The third issue of the Greek e-journal of Perioperative Medicine for 2020 covers a wide range of interest in perioperative scientific articles. The first article of this issue is a narrative review of Staikou Ch et al, which identifies, in the existing literature, the providing information about the development of chronic pain after ICU stay. This article discusses the epidemiology, the risk factors, the pathophysiology and the treatment of chronic pain in intensive care survivors. The authors conclude that chronic pain after ICU stay demands vigilance, care and an individualized multimodal analgesic regimen, in order to improve the quality of surviving patient’s lives. Continue reading
Patients admitted to Intensive Care Units (ICU) have the highest mortality rates among hospitalized patients. For those who survive, recovery is often a prolonged rehabilitation period with physical, cognitive and psychological dysfunction. The aim of the present narrative review was to identify in the existing literature articles providing information about the development of chronic pain after ICU stay. We performed a PubMed search for publications up to 22 March 2020. We identified 41 articles eligible to be included in the present review; 29 of them were original research articles. Pre-existing chronic pain, previous poor health- related quality of life (HRQoL), but also the critical illness itself and organ support with multiple interventions, predispose to the development of chronic pain in the post-critical period, making it difficult to return to the pre-disease functional status. Opioid administration during mechanical ventilation is a common practice, frequently without reliable and systematic assessment of pain or individualized titration of dosage. Continue reading
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
Nosocomial infections continue to increase all over the world and remain a major cause of morbidity and mortality in hospitals. There are three elements required for the transmission of nosocomial infections: a reservoir of microbial agent, a susceptible host with a portal of entry receptive to the agent and a mode of transmission for the microbial agent. Microorganisms that cause nosocomial infections derive primarily from human sources1-3 , but inanimate environmental sources are implicated in transmission4. Human reservoirs include patients, healthcare personnel, household members and visitors5. People in hospitals are usually already in a ‘poor state of health’, impairing their defense against bacteria. Invasive devices impair natural lines of defense against pathogens and provide an easy route for infection. Patients already colonized at the time of admission are instantly put at greater risk when they undergo invasive procedures6. Continue reading
Pneumothorax is a collection of air in the pleural space between the lungs and the chest wall and depending on its cause it could be either spontaneous or traumatic. Tension Pneumothorax (TPT) can be a cause of cardiac arrest (CA) or might be a complication after chest compressions. According to the 2015 European Resuscitation Council guidelines on resuscitation, TP is considered one of the reversible causes of CA, which should be recognized and treated during cardiopulmonary resuscitation (CPR) Continue reading
West Nile virus is an RNA virus, member of the Japanese encephalitis serogroup of the genus Flavivirus, family Flaviviridae. First isolated in 1937, the virus has re-emerged after giving several outbreaks after the 1990 both in Europe and North America. Though severe neurological infection is only 1% of the total cases, mortality can reach 14% after CNS involvement. The present case report describes a case of WNV encephalitis with concomitant acute flaccid paralysis. Continue reading
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