Though metformin is considered as first choice drug in type II diabetes, clinicians should be alert both for presence of potential contraindications to its use and to possible adverse reactions. Bad therapy compliance along and/or concomitant comorbidities may lead to serious toxicity. We hereby describe a case of extreme lactic acidosis- associated with metformin therapy- in an elder woman, managed with Continuous Renal Replacement Therapy in Intensive Care Unit environment. Short review of the literature about the place of renal replacement therapy in such cases is also discussed. Continue reading

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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We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.

Pantoea is a genus of Enterobacteriacae Gram-negative bacteria family that includes at least 20 species; mostly isolated in the ecological niches.

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In this first issue of the Greek e-journal of Perioperative Medicine for 2019various articles are presented. The first article of Katsanoulas K., et al provides a thorough explanation of viscoelastic haemostatic assays (VHA) monitoring, mainly with rotational thromboelastometry (ROTEM®), in contrast to the traditional coagulation management with standard laboratory tests.It may be helpful for young clinicians and those interested to understand this relatively new technique. It provides also evidence based information from current published literature, where it’s utility and value has been proven. Continue reading
Clinical management of acute severe bleeding in the perioperative setting is one of the major challenges for an anesthetic team. The dynamic nature of bleeding calls for rapid diagnosis and immediate interventions. Trauma induced coagulopathy and/or perioperative coagulopathy management is crucial for successful and life saving interventions, involving blood and blood product transfusions in an individualized and rationalized manner. Traditional coagulopathy monitoring using bleeding times offers very little in prediction and guidance during severe bleeding. They are mostly designed for stable patients under anticoagulant treatments and their very long turnaround time renders them impractical for clinical use in this setting. In contrast, viscoelastic devices are designed to assess whole-blood clotting kinetics and whole-blood clot strength and better reflect the interaction between pro- and anti-coagulants, pro- and anti-fibrinolytic factors, and platelets. The most notable advance in haemostatic management using viscoelastic testing is a fibrin-specific clot assessment. The system uses a combination of assays to characterize the coagulation profile for obtaining more detailed information about haemostasis and suggests the cause of the observed coagulopathy. The article offers a thorough and concise presentation of both traditional and viscoelastic methods and techniques in use during severe haemorrhage, followed by a literature review on the use of viscoelastic haemostatic monitoring in different clinical settings. Continue reading

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