Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 6 Articles
Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings\ncould predict pain intensity and analgesic usage following cesarean delivery (CD). Methods. 50 healthy women undergoing\nscheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated\npsychological questionnaires (Anxiety Sensitivity Index (ASI), Fear of Pain (FPQ), Pain Catastrophizing Scale, and Eysenck\nPersonality Questionnaire) and 3 simple ratings: expected postoperative pain (0ââ?¬â??10), anticipated analgesic threshold (0ââ?¬â??10), and\nperceived analgesic needs (0ââ?¬â??10). Postoperative outcome measures included post-CD pain (combined rest and movement) and\nopioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage\n(...
Background: The purpose of this randomised, single-centre study was to prospectively investigate the impact of\nanaesthetic techniques for craniotomy on the release of cytokines IL-6, IL-8, IL-10, and to determine whether\nintravenous anaesthesia compared to inhalational anaesthesia attenuates the inflammatory response.\nMethods: The study enroled 40 patients undergoing craniotomy, allocated into two equal groups to receive either\nsevoflurane (n = 20) or propofol (n = 20) in conjunction with remifentanil and rocuronium. The lungs were ventilated\nmechanically to maintain normocapnia. Remifentanil infusion was adjusted according to the degree of surgical\nmanipulation and increased when mean arterial pressure and the heart rate increased by more than 30 % from\nbaseline. The depth of anaesthesia was adjusted to maintain a bispectral index (BIS) of 40ââ?¬â??60. Invasive haemodynamic\nmonitoring was used. Serum levels of IL-6, IL-8 and IL-10 were measured before surgery and anaesthesia, during\ntumour removal, at the end of surgery, and at 24 and 48 h after surgery. Postoperative complications (pain, vomiting,\nchanges in blood pressure, infection and pulmonary, cardiovascular and neurological events) were monitored during\nthe first 15 days after surgery.\nResults: Compared with patients anaesthetised with sevoflurane, patients who received propofol had higher levels of\nIL-10 (p = 0.0001) and lower IL-6/IL-10 concentration ratio during and at the end of surgery (p = 0.0001). Both groups\nshowed only a minor response of IL- 8 during and at the end of the surgery (p = 0.57).\nConclusions: Patients who received propofol had higher levels of IL-10 during surgery. Neither sevoflurane nor\npropofol had any significant impact on the occurrence of postoperative complications. Our findings should incite\nfuture studies to prove a potential medically important anti-inflammatory role of propofol in neuroanaesthesia...
This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive\npressure ventilation. Fenestrated Portex Blue Line Ultra, TRACOE twist, or R�¨usch Traceofix tracheostomy tubes equipped\nwith nonfenestrated inner cannulaswere tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration\nleakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, airway pressures,\ntemperatures, and simulated static lung compliance settings on leakage characteristics was assessed. We observed substantial\ndifferences in transfenestration pressures and transfenestration leakage rates. The leakage rates of the best performing tubes were\n<3.5% of the delivered minute volume. At body temperature, the leakage rates of these tracheostomy tubes were <1%. The tracheal\ntube design was themain factor that determined the leakage characteristics. Careful tracheostomy tube selection permits the use of\nfenestrated tracheostomy tubes in patients receiving positive pressure ventilation immediately after stoma formation and minimises\nthe risk of complications caused by transfenestration gas leakage, for example, subcutaneous emphysema...
Background: A loss of adequate Situation Awareness (SA) may play a major role in the genesis of critical incidents\nin anesthesia and critical care. This observational study aimed to determine the frequency of SA errors in cases of a\ncritical incident reporting system (CIRS).\nMethods: Two experts independently reviewed 200 cases from the German Anesthesia CIRS. For inclusion, reports\nhad to be related to anesthesia or critical care for an individual patient and take place in an in-hospital setting.\nBased on the SA framework, the frequency of SA errors was determined. Representative cases were analyzed\nqualitatively to illustrate the role of SA for decision-making.\nResults: SA errors were identified in 81.5 %. Predominantly, errors occurred on the levels of perception (38.0 %) and\ncomprehension (31.5 %). Errors on the level of projection played a minor role (12.0 %). The qualitative analysis of\nselected cases illustrates the crucial role of SA for decision-making and performance.\nConclusions: SA errors are very frequent in critical incidents reported in a CIRS. The SA taxonomy was suitable to\nprovide mechanistic insights into the central role of SA for decision-making and thus, patient safety....
Background: A variety of factors have been linked to perioperative visual loss during or directly after nonocular\nand ocular surgeries. Prolonged immobilization, biochemical factors and hemodynamic instability have been discussed\nas factors in the pathogenesis of this devastating complication. Perioperative visual loss in four consecutive patients, all\nfeaturing Flammer syndrome, is reported herein. To our knowledge, we present the first case series, which associates\nperioperative visual loss with Flammer syndrome. We assume that a low perfusion pressure, disturbed autoregulation\nof the ocular blood flow and altered drug sensitivity in such subjects, play significant role in the pathogenesis of this\ndreaded complication.\nCases presentation: We analysed the medical records of four consecutive patients with permanent perioperative\nvisual loss and complemented our findings with additional history taking and clinical examinations. A variety of tests\nwas performed, including colour Doppler ultra sonography of the re troocular vessels, static and dynamic retinal vessel\nanalysis. The visual loss was unilateral in three patients and bilateral in one. An extensive review of published\nperioperative vision loss cases was conducted.\nAll four patients were male Caucasians, and exhibited prominent signs and symptoms of Flammer syndrome.\nThe visual loss originated from a propensity for unstable ocular blood flow, combined with hyperreactivity\ntoward pharmacological stimuli, leading together to disturbed autoregulation of the blood supply, and subsequently - to\nocular hypoxia. An identified intrinsic hypoperfusion diathesis was a crucial pathophysiologic link in all of the patients.\nOther, yet unknown systemic or local factors may also be involved in this process.\nConclusions: A review of numerous publications of perioperative visual loss and our data, support our hypothesis for\na novel pathophy siologic model and incorporate Flammer syndrome as a distinct risk factor for paradoxical visual loss,\nduring nonocular and ocular surgeries, or invasive procedures. To prevent the complications produced by\ndisturbed blood flow auto regulation in such patients, guidelines for screening and tailored preoperative\napproach are given....
Background: Difficult airway may result in significant morbidity and mortality. Proficient airway evaluation,\ntherefore, is one of the key elements in the safe conduct of anesthesia. A three-dimensional (3D) printing model\nwas recently introduced for medical application. 3D printing is a fast, convenient, and relatively affordable\ntechnique. We present a case in which a 3D-printed airway model was successfully used for airway evaluation.\nCase presentation: A 77-year-old man who had previously undergone total laryngectomy was scheduled for\nresection of a pelvic mass. The condition of his airway, however, complicated the procedure. Routine methods to\nevaluate his airway were not suitable. Therefore, the patient�s computed tomography imaging data were used to\ngenerate stereolithography files and then to print out 3D models of his trachea. These 3D models enhanced our\nunderstanding of his tracheal morphology. They helped us devise a preanesthesia plan and effectively execute it\nwithout complications.\nConclusion: 3D printing models allow better understanding of morphological changes in the airway and aid\npreanesthesia planning. The successful outcome of...
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