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
Anesthesia for thoracic surgery presents specific challenges since anesthesiologists have to manage patients with several comorbidities, apply One Lung Ventilation (OLV) to facilitate surgery and at the same time they should try to maintain adequate safe oxygen levels. Hypoxemia is a common consequence of OLV. The aim of the present retrospective study was to investigate the impact of intraoperative hypoxia on the early outcome of patients. Continue reading
Increased Intraabdominal Pressure (IAP) is common in critical care patients and has detrimental effects on organs and systems. Several mechanisms and causes are involved in its pathogenesis. The aim of the present study was to investigate and record IAP effects alone and in combination with sepsis on respiratory mechanics. Continue reading
Η περιεγχειρητική χορήγηση υγρών αποτελεί τον ακρογωνιαίο λίθο στη διαχείριση των χειρουργικών ασθενών, αλλά και σημείο έντονων επιστημονικών αντιπαραθέσεων και διχογνωμιών για το είδος και την ποσότητα των χορηγούμενων διαλυμάτων3,4
. Οι χειρουργικοί ασθενείς κατά την περιεγχειρητική περίοδο, χρειάζονται υγρά, και μερικές φορές απαιτούνται μεγάλες ποσότητες για τη διατήρηση του ενδαγγειακού όγκου και της αιμοδυναμικής σταθερότητας. Ο περιορισμός στη χορήγηση υγρών αλλά και η υπερχορήγηση μπορεί να δημιουργήσουν προβλήματα ικανά να επηρεάσουν την έκβαση5,6
. Continue reading
Several prevention and treatment strategies have been applied in order to prevent hypoxemia after open heart surgery with comparable good results.
The aim of this study is to compare the effectiveness of two different alveolar recruitment maneuvers [RM] for the management of oxygenation impairment in cardiac surgical patients.
A total number of sixty patients were included in this study. All patients underwent cardiac surgical procedures with extracorporeal circulation and developed oxygenation impairment after withdrawal of extracirculation support and sternal closure.
Patients were randomly assigned into two Groups A and B according to the applied RM. In Group A three hyperinflations of the lungs were applied at an airway pressure of 40cmH2
O for 10 sec, whereas in Group B Pressure Control Ventilation was applied for 2min with the inspiratory pressure set at 40cmH2
O. After application of any of the two RM, PEEP was increased from 5 to 10 cmH2
O in all patients. Anesthesia induction and maintenance and mechanical ventilation settings were similar in both study Groups. Continue reading
Pericardial decompression syndrome (PDS) is a rare but eventually fatal syndrome, which occurs after pericardial drainage. In this report we describe a patient who suffered from cardiovascular collapse and pulmonary edema after pericardial drainage. A male patient aged 42yrs complained of progressive dyspnea over the past 2 months and presented with clinical signs of pericardial tamponade. The patient underwent a surgical subxiphoid pericardial drainage under general anesthesia and mechanical ventilation. After pericardial drainage of 2.2lt, the patient was transferred to the Intensive Care Unit, where he was extubated2 hours later. Immediately after extubation, he showed clinical signs of cardiovascular collapse and pulmonary edema. The patient was reintubated immediately and placed on mechanical ventilation. He was extubated after 12hrs. His postoperative course was uneventful and he was discharged from the hospital after a few days. Continue reading
Codes of ethics are considered as indispensable parameters of every aspect of medical care. When performing cardiopulmonary resuscitation (CPR) ethical issues become even more important since cardiac arrest (CA) is directly related to death. The aim of this study was to record personal opinions and everyday clinical practice approaches of healthcare professionals (HCPs) regarding ethical issues related to CPR. HCPs answered a questionnaire consisting of 30 questions related to ethical issues in CPR on a voluntary basis. The study included 195 HCPs (88♂& 107♀). Out of the 195 HCPs, 95 were physicians, 71 nurses and 29 paramedics. 49 HCPs (25.1%) worked in the prehospital setting (EMS or Healthcare Centers) and 147 (74.9%) in hospitals. Continue reading
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. Continue reading
Central venous pressure (CVP) measurement along with invasive arterial pressure measurement are the two most widely used monitoring parameters in the Intensive Care Unit (ICU) and in the operating room (OR).In contrast with left heart catheterization, right heart catheterization is a procedure which is performed in the daily clinical practice both in the OR and the ICU and with which all anesthesiologists are well familiarized. Despite the limited usefulness of absolute CVP values, analysis of the CVP waveform offers important information regarding patient’s underlying pathology.ECG tracing should be taken concurrently with CVP measurement and CVP should be evaluated and interpreted in relationship to the ECG. CVP values are affected by several parameters such as mechanical ventilation and PEEP application, which should be taken into account when interpreting CVP measurements.
Tricuspid regurgitation (TR) is a relatively common abnormality and in most of the cases it is asymptomatic and has no clinical significance. In regard to etiology, TR can be categorized as primary (or organic) and secondary (or functional).TR allows blood to flow backwards across the valve from the right ventricle to the right atrium during right ventricle systole. When blood backflow is significant there may be giant systolic V waves in the CVP waveform. In case of severe TR, the giant systolic V waves are so prominent that the CVP waveform resembles the right ventricular pressure contour. This is called ventricularization of the right atrial pressure waveform. In contrast with the giant V waves in the CVP waveform, ventricularization of the right atrial pressure waveform is the most specific diagnostic criterion of severe TR. TR disease is diagnosed and thoroughly evaluated by echocardiography, which can give us information about its etiology and severity. However, CVP waveform may be indicative of TR and therefore could trigger further investigation and evaluation by echocardiography. Continue reading