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
The COVID-19 pandemic was caused by the severe acute respiratory syndrome corona virus-type 2 (SARS-CoV-2) that started in late 2019 in Wuhan, China. COVID-19 has infected 60.074.174 people, including 1.416.292 deaths by November 26th,
. Globally, hospitals were forced to stop most surgeries and redirected resources and staff to accommodate the growing burden of COVID-19. Anesthesia and surgical practice worldwide suffer from radical changes in protocols, especially those related to pre-operative screening, testing, and infection control policies2,3
. 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
Patient care in Intensive Care Units is characterized be high demanding tasks, which lead in daily high workload. In the present study, a questionnaire-based evaluation of ICU nurse’s workload was conducted at the adult general 7 - beds ICU of a small urban hospital. NASA Task Load Index (TLX) along with other two tools, used for the first time in healthcare environment: Instantaneous Self-Assessment (ISA) and Crew Status Survey (CSS) were used for that purpose. Information about every nurse’s professional background and basic demographics were also collected. Responses from 70% of total nurse staff were collected. 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
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
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
The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system. Along with that, the effects of noise-induced stress in intensive care units, is well explored. This study explores the noise-induced acute electrodermal activity changes in adult critical care patients and to compare these changes with cardiovascular effects of the same stress (noise) stimulus. Skin conductance variability, noise level, selected hemodynamic and respiratory parameters were monitored during 4 hour routine daytime intensive care nursing and treatment in an adult Intensive Care Unit. Average ambient noise levels during the time window (4 min) before the stimulation were 54.33(2.65) dB for Group A and 55.65(3.31) dB, while the noise stimulation was on average for Group A 70.8 (1.98) dB, and for Group B: 71.31(3.31) dB. EDA changes to noise stimulus were more distinct than hemodynamic and respiratory parameters. Yet, a weak relation was found between all EDA parameters and the particular noise level changes. Noise-induce stress causes more distinct EDA changes when measured immediately post stimulus. In addition, sedation level seems to affect the intensity of these changes. However, further studies are needed in to order to reach a definite conclusion. Continue reading