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

Despite stable background pain, most cancer patients suffer 3-4 episodes of breakthrough pain daily. Aim of the present study was the evaluation of potential correlation between effective doses of sublingual fentanyl citrate, administered for controlling breakthrough pain, with transdermal fentanyl used for background pain. Fifty-six cancer patients were prospectivelly recruited. All patients were suffering episodes of breakthrough pain and managed with transdermal fentanyl 25-300μg/h for their background pain.

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Apneic oxygenation is an adjunct „ventilation‟ technique that involves insufflation of oxygen at varying flows through a catheter that is inserted through the endotra-cheal tube and is positioned above the carina. Apneic oxygenation improves gas exchange efficiency and preserves the arterial oxygenation at an acceptable level.

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Our study compared the effectiveness between two of the proposed as rescue manoeuvres to overcome difficulty, in advancing a tracheal tube, during railroading over the fibreoptic bronchoscope. A ninety degrees anti-clockwise rotation (90ΑCWR) of the tube or cricoid cartilage pressure application (CCPA) was randomly performed in eighty patients undergoing fibreoptic orotracheal intubation under general anaesthesia, in whom first attempt to railroad the tracheal tube had failed.

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Pulmonary capillary pressure (Pcp) is the primary driving force determining the fluid flux across pulmonary capillary wall. Alterations of Pcp have been described in systemic inflammation, sepsis, ARDS, hypoxaemia and acute heart failure. The purpose of this study was to examine the Pcp alterations after lipopolysaccharide (LPS) intravenous administration in pigs. LPS has been administered (150μg/Kg BW) in the right atrium of 8 anesthetized and mechanical ventilated pigs (Group A) and the Pcp was calculated from pulmonary artery pressure tracings using the Gaar equation before, after LPS infusion and in 20min intervals for two hours.

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