The first issue of the Greek e-journal of Perioperative Medicine for 2023 presents a systematic review article of Papageorgiou L et al, in which the authors reviewed the existing evidence regarding superiority of ketofol (ketamine/propofol) in mitigating cardiorespiratory effects when administered as a main agent for procedural sedation and analgesia (PSA) in comparison to other drugs administered for such purposes underlying the safety and efficacy profile of this cocktail medication. They found limited evidence to support superiority of ketofol compared to other agents, specifically to propofol. They noted that the addition of ketamine to propofol in sub-dissociative doses is associated with less respiratory and haemodynamic complications during PSA, while achieving adequate analgesia and deeper sedation, possibly more amnesia and consequently high satisfaction in both patients and health-care professionals.
The next article of Varvarousi G et al was aimed to present the current knowledge on the treatment of postdural puncture headache (PDPH) in obstetric anesthesia practice, given to the fact that the incidence of accidental dural puncture complicating epidural cathether placement, in obstetric patients, varies between 0,13-0,91%.
The review article of Schizodimos Th et al described several systemic factors (arterial hypotension, low cardiac output, hypercapnia, hypocapnia, systemic hypoxia, anemia,… Continue reading
Procedural sedation and analgesia (PSA) is often necessary in order to deal with anxiety, pain and stress that may accompany patients at the hospital during invasive, unpleasant and/or painful procedures. The literature has not presented firm conclusions regarding ideal sedative agents in terms of efficacy and safety in PSA or even present firm data regarding superiority of specific drugs over others which are considered the “gold-standard” in sedation (i.e. propofol). Continue reading
Neuraxial analgesia and anaesthesia in an obstetric patient is associated with the risk of accidental dural puncture and subsequent development of a post dural puncture headache (PDPH). The management of accidental dural puncture requires consists of prevention of PDPH, patient’s information, early diagnosis, treatment, and monitoring until remission of PDPH. Continue reading
Η οξεία εγκεφαλική βλάβη (acute brain injury, ABI) αποτελεί συχνό κλινικό πρόβλημα, που απαιτεί άμεση και επείγουσα αντιμετώπιση. Περιλαμβάνει οποιαδήποτε πάθηση επηρεάζει οξέως το κεντρικό νευρικό σύστημα (ΚΝΣ), [π.χ. τραυματική εγκεφαλική βλάβη (traumatic brain injury, TBI)] και έχει δύο συστατικά, την πρωτογενή (primary brain injury, PBI) και τη δευτερογενή εγκεφαλική βλάβη (secondary brain injury, SBI)1
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The work of breathing (WOB) is the amount of energy, which is consumed by the respiratory muscles, in order to perform one complete respiratory cycle. In several medical conditions, WOB might rise to a critical level which could necessitate initiation of mechanical ventilation (MV) or complicate weaning of the patient from MV. Continue reading
Alport syndrome (AS) is a rare hereditary disease, in which there is a defect in type IV collagen, an essential constituent of basal membrane in kidney, ear and eye. This can cause progressive renal damage and eventually renal failure, as well as hearing loss and visual impairment. Definitive treatment, when end stage renal disease (ESRD) has ensued, is renal transplantation. Continue reading