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The second issue of the Greek e-journal of Perioperative Medicine for 2022 presents various articles including Reviews Articles and Case Reports concerning perioperative medicine.
The review article of Varvarousi G et al. reviews the perioperative management of haemotherapy in obstetric patients with haemorrhage and coagulopathy abnormalities. Authors concluded that hypofibrinogenemia is the most common coagulation disorder in these patients. They also noted that point-of-care viscoelastic testing contributes to early identification and targeted treatment in obstetric bleeding and that timely administration of tranexamic acid is considered important in order to reduce blood loss for the treatment of postpartum haemorrhage.
The next review article of Zafeiriadis et al. describes the ethical and philosophical aspects of intraoperative pain management. The authors emphasize that these aspects are of great importance because the presence of complications, due to inadequate pain control during general anesthesia, comes mainly from the anesthetists’ unawareness about the patient’s exact nociceptive depth. They also noted that the need for efficient intraoperative monitoring of the patient’s nociception level is of extreme value, when considered through the bioethical and philosophical approach, in order the anesthetists to fulfil their preliminary duty, this of pain control.
The following article of Fyntanidou B et… Continue reading
Obstetric haemorrhage is the leading cause of mortality in parturients. In massive haemorrhage, fibrinogen is the first coagulation factor to decrease and a value < 2 gr/lt is a prognostic indicator of severe haemorrhage. A small decrease in fibrinogen leads to an increased effect on coagulability and continued haemorrhage. Coagulation disorders may be due to either consumption of coagulation factors or dilution. The type, severity and time of onset of the coagulation disorder depend on both the size and the cause of the haemorrhage. Early recognition of the cause of haemorrhage, low fibrinogen and its immediate correction are essential in the perioperative management of haemorrhage. Continue reading
According to IASP (International Association for the Study of Pain) the definition of pain is: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Furthermore, is expanded on: 1) Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons and 2) Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain. Continue reading
Four patients (♂/♀: 1/3), aged 51, 52, 50 and 58 years old, who underwent general surgery procedures, suffered acute major blood loss intraoperatively. For the management of acute hemorrhage, 4ml/kg NaCl 7.5% were administered in each patient at the fastest possible rate through the existing intravenous line. Both standard monitoring and Oesophageal Doppler Monitoring (ODM) were applied and heart rate (HR), mean arterial pressure (BPmean), stroke volume (SV), peak velocity (PV), mean acceleration (MA) and corrected flow time (FTc) were recorded at six different phases, before blood loss (Phase 1), before and after completion of NaCl 7.5% administration (Phases 2 & 3), 10min and 20min after NaCl 7.5% administration (Phases 4 and 5) and at the end of the surgical procedure (Phase 6). Continue reading
Thoracic epidural anaesthesia (TEA) is frequently used for anaesthesia and analgesia in today's practice. Although cholecystectomy is a surgical procedure performed under general anaesthesia (GA), many studies in recent years have shown that neuraxial techniques can be used safely. We aimed to present the anaesthesia management under dexmedetomidine sedation with TEA in high-risk patients who underwent laparoscopic cholecystectomy surgeries. Both patients were of geriatric age and had several comorbidities. In patients, we preferred TEA to avoid the cardiorespiratory effects of GA. Preoperative preparation of patients with a multidisciplinary approach, cooperation, and close follow-up is essential in preventing complications. Continue reading
Choice of peritoneal dialysis over other renal replacement therapy modalities for adult critically ill patients is still limited; despite the data against it. The present article presents a case of peritoneal dialysis in a patient with intracerebral hemmorhage and reviews the relevant literature. Continue reading
The firs tissue of the Greek e-journal of Perioperative Medicine for 2022 presents a variety of scientific articles.
The systematic review article of Guimarães Pereira JE et al. presents the efficacy and safety of medicinal cannabis on clinical outcomes of patients suffering from sickle cell (SCD) anemia pain. Due to the lack of evidence in the current literature, the authors noted in their conclusion, the need for large RCTs in order to evaluate the impact of cannabis use among SCD patients on quality of life and also on the controversial association between cannabis use and an increase in Emergency Room visits.
Next, the article of Aslanidis Th et al. reviews the available literature about the possible need for a new definition of death due to the fact that the advance of resuscitation medicine (in intensive care units or not) profoundly modified the durations of agony and the survival times, and perhaps also the essential meaning of death.
The retrospective clinical study of Deligianni M et al. showed that hypoxia during one lung ventilation (OLV) did not have negative impact on early outcome in patients that underwent thoracic surgical procedures, on the precondition that there was no underlying… Continue reading