Review Articles

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
Acute sepsis-related kidney damage (S-AKI) is a common complication of the critically ill patient, with high mortality rates. Prevention of S-AKI is a daunting task because by the time patients seek medical help, most have already developed acute kidney damage. Thus early detection is an issue of utmost importance. Recent studies show that Continue reading
The introduction of the laparoscopic and robotic assisted laparoscopic technique in total hysterectomy patients alleviated significantly their postoperative pain and lowered the opioid consumption rate during their recovery. In the present article, we review the use of the Transversus Abdominis Plane block technique and the probability of further lessening the patients’ pain. Hereby we adduce the different variations of the TAP-block and the results of several clinical trials, after a thorough search in the existing literature. Continue reading
Inhalational anaesthesia induction technique goes back to 1846, when the first public administration of inhaled ether was demonstrated in the Ether Dome of Massachusetts General Hospital. Ever since, there has been a dizzying evolution in anaesthetic practice, but the main objectives of anaesthesia have remained unnegotiable. Inhalational sevoflurane induction is still applied in paediatric cases, non-compliant adult patients and in cases of difficult airway1. Continue reading
Post-extubation dysphagia (PED) is a common complication in ICU patients and it worsens their prognosis and quality of their life after their discharge from the ICU. This pathologic condition is independently associated with adverse patient outcomes and high-risk patients should be early recognized, because this situation can lead to aspiration pneumonia. The underlying pathophysiology of dysphagia is multifactorial. A team consisted of doctors, nurses, dietologists, speech therapists and physical therapists should deal with the situation. Flexible endoscopic evaluation of swallowing and videofluoroscopy are necessary tests for the assessment. Screening ICU protocols lead in early identification and proper therapeutic interventions. Continue reading
Respiratory failure due to Coronavirus 2019 (COVID-19) disease has triggered a debate about when and how to apply mechanical ventilation in these patients, as it has been proposed that severe "atypical" ARDS of COVID-19 cause an ARDS pandemic. As global database grows, it is evident that about 6% of patients will need admission to the ICU. About 75% of these will require invasive ventilation, and approximately 10% will need ventilation beyond 14 days. Different ventilation strategies are followed yet there is no strong evidence in favor of anyone. The present article attempts to gather the daily evolving evidence on the subject. 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
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