Erector Spinae Plane Block as the Phrenic Nerve Sparing Anaesthetic Technique for Shoulder Arthroplasty.

The utilization of the brachial plexus block has become commonplace in shoulder replacement surgery and the management of postoperative pain. Nonetheless, this technique carries risks, including the occurrence of phrenic nerve palsy and subsequent postoperative dyspnea. In light of these concerns, the erector spinae plane block emerges as a safe, simple, and effective alternative for shoulder surgery with reduced risk of phrenic nerve palsy and potential motor sparing in the affected limb. This research endeavors to elucidate the analgesic application of erector spinae plane block (ESPB) through the presentation and analysis of two cases involving reverse shoulder arthroplasty.

[Utility of point-of-care ultrasound in lung disease diagnosis]. / Przydatnosc point-of-care USG w diagnostyce chorób pluc.

A new method in the diagnostics of respiratory failure is lung ultrasound (LUS). The test assesses the pleural line and its related artefacts caused by the changing content of extravascular lung water which conditions the degree of lung aeration. Assessment of the movement of the pleural line and the related artefacts (A lines and B lines) enables diagnosis of respiratory failure and treatment monitoring. The advantage of LUS is the possibility of assessing lung function in real time, and the possibility of obtaining information about aeration of the examined part of lung parenchyma. In comparison to other imaging methods, ultrasound is characterized by a considerable specificity and sensitivity in diagnostics and differentiation of numerous diseases, such as pneumothorax, pneumonia, ARDS, and pulmonary edema.

Ascending aortic dissection diagnosed with the use of point-of-care sonography. Case report.

The presented case of a patient in cardiogenic shock in the course of aortic dissection with concomitant cerebral circulation illustrates the effectiveness of sonography in the intensive care unit as a tool that aids the diagnostic process. Point-of-care sonography involves ultrasound assessment performed by the attending physician, being an integral part of a physical examination. A 67-year-old female was brought to the emergency department with a suspicion of stroke, comatose, with focal neurological deficits and was admitted to the intensive care unit due to circulatory and respiratory failure. Based on the findings from a bedside ultrasound examination, the diagnostic process was extended, and the patient was rapidly transferred to the department of cardiac surgery with diagnosed ascending aortic dissection. The case presented demonstrates how point-of-care sonography facilitates and accerelates the diagnostic process and speeds up the implementation of de finitive treatment thus affecting the patient's outcome.

Multiwavelength time-resolved detection of fluorescence during the inflow of indocyanine green into the adult's brain.

Optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for clinical assessment of brain perfusion in adults at the bedside. Methodology of multiwavelength and time-resolved detection of fluorescence light excited in the ICG is presented and advantages of measurements at multiple wavelengths are discussed. Measurements were carried out: 1. on a physical homogeneous phantom to study the concentration dependence of the fluorescence signal, 2. on the phantom to simulate the dynamic inflow of ICG at different depths, and 3. in vivo on surface of the human head. Pattern of inflow and washout of ICG in the head of healthy volunteers after intravenous injection of the dye was observed for the first time with time-resolved instrumentation at multiple emission wavelengths. The multiwavelength detection of fluorescence signal confirms that at longer emission wavelengths, probability of reabsorption of the fluorescence light by the dye itself is reduced. Considering different light penetration depths at different wavelengths, and the pronounced reabsorption at longer wavelengths, the time-resolved multiwavelength technique may be useful in signal decomposition, leading to evaluation of extra- and intracerebral components of the measured signals.

Modern methods of assessment of lung aeration during mechanical ventilation.

Despite the fact that several modes of ventilation are being used, it is not always possible to maintain adequate parameters of gas exchange. In order to provide proper ventilation, it is necessary to assess the lung function. The aim of this article is presentation of different methods of assesment of lung aerations including its advantages, disadvantages and possibilities for implementation in clinical practice. Computed tomography provides information regarding morphology and aeration of lung tissue, but has several limitations: necessity of patients transportation, it cannot be performed in a continuous manner, a quantitative assessment of picture seems to be rather complicated. Ultrasonography is widely used in intensive care and is a noninvasive and bedside method. It gives the opportunity to assess an investigated organ in real time. Its clinical utility in patients with ARDS was proved by Lichtenstein et al. Another technology which has been implemented for the purpose of lungs visualization is electrobioimpedancy (EIT). This new method consists of continuous monitoring of chest electrobioimpedancy changes due to its air content. Unlike to techniques mentioned above, lung images generated with EIT do not provide any information about morphology of affected tissue. The method which indirectly describes the sum of lung interactions is the assessment of quasi-static P/V curve. This method provides information allowing to draw conclusions regarding the usefulness of recruitment maneuvers, but does not provide information regarding the nature of morphologic changes and their location. In the search for the ideal method of lung aeration assessment, it is necessary to define its characteristics, such as noninvasiveness, availability and visualization of tissue morphologic changes in real time.