented a significant change only in Group B, an initial increase immediately after LPS administration, followed by a decrease. CVP, RVPs and PAP (s, d, m) increased in both groups after IAP increase, whereas they presented an additional increase in Group B, after LPS administration. PΑWP changed only in Group B, after LPS administration. CO and SV were dramatically reduced in Group B, immediately after LPS administration, but gradually recovered their initial values until the end of the experiment. SVR changed only in Group B. They increased after LPS administration and then they gradually decreased. PVR increased dramatically after LPS administration and, despite gradual decrease they remained at high values until the end of the experiment. SvO2 decreased in Group B after LPS administration but gradually recovered its initial values. At the conditions of this particular experiment, the increase in intra-abdominal pressure was well tolerated by the laboratory animals. On the contrary, sepsis induction by LPS administration had an unfavorable effect on the cardiovascular system.
Continue readingAdequate adrenocortical function is essential to survive critical illness. The goal of this study was to determine whether eosinophilia could serve as a useful and early marker of adrenal insufficiency in critically ill patients with severe septic shock. During a 1-year period, we prospectively studied 294 ICU patients.16 patients (5.4% of ICU admissions) with eosinophilia more than 3% of the white blood cell count and septic shock unresponsive to adequate fluid and vasopressor therapy, were included. A high dose (250 mcg i.v) corticotropin stimulation test was performed. Eosinophilia (>3%) was diagnosed in 16 patients with vasopressor-unresponsive septic shock. Eosinophilia was present 1.9±0.9d (range 8-96h) before the onset of septic shock. 11/16 patients failed to respond to corticotropin stimulation test above the critical level of 9 mcg/dL rise and 2/16 had baseline cortisol concentration <10 mcg/dL. Baseline cortisol level, maximal cortisol increase post-corticotropin administration and Eosinophils count (%) were higher in survivors (p≤0.05). A hydrocortisone infusion (300mg/d) treatment resulted in haemodynamic improvement in 12 of 16 patients (75%). The 28-day mortality (following the onset of septic shock) was 43.7%. Relative eosinophilia may be considered as a useful and early bioassay for adrenocortical function assessment in critically ill patients with septic shock and assumed adrenocortical depression.
Continue readingThere are various formulas and algorithms for the prediction of body weight and appropriate ETT size, in pediatric patients. Body Weight estimation is of paramount importance in pediatrics, especially in emergencies. Predicting the appropriate size of the endotracheal tube saves time, money and reduces complications. The goal of this study was to evaluate the validity of two commonly used formulas for predicting the body weight and the size of the appropriate endotracheal tube, both based on age.353 consecutive pediatric surgical patients aged 2 to 12 years, who required general anesthesia and oral endotracheal intubation were included in this study. Patients were stratified according to their age in two groups: group 2-5 (79 children, 2 to 5 years) and group 6-12 (274 children, 6 to 12 years). At the end of surgery an anesthesiologist, who was not involved in the perioperative treatment, recorded the demographic data and also the size and type of the endotracheal tube used. The prediction of Body Weight (BW) was made according to the following formula: 2-5 y.o.: Weight (kg) = (2 x age in years) + 8 and 6-12 y.o.: Weight (kg) = (3 x age in years) + 7. The formula for calculating the size (size= internal diameter=I.D.) of the endotracheal tube (ETT) was: I.D. for cuffed ETT (mm) = (age / 4) + 3.5 and I.D. for uncuffed ETT (mm) = (age / 4) + 4. For all statistical tests p value <0.05 was considered as statistically significant. In all patients as sum and in both age groups, the predicted body weight was significantly (p<0.05) lower than the actual (measured) weight. In group 2-5y.o, 74.7% of patients received cuffed ETT In group 6-12y.o. 100% of patients received cuffed ETT. In group 2-5 y.o, all patients showed a significantly (p<0.05) lower predicted internal diameter of the ETT, either cuffed or uncuffed, compared to ETT ultimately used. In group 6 -12y.o, there was no statistically significant difference between the predicted and the actually used ETT size. The prediction of body weight in children, by the use of the particular formula, led to underestimation. In children aged 2 to 5 years, the application of the inner diameter calculation of the ETT formula also underestimated the appropriate ETT size. It seems that the traditional age-based formulas often fail to predict the correct ETT size in smaller children which probably does not seem to apply to older children.
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