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1.
Med Sci Monit ; 25: 5727-5737, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31371694

RESUMO

BACKGROUND Patients under 30 years of age constitute a unique population in the Intensive Care Unit (ICU). The aim of this study was to obtain information on young adults admitted to Polish ICUs and to identify independent predictors of favorable outcome in this population. MATERIAL AND METHODS Data from 20 651 adult patients from the Silesian Registry of Intensive Care Units conducted in the Silesian Region of Poland since October 2010 were analyzed. Patients aged 18-29 years were identified and their data were compared to the remaining population. Preadmission and admission variables that independently influence the favorable outcome (defined as survival of ICU stay and discharge in a condition other than vegetative state or minimally conscious state) were identified. RESULTS Among 20 609 analyzed adult patients, 850 (4.1%) were under the age of 30 years. Young adults had a lower mean APACHE II and SAPS III score at admission and were more frequently admitted to the ICU due to trauma, poisonings, acute neurological disorders, and obstetric complications. ICU mortality was over 2 times lower (20.1% vs. 45.3%, p<0.001). Independent variables affecting favorable outcome in this population were: admission to ICU from the operating theatre and multiple trauma as a primary cause of admission. CONCLUSIONS The greater chance of favorable outcome in adults under the age of 30 years admitted to the ICU is due to their unique characteristics. Favorable outcome in young adults is most likely among patients admitted to the ICU following multiple trauma or admitted from the operating theatre.


Assuntos
Unidades de Terapia Intensiva/tendências , Prognóstico , Resultado do Tratamento , APACHE , Adulto , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Tempo de Internação , Masculino , Alta do Paciente , Polônia , Sistema de Registros , Estudos Retrospectivos , Escore Fisiológico Agudo Simplificado , Adulto Jovem
2.
Arch Med Sadowej Kryminol ; 68(3): 161-170, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30786657

RESUMO

INTRODUCTION: In medicolegal practice, rare cases associated with suicidal, criminal or accidental overdose of insulin are both analytically and forensically challenging. The determination of insulin in post-mortem blood has limited diagnostic value, mainly on account of post-mortem chemical degradation processes (particularly hemolysis), and hence is not useful in medicolegal practice. AIM OF THE STUDY: The aims of the study were: 1) to assess the usefulness of the immunoradiometric method, used in clinical practice, for post-mortem measurement of insulin concentration in the intraocular fluid, 2) to preliminarily evaluate the usefulness of the obtained results for toxicological and medicolegal assessment, and 3) to verify on the basis of our own material the validity of the cited literature data on the effect of hemolysis on the result of insulin level determination in post-mortem blood. MATERIAL AND METHODS: The study material consisted of 93 samples of intraocular fluid collected during consecutive medicolegal autopsies performed in the Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice. In addition, 10 samples of peripheral blood taken from living people (5 women and 5 men) for clinical and diagnostic purposes were analyzed. Insulin(e) IRMA KIT from IMMUNOTECH was used for the analyses. RESULTS: In 86 (92.5%) samples, the insulin concentration was below the analytical sensitivity of the method (less than 0.5 µIU/ml), while in 7 cases it was in the range of 1.42-24.42 µIU/ml. CONCLUSIONS: Determination of the insulin level in the intraocular fluid by the immunoradiometric method provides an opportunity for objective verification of poisoning, however this claim requires further research.


Assuntos
Humor Aquoso/química , Toxicologia Forense/métodos , Insulina/análise , Manejo de Espécimes/métodos , Autopsia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Ensaio Imunorradiométrico , Masculino , Polônia
4.
Kardiochir Torakochirurgia Pol ; 21(2): 96-98, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39055252

RESUMO

Angiotensin II (AT) is a potent vasoconstrictor and hypertensive drug that is registered for the treatment of severe hypotension in vasoplegic shock. Growing experience with the use of AT in cardiac surgery allows the first therapeutic algorithms to be created. This paper is a proposal for the use of AT in distributive shock after extracorporeal circulation.

5.
Biomedicines ; 11(4)2023 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-37189842

RESUMO

The present study aimed to assess the changes in the immunological parameters of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The serum or plasma samples of patients were assessed to determine the concentrations of IL-6, one of the major proinflammatory cytokines (seven females and six males), and selected classes of immunoglobulins (six females and seven males). The samples for ELISA (enzyme-linked immunosorbent assay) were collected from patients before the use of CPB, at 60 min of the use of CPB, and at 24 h after the surgery. After 24 h of the surgery, IL-6, IgM, and IgG concentrations were higher in the serum of female patients than in the serum of male patients. However, compared to female patients, male patients showed a significant increase in IgG3 concentration after 24 h of the surgery. Regardless of age, the levels of the analyzed classes of immunoglobulins were similar in all patients. Additionally, in both age groups, a significant increase in the serum IL-6 concentration was observed after the first postoperative day, and this increase was more pronounced in patients diagnosed to have postoperative infections. The serum IL-6 concentration can serve as a potential marker of pathogenic infections in patients undergoing cardiac surgery with CPB and is thus useful for the early diagnosis of postoperative infections.

6.
Artigo em Inglês | MEDLINE | ID: mdl-36554855

RESUMO

The debate on limiting futile therapy in the aspect of End of Life (EoL) care has been going on in Poland over the last decade. The growing demand for EoL care resulting from the aging of societies corresponds to the expectation of a satisfactory quality of life and self-determination. The authors designed a cross-sectional study using a newly designed questionnaire to assess the opinions of 190 nurses employed in intensive care units (ICUs) on futile therapy, practices, and the respondents' approach to the issue. The problem of futile therapy and its clinical implications are known to the nursing community. Among the most common reasons for undertaking futile therapy in adult patients, the respondents declared fear of legal liability for not taking such actions (71.58%), as well as fear of being accused of unethical conduct (56.32%), and fear of talking to the patient/patient's family and their reaction (43.16%). In the case of adult patients, the respondents believed that discontinuation of futile therapy should be decided by the patient (84.21%), followed by a doctor (64.21%). As for paediatric patients, two-thirds of the respondents mentioned a doctor and a court (64.74% and 64.21%, respectively). Overall, 65.26% of the respondents believe and agree that the comfort of the patient's last days is more important than the persistent continuation of therapy and prolonging life at all costs. The presented results clearly show the attitude of the respondents who defend the patient's dignity and autonomy.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem , Adulto , Humanos , Criança , Estudos Transversais , Polônia , Qualidade de Vida , Inquéritos e Questionários
7.
Anaesthesiol Intensive Ther ; 54(3): 279-284, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36189906

RESUMO

The debate about medical futility often involves intensive care units where life-support procedures are routinely applied. Futile therapy is part of end-of-life therapy. In the discussion about medical futility it is important to distinguish the effect of therapy from the benefit for the patient. The goal of treatment is not to maintain the function of an organ, body part or physiological activity, but to maintain health as a whole. Prolonging ineffective treatment violates the standard of good medical practice. In 2014, the first Polish guidelines on limiting futile therapy in patients treated in intensive care units were published. This document presents the official position of intensive care experts consulted by medical societies of other medical disciplines. Limitation of futile therapy by withdrawing from already used treatments or withholding new therapies does not mean that the role of medical personnel has ended. Intensive care turns into palliative care. The list of comorbidities showing a statistically significant correlation with medical futility has been refined. These include heart failure (NYHA III/IV), neoplastic disease and disseminated neoplastic process, and failure of two or more organs. The published survey results are devastating; 66-89% of intensive care nurses have provided futile treatment in their careers. Intensivists estimated that, on average, 20% of patients in intensive care units receive futile therapy. There is a need to disseminate standards and procedures related to end-of-life care in Polish intensive care units.


Assuntos
Futilidade Médica , Assistência Terminal , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Cuidados Paliativos
8.
Adv Med Sci ; 66(2): 246-253, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33892212

RESUMO

PURPOSE: Flexible bronchoscopy (FB) causes airway narrowing and may cause respiratory failure (RF). Noninvasive mechanical ventilation (NIV) is used to treat RF. Until recently, little was known about noninvasive mechanical ventilation assisted flexible bronchoscopy (NIV-FB) risk and complications. MATERIALS AND METHODS: A retrospective analysis of NIV-FB performed in 20 consecutive months (July 1, 2018-February 29, 2020) was performed. Indications for: FB and NIV, as well as impact of comorbidities, blood gas results, pulmonary function test results and sedation depth, were analyzed to reveal NIV-FB risk. Out of a total of 713 FBs, NIV-FB was performed in 50 patients with multiple comorbidities, acute or chronic RF, substantial tracheal narrowing, or after previously unsuccessful FB attempt. RESULTS: In three cases, reversible complications were observed. Additionally, due to the severity of underlining disease, two patients were transferred to the ICU where they passed away after >48h. In a single variable analysis, PaO2 69 â€‹± â€‹18.5 and 49 â€‹± â€‹9.0 [mmHg] (p â€‹< â€‹0.05) and white blood count (WBC) 10.0 â€‹± â€‹4.81 and 14.4 â€‹± â€‹3.10 (p â€‹< â€‹0.05) were found predictive for complications. Left heart disease indicated unfavorable NIV-FB outcome (p â€‹= â€‹0.046). CONCLUSIONS: NIV-FB is safe in severely ill patients, however procedure-related risk should be further defined and verified in prospective studies.


Assuntos
Ventilação não Invasiva , Respiração Artificial , Broncoscopia/efeitos adversos , Humanos , Ventilação não Invasiva/efeitos adversos , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
9.
Anaesthesiol Intensive Ther ; 52(4): 312-315, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33165882

RESUMO

The coronavirus disease (COVID-19) was previously unknown, and we are learning about it day by day, but pandemic-associated ethical dilemmas have been studied and discussed for years. Triage means not only ranking in terms of importance (prioritisation) but also allocation of limited medical resources. Survival, post epidemic-quality of life, and consumption of medical resources required to achieve the set goal are crucial for making triage decisions. The pandemic triage decisions should be based on a protocol, considering the need for medical measures and therapy benefits. The first step is to consider the exclusion criteria and the risk of death. The next step is sequential clinical assessment, repeatable at defined intervals. It seems that the preferable solution is to triage all the patients and give priority to those who would benefit more. A prerequisite for allocating insufficient medical resources is public trust in the criteria for allocation.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Triagem/tendências , COVID-19 , Tomada de Decisão Clínica , Humanos , Triagem/estatística & dados numéricos
10.
Kardiochir Torakochirurgia Pol ; 17(4): 198-202, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33552184

RESUMO

INTRODUCTION: Over the last two decades transcatheter aortic valve replacement (TAVR) has been approved for clinical use. The anaesthetic choice for this procedure is evolving. General anaesthesia was the predominant anaesthetic technique. Growing experience and advances in technology and economic considerations have led to an increasing interest in performing TAVR under monitored sedation. AIM: The assessment of monitored sedation, called cooperative sedation, involves pharmacologically mediated suppression of consciousness and preservation of verbal contact in response to stimulation as a safe method of anaesthesia for TAVR. MATERIAL AND METHODS: Sixty out of 63 TAVR patients with femoral access received monitored sedation. Dexmedetomidine was administered in most of such cases (46 patients). A questionnaire was also carried out by staff involved in performing TAVR procedures, with more than 5 years of experience in it, concerning the method of anaesthesia and perioperative care. RESULTS: Conversion to general anaesthesia was required in 10% of patients (6 cases), only one as a patient-related complication (hypercarbia). The questionnaire carried out showed that anaesthesia and postoperative care after TAVR are underestimated. CONCLUSIONS: The preliminary results regarding anaesthetic management in TAVR procedures demonstrate that monitored sedation is safe, provided that contraindications are observed.

11.
Kardiol Pol ; 78(7-8): 825-834, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32788567

RESUMO

Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitivity of cardiomyocytes, acts as a vasodilator due to the opening of potassium channels, and has a cardioprotective effect. Levosimendan is mainly used in the treatment of acute decompensated heart failure (class IIb recommendation according to the European Society of Cardiology guidelines). However, numerous clinical trials indicate the validity of repeated infusions of levosimendan in patients with stable heart failure as a bridge therapy to heart transplantation, and in patients with accompanying right ventricular heart failure and pulmonary hypertension. Due to the complex mechanism of action, including the cardioprotective and anti- -aggregating effect, the use of levosimendan may be particularly beneficial in acute coronary syndromes, preventing the occurrence of acute heart failure. There are data indicating that levosimendan administered prior to cardiac surgery may improve outcomes in patients with severely impaired left ventricular function. The multidirectional mechanism of action also affects other organs and systems. The positive effect of levosimendan in the treatment of cardiorenal and cardiohepatic syndromes has been shown. It has a safe and predictable profile of action, does not induce tolerance, and shows no adverse effects affecting patients survival or prognosis. However, with inconclusive results of previous studies, there is aneed for awell-designed multicenter randomized placebo-­controlled study, including an adequately large group of outpatients with chronic advanced systolic heart failure.


Assuntos
Insuficiência Cardíaca , Piridazinas , Cardiotônicos/uso terapêutico , Prova Pericial , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hidrazonas/uso terapêutico , Polônia , Piridazinas/uso terapêutico , Simendana
12.
Kardiol Pol ; 67(9): 989-94, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19838955

RESUMO

BACKGROUND: Single lung transplantation, bilateral lung transplantation and combined heart-lung transplantation are the procedures currently being performed in patients with arterial pulmonary hypertension and pulmonary hypertension as a result of end-stage lung disease. In patients with severe pulmonary hypertension, regardless of its aetiology, general anaesthesia and mechanical ventilation could precipitate the onset of cardiac failure and the necessity of extracorporeal circulation employment. AIM: To assess the clinical and prognostic value of the pulmonary artery pressure (PAP) measured during the intra- and early postoperative period in patients undergoing lung transplantation. METHODS: We analysed 20 patients undergoing lung transplantation in the Silesian Centre for Heart Disease in Zabrze, of whom 13 suffered from pulmonary hypertension before the operation. The PAP was measured using Swan-Ganz catheters. RESULTS: Pulmonary artery pressure markedly decreased after transplantation (systolic, diastolic and mean PAP values were 31/19/23 mmHg, respectively) but in 3 recipients the mean PAP exceeded 25 mmHg (45/23/30 mmHg). In all 3 cases a cardiopulmonary bypass was required and single-lung transplantation was performed. Pulmonary hypertension immediately after the operation was the potential marker of lung dysfunction (pulmonary oedema, ischaemia-reperfusion injury, infection) - all 3 patients with increased PAP developed complications. CONCLUSIONS: Lung transplantation is associated with a significant reduction in pulmonary artery pressures immediately after graft implantation. The persistence of pulmonary hypertension in the early postoperative period suggests temporal allograft dysfunction and affects the post-operative outcome.


Assuntos
Hipertensão Pulmonar/cirurgia , Transplante de Pulmão/métodos , Monitorização Intraoperatória , Cuidados Pós-Operatórios/métodos , Adulto , Circulação Extracorpórea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pressão Propulsora Pulmonar
13.
Neurol Neurochir Pol ; 43(4): 321-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19742390

RESUMO

BACKGROUND AND PURPOSE: People with mild cognitive impairment (MCI) have higher risk of developing dementia than the general population. Currently known risk factors for dementia include older age, low education level, gait disorders, hippocampal atrophy, and apolipoprotein E allele. Vascular risk factors may modify the neurodegenerative process. The aim of this study was therefore to assess the influence of vascular (genetic and environmental) risk factors on progression to dementia in an MCI group during a one-year period. MATERIAL AND METHODS: Fifty-five MCI patients (30 men and 25 women) and 44 controls (25 men and 19 women) matched for age, gender and education were studied. Mild cognitive impairment was diagnosed according to Petersen criteria (Mayo Clinic Group). Neuropsychological evaluation was made. Assessed vascular risk factors included hypertension, cardiovascular disease, diabetes, cigarette smoking, hyperlipidaemia, hyperhomocysteinaemia with vitamin B12 and folate deficiency. Genetic risk factors (APOE polymorphism, C677T and A1298C MTHFR polymorphisms) were also assessed. RESULTS: Vascular risk factors were found significantly more often in the MCI group (p = 0.041), including APOE4 allele (p = 0.018), hyperhomocysteinaemia (p = 0.012) and folate deficiency (p = 0.023). Discriminant function analysis showed that only age and hypertension are potential factors which may have an influence on progression to dementia in the MCI group within one year of prospective observation. CONCLUSION: Vascular risk factors are associated with cognitive impairment but do not have a significant influence on progression to dementia in the MCI group.


Assuntos
Doença de Alzheimer/epidemiologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/metabolismo , Ácido Fólico/metabolismo , Homocisteína/metabolismo , Hiper-Homocisteinemia/epidemiologia , Deficiência de Vitamina B 12/epidemiologia , Idoso , Apolipoproteínas E/genética , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Causalidade , Comorbidade , Diabetes Mellitus/epidemiologia , Progressão da Doença , Feminino , Seguimentos , Heterozigoto , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Masculino , Polônia/epidemiologia , Polimorfismo Genético , Fatores de Risco , Fumar/epidemiologia , Vitamina B 12/metabolismo
14.
Anestezjol Intens Ter ; 41(1): 37-40, 2009.
Artigo em Polonês | MEDLINE | ID: mdl-19517676

RESUMO

BACKGROUND: The TISS-28 scoring system, commonly used in Poland in general intensive care, relies mostly on nursing activities in individual patient care. It is not known, however, whether this system can also be useful in specialised intensive care. The aim of this study was to assess the usefulness of the TISS-28 scoring system in cardiac surgical intensive care. METHODS: Clinical records of three hundred and fifty-nine consecutive patients, treated in a cardiac surgical intensive care unit, were retrospectively analyzed. The records were analyzed overall, and in subgroups according to various ranges of operative risk according to the EuroSCORE (a scoring system commonly used in the preoperative assessment of cardiac surgical patients). The TISS-28 scores for each individual day of treatment were calculated. Additionally, individual real costs of treatment were calculated for each patient. RESULTS: One hundred and four patients (28.9%) were preoperatively allocated to the EuroSCORE low-risk group, 158 (44.0%) to the medium-risk group, and 97 (27.1%) to the high-risk group. The overall mean TISS-28 score was high (39.2+/-7.6). Patients in the high-risk group had the highest TISS-28 scores. Overall costs of treatment, calculated for individual patients, were closely correlated to the TISS-28 scores (r=0.76, p<0.0001). CONCLUSIONS: The TISS-28 scoring system may be useful in prediction of treatment costs and in planning of nursing staff allocation in a specialized cardiac surgical intensive care.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cuidados Críticos/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Objetivos Organizacionais , Admissão e Escalonamento de Pessoal/organização & administração , Carga de Trabalho , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/economia , Cuidados Críticos/economia , Alocação de Recursos para a Atenção à Saúde/economia , Custos Hospitalares , Humanos , Recursos Humanos de Enfermagem Hospitalar/economia , Objetivos Organizacionais/economia , Admissão e Escalonamento de Pessoal/economia , Polônia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Carga de Trabalho/economia
15.
Eur J Pharmacol ; 859: 172545, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31319066

RESUMO

Human amniotic cells (hAC) possess multiple unique immunomodulatory properties. They are believed to be a very appealing and safe material for clinical applications. Primary hAC have been proposed as an efficient source of immunomodulatory factors that could be used as alternative or supporting to classical drug immunosuppression. The aim of this study was to evaluate hAC immunomodulatory properties post-activation by inflammatory cytokines as Interleukin 1ß and Interferon γ. hAC were isolated and characterized by the expression of pluripotency marker SSEA4, epithelial marker CK7, HLA-G antigen, mRNA for PTGS2, NOS2 and HLA-G gene, and secretion of soluble mediators as HLA-G and PGE2 in the culture medium in presence or absence of INF-γ and IL-1ß. Heterogeneity of the cultured hAC was proved, with 50 ±â€¯8% of cells positive for epithelial marker (CK7), and 73 ±â€¯3% expressing SSEA4 pluripotency marker. Priming effect by in vitro exposure to INF-γ and IL-1ß resulted in a significant increase in expression of PTGS2, NOS2 and HLA-G gene, with a peak between 32 and 64 h. The highest PGE2 concentration was measured in the culture medium at 48 h. At 96 h, a significant difference in the percentage of SSEA4+ hAC between activated and non-activated cells, as well as the highest expression of HLA-G - especially in SSEA4+ cells, and highly elevated concentration of soluble HLA-G (sHLA-G) in the medium of activated cells, were found. The prolonged exposure of primary human amnion-derived cells to inflammatory cytokines INF-γ and IL-1ß may result in enhanced expression and secretion of immunomodulatory molecules important in allogenic therapies.


Assuntos
Âmnio/citologia , Quimiocinas/metabolismo , Imunomodulação , Adulto , Dinoprostona/metabolismo , Feminino , Regulação da Expressão Gênica/imunologia , Antígenos HLA-G/metabolismo , Humanos , Inflamação/metabolismo , Interferon gama/metabolismo , Interleucina-1beta/metabolismo
16.
Anaesthesiol Intensive Ther ; 51(4): 262-267, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31550872

RESUMO

BACKGROUND: The search for ideal anaesthesia is still an open research issue. The aim of the study was to evaluate and compare two methods of general anaesthesia with preserved own breath - propofol with ketamine and propofol with remifentanil - in children anaesthetized for gastroscopy. METHODS: The study included 90 children enrolled for elective endoscopy of the upper gastrointestinal tract under general anaesthesia. The patients were randomized to one of two groups: Group K consisted of children anesthetized with propofol and ketamine, Group R included children anesthetized with propofol and remifentanil. Parameters monitored during anaesthesia were induction time, respiratory and circulatory parameters, adverse events, waking time and the child's condition after regaining consciousness. RESULTS: The groups differed significantly in time of induction of anaesthesia (Group K 3 ± 1 min vs. Group R 4 ± 2.5 min; P < 0.001), waking time (Group R 4 ± 4.5 min vs. Group K 6 ± 5 min; P < 0.01), condition of the child after regaining consciousness (Group R 90.9% calm, Group of K 54% confused; P < 0.001) and evaluation of test conditions in the opinion of the gastroenterologist (in favour of Group K; P < 0.05). CONCLUSIONS: Both methods of anaesthesia presented in the paper are safe and can be used in children to perform endoscopy. Combining propofol with ketamine allows fast induction of anaesthesia and creates very good conditions for the examination. Combining propofol with remifentanil allows fast and full return of consciousness after anaesthesia.


Assuntos
Gastroscopia/métodos , Ketamina/administração & dosagem , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Adolescente , Período de Recuperação da Anestesia , Anestésicos Combinados/administração & dosagem , Anestésicos Combinados/efeitos adversos , Anestésicos Dissociativos/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Ketamina/efeitos adversos , Masculino , Propofol/efeitos adversos , Remifentanil/efeitos adversos , Método Simples-Cego , Adulto Jovem
17.
Eur J Cardiothorac Surg ; 55(6): 1086-1094, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649238

RESUMO

OBJECTIVES: No experimental study has shown that the myocardium of a remotely preconditioned patient is more resistant to a standardized ischaemic/hypoxic insult. METHODS: This was a single-centre randomized (1:1), double-blinded, sham-controlled, parallel-group study. Patients referred for elective coronary bypass surgery were allocated to either remote ischaemic preconditioning (3 cycles of 5-min ischaemia/5-min reperfusion of the right arm using a blood pressure cuff inflated to 200 mmHg) or sham intervention. One hundred and thirty-four patients were recruited, of whom 10 dropped out, and 4 were excluded from the per-protocol analysis. The right atrial trabecula harvested on cannulation for cardiopulmonary bypass was subjected to 60 min of simulated ischaemia and 120 min of reoxygenation in an isolated organ experiment. Postoperative troponin T release and haemodynamics were assessed in an in vivo study. RESULTS: The atrial trabeculae obtained from remotely preconditioned patients recovered 41.9% (36.3-48.3) of the initial contraction force, whereas those from non-preconditioned patients recovered 45.9% (39.1-53.7) (P = 0.399). Overall, the content of cleaved poly (ADP ribose) polymerase in the right atrial muscle increased from 9.4% (6.0-13.5) to 19.1% (13.2-23.8) (P < 0.001) after 1 h of ischaemia and 2 h of reperfusion in vitro. The amount of activated Caspase 3 and the number of terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells also significantly increased. No difference was observed between the remotely preconditioned and sham-treated myocardium. In the in vivo trial, the area under the curve for postoperative concentration of troponin T over 72 h was 16.4 ng⋅h/ml (95% confidence interval 14.2-18.9) for the remote ischaemic preconditioning and 15.5 ng⋅h/ml (13.4-17.9) for the control group in the intention-to-treat analysis. This translated into an area under the curve ratio of 1.06 (0.86-1.30; P = 0.586). CONCLUSIONS: Remote ischaemic preconditioning with 3 cycles of 5-min ischaemia/reperfusion of the upper limb before cardiac surgery does not make human myocardium more resistant to ischaemia/reperfusion injury. CLINICAL TRIAL REGISTRATION NUMBER: NCT01994707.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Precondicionamento Isquêmico Miocárdico/métodos , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Troponina T/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doença da Artéria Coronariana/cirurgia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/sangue , Resultado do Tratamento , Adulto Jovem
18.
Kardiochir Torakochirurgia Pol ; 16(1): 32-36, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31043973

RESUMO

The concept of early recovery after surgery (ERAS) consists of bundle interventions during the pre-, intra- and postoperative periods and team work. The ERAS, which is a multimodal strategy, enables one to limit the neurohumoral response to the surgery, maintain homeostasis, reduce the risk of complications, shorten the hospital stay, accelerate the return to everyday functioning, improve the patient's satisfaction, achieve a satisfactory quality of life and finally reduce the treatment costs and eliminate any redundant and ineffective practices. Almost every patient can be classified for the ERAS strategy except for patients undergoing urgent and emergency surgery. The necessity to give up ERAS can result from poor organisation and management. Moreover, the procedure itself can be the cause of the lack of adherence to the planned standard. It is necessary to use protocols and checklists. While fulfilling this doctrine, the anaesthesiologist becomes a perioperative specialist.

19.
Anaesthesiol Intensive Ther ; 51(1): 70-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30667036

RESUMO

BACKGROUND: The aim of this paper is to describe the third pregnancy trimester, delivery and puerperium in patient with idiopathic pulmonary hypertension. CASE REPORT: a 30-year-old primigravida with idiopathic pulmonary hypertension was qualified for emergency Caesarean section. In the post partum period no improvement in managing pulmonary arterial hypertension was achieved. Because of progressive respiratory and circulatory failure as well as the pulmonary artery pressure exceeding the systemic pressure the AV ECMO was applied on postoperative day 6. During the ECMO period the emergency laparotomy due to bleeding was necessary. The further course of ICU treatment was uneventful. CONCLUSION: In described case things are left to chance or goodwill of specialists and final outcome depend on happy coincidences.


Assuntos
Cesárea , Emergências , Hipertensão Pulmonar Primária Familiar/terapia , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Recém-Nascido , Masculino , Cuidado Pós-Natal , Gravidez
20.
Anestezjol Intens Ter ; 40(3): 192-4, 2008.
Artigo em Polonês | MEDLINE | ID: mdl-19469123

RESUMO

Arthur Ernest Guedel was a US born anaesthetist, whose name found its place among key persons in our specialty. Commonly known as a developer of the oropharyngeal airway, he did much more. Possibly, his major achievements were the detailed description of nitrous oxide and diethyl ether anaesthesia. He was among the firstfull-time US anaesthesiologists, and also served in his profession during the First World War. So called Guedel charts, describing the relationship between the level of anaesthesia and pupillary reactions, allowed many non-anaesthesiologists to administer diethyl ether relatively safely. Together with Waters, he was among pioneers of cuffed endotracheal tubes. At the end of his career, in 1937, he produced a manual "Inhalational Anaesthesia--A Fundamental Guide, which served at least three generations of medical professionals.


Assuntos
Anestesiologia/história , Anestesia/história , Anestesia/métodos , História do Século XIX , História do Século XX , Intubação Intratraqueal/história , Estados Unidos
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