Postdural puncture headache (PDPH) may occur after inadvertent dura mater puncture inepidural anaesthesiaor after spinal puncture in spinal anesthesia, spinal diagnostic or therapeutic procedures. It is characterized by severe headache that occurs within 5 days following thepuncture, located in the frontal and/or occipital region, not necessarily worsened in the upright position. PDPH is associated with substantially increased postpartum risks of major neurologicand other maternal complications, underscoring the importance of early recognition, follow up andtreatment particularly in obstetrics. Despite the fact that epidural blood patch is recognized as thegold standard in the treatment of PDPH, it is not without risk andpotentially may fail. Nerve blocks andnewer therapieshave been reported that could be efficacious, easy to administer and with less risk. In this review wepresent updated evidence and potential alternative therapies in the treatment of PDPH. Continue reading
We have noted an ongoing interest for the anaesthetic practices for caesarean section (CS) throughout Europe, which may differ from one country to the other for several reasons. In a very recent EJA article, a national survey in the Czech Republic and Slovakia has shown that national audits may allow and promote focusing on education and interstate cooperation. Impressively, even if the two countries were united in the past, the rate of general anaesthesia (GA) for CS in the Czech Republic was lowered from 34 to 26% for elective and from 59 to 39% for non-elective CS. This was not the case for the neighboring Slovakia, where the rate for GA was already low. Besides, in a 2017 survey from Austria, the rate of routine use for regional anaesthesia for CS reaches almost 100% and in France has a similar trend. 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
The case of a 33y old man is presented, who after a car accident, was transferred to the ED with a right hip dislocation and slightly obtunded but in a stable hemodynamic condition. After an emergent CT scan, a thoracic aortic rupture along with intestine rupture and retroperitoneal hematoma were noted. The patient was administered 1 g tranexamic acid (TXA) and 1 g fibrinogen concentrate (FC) preoperatively and then was transferred to the OR, where primarily, under monitored anesthetic care (MAC) the aortic trauma was restored intraluminally and then, under general anesthesia, he underwent laparotomy and hip dislocation reduction. During operation, no diffuse bleeding was noted, nor was any transfusion of blood or blood product necessary. After a short ICU stay the patient was discharged in good general health state. The aim of this case report is to present a case of traumatic aortic rupture bleeding, effectively managed with prophylactic tranexamic acid (TXA) and fibrinogen concentrate (FC) administration without need of any kind of transfusion. Continue reading
Certainly, nobody during the autumn of 1990, when the 1st Congress of Anesthesiology & Intensive Medicine was first inaugurated, had any idea of the impact and the influence this new institution would gain in the years to come. This very first congress was under the organizational presidency of Dr. Nikos Balamoutsos, respectable teacher and skillful director in the field.
But this was not a surprise; Thessaloniki had already experienced pioneering in Anesthesiology. Dr. Spyros Makris (1926-1978) was the first ever Professor of Anesthesiology in Greece (1974) at the Aristotle University of Thessaloniki. He wrote the very first textbooks of Anesthesiology in Greek and published more than one hundred papers, in Science, Anaesthesia and Analgesia, and other journals. This is the reason why during the opening ceremony, the honorary lecture has his name and is assigned to an academic with a broader scientific flair, normally from the local medical community. Continue reading
Early tracheal extubation has been safely performed after large operative procedures, questioning the need for routine postoperative ventilation. Because immediate postoperative tracheal extubation of liver transplanted patients has not been previously reported in Greece, we announce the first case report. Continue reading
The essential help of medical emergency teams (M.E.T.) is to decrease the frequency of sudden deaths and the pointless transport of patients in the intensive care units. Aim of present study is to record the number and the type of urgent intrahospital callings, the departments of hospital that were covered by M.E.T, the staff (medical and/or nursing) that participated in them, the medications that were used, and the number of involved individuals per incident, as well as the type of monitoring and the fluids that were used. In the particular study were recorded the urgent calls from the 07/06/2006 up to the 07/01/2007 (7 months). Continue reading