Surgery, as a field itself, is a high stress and high pressure workplace environment. The difficulty that surgeons face, in maintaining their work-life balance along with the increasing litigation instances, has made this profession a less rewarding one. Continue reading
Aortic aneurysms occur mainly due to atherosclerotic disease, and their conventional surgical repair is reserved for patients with anatomy unfavorable to endovascular repair. In this context, one of the challenges for the anesthesiologist is perioperative anesthetic-analgesic control. Continue reading
Orthotopic liver transplantation (OLT) has become a relatively safe procedure over the last decades, with reported 5-year survival rate of over 80%. Increasing numbers of patients will be transplated at a younger age and they will seek obstetric anaesthesia services, as their fertility is restored after succesful transplantation. In 1978, the first succesful pregnancy was reported. Continue reading
Medical nutrition therapy shall be considered for all patients staying in the intensive care unit (ICU), mainly for more than 48 hours. It is well-known that over- and underfeeding are associated with worse outcome, so optimization of nutrition support is one of the most important goals of clinicians. 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. Continue reading
Obstetric haemorrhage is the leading cause of mortality in parturients. In massive haemorrhage, fibrinogen is the first coagulation factor to decrease and a value < 2 gr/lt is a prognostic indicator of severe haemorrhage. A small decrease in fibrinogen leads to an increased effect on coagulability and continued haemorrhage. Coagulation disorders may be due to either consumption of coagulation factors or dilution. The type, severity and time of onset of the coagulation disorder depend on both the size and the cause of the haemorrhage. Early recognition of the cause of haemorrhage, low fibrinogen and its immediate correction are essential in the perioperative management of haemorrhage. Continue reading
According to IASP (International Association for the Study of Pain) the definition of pain is: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Furthermore, is expanded on: 1) Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons and 2) Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain. Continue reading
Sickle cell disease (SCD) is an umbrella term that defines a group of inherited diseases (in-cluding sickle cell anaemia (SCA), HbSC and HbSβ-thalassaemia) characterized by mutations in the gene encoding the haemoglobin subunit β1. One of the most frequent and debilitant complications of the disease is the vaso-occlusive crisis (VOC), which is mediated by multicell adhesion between red blood cells (RBCs), white blood cells, platelets, and endo-thelial cells and causes intense pain in conse-quence of impaired oxygen supply, but also in-farction-reperfusion injury2,3. Continue reading
