Anaesthesiology intensive therapy最新文献

Introduction: The healthcare system is one of the areas most affected by the COVID-19 pandemic in Poland. This resulted in a higher occurrence of medical errors at diffe-rent stages of diagnosis and patient treatment. This study aimed to determine how the COVID-19 pandemic affected the number and type of medical errors in Poland and the type of medical facility where the irregularity occurred.

Material and methods: We reviewed inquiries into the correctness of medical proceedings related to COVID-19; these were received by our department from prosecutor's offices throughout Poland during the pandemic and after its end: from the beginning of January 2020 to the end of December 2023. During the examined period (48 months), the department received a total of 4,483 inquiries, i.e. approximately 4.5 per day (approximately 1,000 working days). Of these, 293 were related to the COVID-19 pandemic (6.54%) and were further analyzed according to the selected criteria. Inquiries regarding "COVID" cases concerned all aspects of medical procedures, all medical professions, and all healthcare entities.

Results: A clear correlation was found: most inquiries raising doubts about the correctness of medical procedures were received during the peaks (waves) of the pandemic: autumn 2020, spring 2021, late autumn 2021, and winter 2021/2022.

Conclusions: Despite the introduction of legal regulations intended to decriminalize consequences of medical errors related to the COVID-19 pandemic, such cases were still submitted to prosecutors' offices; prosecutors initiated proceedings and then commissioned expert opinions on the correctness of the medical procedure.

Introduction: Maintaining control over the airway is critical during general anesthesia induction, particularly in patients with anticipated difficult airways. Video laryngoscopy with various devices has emerged as a valuable tool in such scenarios and has shown promising performance. This study aimed to evaluate glottic visualization and the first attempt success rate of tracheal intubation of GlideScope and Sanyar video laryngo- scopes in adult patients with predicted difficult intubation.

Material and methods: A randomized, controlled, two-armed, parallel clinical trial was conducted, in adult patients with anticipated difficult intubation undergoing elective surgery under general anesthesia. Participants were randomly assigned to either the GlideScope or Sanyar group. The primary outcome was the success rate of intubation in the first attempt at laryngoscopy, and secondary outcomes were the duration of intubation, glottic visualization, blood pressure and heart rate after intubation.

Results: A total of 93 patients were included in the analysis, with 46 in the S group and 47 in the G group. The S group demonstrated a significantly higher first-attempt success rate of tracheal intubation (93.4% vs. 85.2%; P = 0.002) and shorter intubation time (29.28 ± 8.00 seconds vs. 42.73 ± 15.50 seconds; P = 0.0001) compared to the G group. Glottic visualization and hemodynamic changes did not significantly differ between the two groups.

Conclusions: The Sanyar video laryngoscope exhibited superior efficacy in terms of first-attempt tracheal intubation success and shorter intubation time compared to the GlideScope in adult patients with predicted difficult airways. These findings suggest that the Sanyar video laryngoscope may serve as a valuable alternative in challenging intubation scenarios.

Robotic surgery has become increasingly popular over the last 30 years. This technique is particularly attractive due to its minimally invasive nature, high precision compared to open and laparoscopic techniques, less postoperative pain, shorter hospital stay for patients, and faster recovery. For an anesthesiologist, robot-assisted operations involve numerous challenges resulting from the surgical technique. The most important problems during anesthesia include changes in physiology resulting from the development of pneumoperitoneum and a steep Trendelenburg position. This review discusses problems that may be encountered by an anesthesiologist performing anesthesia during robotic surgery.

Introduction: This study evaluated the efficacy of ultrasound-guided erector spinae plane block (ESPB) and pericapsular nerve group (PENG) block under spinal anesthesia for postoperative analgesia in elderly patients undergoing total hip arthroplasty.

Material and methods: In this randomized, controlled, double-blind study, 90 elderly patients (aged 67-89 years, ASA II and III), scheduled for total hip arthroplasty under spinal anesthesia were randomly allocated to three groups: PENG block (n = 30), ESPB (n = 30), and Control group (n = 30). Ultrasound-guided blocks were administered using 20 mL of 0.2% ropivacaine. The primary outcome was total opioid consumption over 48 hours. Secondary outcomes included pain scores, time to first rescue opioid analgesia, quadriceps muscle strength, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).

Results: Opioid consumption within 48 hours was significantly lower in both the PENG (3.5 ± 4.0) and ESPB (3.4 ± 3.8) groups compared to the Control group (16.07 ± 3.8 ), with P < 0.001, and no significant difference between PENG and ESPB groups (P = 1.0). Time to first rescue analgesia was longer in the PENG (12.3 ± 3.2) and ESPB (11.2 ± 2.9) groups relative to the Control group (4.2 ± 1.1), P < 0.001. Pain scores remained consistently lower in both intervention groups at all time points compared to the Control group. Quadriceps strength was lower in the PENG group at 6 hours postoperatively compared to ESPB. NLR and PLR values were lower in both block groups than in the Control group.

Conclusions: Ultrasound-guided PENG and ESPB are effective for postoperative analgesia in elderly patients undergoing total hip arthroplasty, significantly reducing opioid requirements and enhancing recovery quality.

Introduction: The evaluation of postoperative convalescence requires a patient-reported quality of recovery. One of the tools that facilitate such evaluation is the Quality of Recovery-15 (QoR-15) questionnaire. Even though it has been validated in several languages, a Polish version of the questionnaire has not been available until now.

Material and methods: The study was conducted in 5 Polish hospitals from 22 January 2023 to 7 May 2023. Patients aged over 18 years undergoing a surgical procedure with planned general anaesthesia were considered eligible for the study. The participants completed the translated QoR-15 questionnaire twice: before surgery and on day 1 after surgery. 20% of patients were asked to complete the questionnaire twice after surgery in order to establish the test-retest reliability. Visual Analogue Scale results were obtained at each time point. Comprehensive data regarding patients' clinical characte-ristics, surgical procedure and postoperative complications were obtained from medical records.

Results: 342 patients (52.6% females) successfully completed both preoperative and postoperative questionnaires. The Cronbach's a values for preoperative and postoperative questionnaires were 0.85 and 0.86, respectively. Test-retest reliability indicated by the intraclass correlation coefficient was 0.91 (95% CI: 0.85 to 0.94, P < 0.01). Cohen's effect size was 0.78 (95% CI: 0.62 to 0.93) with a standardized response mean of -0.65 (95% CI: -0.75 to -0.54).

Conclusions: The Polish version of the QoR-15 questionnaire is a reliable and effective tool for assessing the quality of recovery reported by patients after surgery and general anaesthesia.

Introduction: The purpose of this survey was to investigate the opinions on futile therapy among anaesthesiologists and residents in anaesthesiology and intensive therapy as well as to determine the frequency of the futile therapy protocol being used. Additionally, the survey aimed to determine the factors responsible for futile therapy being still practised in intensive care units (ICUs).

Material and methods: The authors developed a questionnaire for the purpose of the study. In addition to questions about professional status, gender, age, seniority, and place of work, questions regarding aspects of futile therapy in the context of medical decision-making were included in the study tool. A question was also asked about whether the COVID-19 pandemic might have influenced the perception of futile therapy. The survey was conducted using the computer-assisted web interview (CAWI) technique. The questionnaires were completed in an online form between May and October 2023.

Results: The study group consisted of 488 respondents including anaesthesiologists and residents in anaesthesiology and intensive therapy. About 80% of the respondents were anaesthesiologists, with an average ICU experience of about 15 years. The vast majority of anaesthesiologists (n = 458) were of the opinion that the decisions on intensive care limits should be subject to legal regulations.

Conclusions: Polish anaesthesiologists recognise the need to regulate the decision-making process as part of the legal system while not perceiving a need for their decisions to be subject to authorization by hospital ethics committees. Respondents also note the need to educate the public on the subject of end-of-life care.

Introduction: Unfractionated heparin (UFH) is the traditional anticoagulant of choice in critically ill COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO). Nadroparin, a low molecular weight heparin, potentially offers advantages such as predictable pharmacokinetics and reduced bleeding risks compared to UFH, with complex pharmacokinetics, influencing activated partial thromboplastin and causing substantial haemorrhagic risks. Bleeding, the most common adverse event during ECMO, is associated by many with increased activated partial thromboplastin time.

Material and methods: This retrospective, bicentric analysis involved 38 consecutive ECMO-supported COVID-19 patients from two Polish hospitals. The study compared 27 patients receiving UFH and 11 patients treated with 5700 IU of nadroparin administered subcutaneously twice daily. Thrombotic and haemorrhagic complications were assessed to determine the safety and feasibility of each anticoagulant.

Results: Resistance to flow throughout the therapy in the ECMO membrane oxygenator was significantly lower in the group anticoagulated with UFH (1.74 mmHg × minute × L^-1 [1.38-2.6] vs. 6.13 mmHg × minute × L^-1 [5.93-14.81]; P < 0.001). However, the number of transfused red blood cell packs in the aforementioned group was significantly greater (10 units [5-17] vs. 4 units [2-8]; P = 0.027), and the haemoglobin level after ECMO therapy was significantly lower (7.8 g dL^-1 [6.9-8.8] vs. 10.2 g dL^-1 [8.5-12.2]; P = 0.003). Moreover, there was a higher number of life-threatening events in the UFH group.

Conclusions: UFH anticoagulation may provide better flow optimization in the oxygenator, but the risk of life-threatening bleeding may increase. The present findings need to be fully elucidated in prospective studies on a larger critically ill population supported with respiratory ECMO.