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1.
J Clin Monit Comput ; 2024 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-39048785

RESUMO

PURPOSE: Intraoperative hypotension (IOH) during general anesthesia is associated with higher morbidity and mortality, although randomized trials have not established a causal relation. Historically, our approach to IOH has been reactive. The Hypotension Prediction Index (HPI) is a machine learning software that predicts hypotension minutes in advance. This systematic review and meta-analysis explores whether using HPI alongside a personalized treatment protocol decreases intraoperative hypotension. METHODS: A systematic search was performed in Pubmed and Scopus to retrieve articles published from January 2018 to February 2024 regarding the impact of the HPI software on reducing IOH in adult patients undergoing non-cardio/thoracic surgery. Excluded were case series, case reports, meta-analyses, systematic reviews, and studies using non-invasive arterial waveform analysis. The risk of bias was assessed by the Cochrane risk-of-bias tool (RoB 2) and the Risk Of Bias In Non-randomised Studies (ROBINS-I). A meta-analysis was undertaken solely for outcomes where sufficient data were available from the included studies. RESULTS: 9 RCTs and 5 cohort studies were retrieved. The overall median differences between the HPI-guided and the control groups were - 0.21 (95% CI:-0.33, -0.09) - p < 0.001 for the Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) < 65mmHg, -3.71 (95% CI= -6.67, -0.74)-p = 0.014 for the incidence of hypotensive episodes per patient, and - 10.11 (95% CI= -15.82, -4.40)-p = 0.001 for the duration of hypotension. Notably a large amount of heterogeneity was detected among the studies. CONCLUSIONS: While the combination of HPI software with personalized treatment protocols may prevent intraoperative hypotension (IOH), the large heterogeneity among the studies and the lack of reliable data on its clinical significance necessitate further investigation.

2.
J Anaesthesiol Clin Pharmacol ; 40(2): 283-292, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38919447

RESUMO

Background and Aims: Although thoracic paravertebral blockade (TPVB) is employed in thoracic surgery to ensure satisfactory postoperative analgesia, large doses of anesthetics are required and manifestations of local anesthetic systemic toxicity (LAST) may appear. Currently, there are limited data on the pharmacokinetics of ropivacaine after continuous TPVB. The aim of this prospective study was to investigate ropivacaine kinetics, in the arterial and venous pools, after continuous TPVB and assess the risk of LAST. Material and Methods: Immediately after induction of general anesthesia, an ultrasound-guided continuous TPVB at T5 or T6 or T7 thoracic level was performed in 18 adult patients subjected to open thoracotomy. A 25-ml single bolus injection of ropivacaine 0.5% was administered through thoracic paravertebral catheter, followed by a 14 ml/h continuous infusion of ropivacaine 0.2% starting at the end of surgery. Quantification of total ropivacaine concentrations was performed using a validated high-performance liquid chromatography method. Population pharmacokinetic models were developed separately for arterial and venous ropivacaine data. Results: The best model was one-compartment disposition with an additional pre-absorption compartment corresponding to thoracic paravertebral space. Gender had a significant effect on clearance, with females displaying lower elimination than males. Some patients had ropivacaine concentrations above the toxic threshold, but none displayed evidence of LAST. Continuous thoracic paravertebral nerve blocks provided adequate postoperative analgesia. Conclusion: Ropivacaine doses at the upper end of clinical use (800 mg/d) did not inflict the manifestations of LAST and provided adequate postoperative pain control. Pharmacokinetic models were developed, and the effect of gender was identified.

3.
J Anaesthesiol Clin Pharmacol ; 36(Suppl 1): S121-S124, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33100660

RESUMO

We report the successful anesthetic management of a 24-year-old patient, with an active COVID-19 viral infection, scheduled for elective Cesarean section at 40th week of pregnancy. This was the first case in Greek region, and we report and discuss the difficulties and safety issues regarding a COVID-19 positive patient during an elective cesarean delivery. Regional anesthesia with full protective equipment for health personnel involved, along with careful planning and adherence to guidelines achieved safe completion of the operation.

4.
J Anaesthesiol Clin Pharmacol ; 35(2): 202-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303710

RESUMO

BACKGROUND AND AIMS: The aim of this study was to investigate the current status of clinical practice regarding neuromuscular blocking drugs and their antagonists in Greece. MATERIAL AND METHODS: This is a multicenter survey, including a questionnaire based on previous studies, which was translated and modified by a Task Force of the Hellenic Society of Anaesthesiology. It was completed on a web-based database after invitation via e-mail and was left online for a period of 2 months. RESULTS: A total of 1,100 questionnaires were sent, with a response rate of 7.9%. 13.7% stated that they do not use neuromuscular monitoring. Rocuronium was most commonly used for intubation ["often" stated by 19 (21.8%) and "very often" by 62 (71.2%)], followed by cis-atracurium, atracurium, and succinylcholine. Neostigmine and sugammadex were both used, with reversal not always administered by 23 (26.4%). Both agents were mostly used at fixed doses and not calculated based on TOF monitoring or body weight. Sugammadex was preferred in special patient groups and in operations of short duration. Reversal was most often administered based on clinical signs of neuromuscular recovery rather than objective monitoring. A significant percentage of respondents used an inadequate TOF ratio for extubation [37 (43.2%) used a TOF ratio <90%]. The reported incidence of observed residual neuromuscular blockade (RNMB) was 44.8%. CONCLUSION: Great variability was observed in Greek clinical practice regarding the use of neuromuscular blockade, which indicates serious issues that must be addressed. The needs for educating anesthesia providers and developing official guidelines are obvious in order to improve patient outcomes.

5.
Immunol Invest ; 47(4): 327-334, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29412077

RESUMO

The effects of anesthetics on immune cell apoptosis and cytokine stimulation were studied in a prospective study. American Society of Anesthesiologists I/II patients underwent elective inguinal hernia repair or varicose veins stripping surgery and were randomized to either epidural anesthesia (n = 14) or general anesthesia with sevoflurane (n = 19) or propofol (n = 15). Blood was sampled before anesthesia induction (T0), at the end of surgery (T1), and 6 h later (T2). Apoptosis was determined by ANNEXIN-V staining of white blood cells; monocytes were isolated and stimulated for cytokine production. Results were compared with 10 healthy volunteers well-matched for age and gender. Apoptosis of lymphocytes and monocytes was increased in the epidural and sevoflurane groups at T2. Propofol group had increased production of interleukin-6 at T1 and sevoflurane and epidural groups had decreased production of tumor necrosis factor-alpha at T2. Results emphasize the modulation of immune function by epidural and sevoflurane but not propofol anesthesia in a clinical setting.


Assuntos
Anestesia Geral , Anestésicos/farmacologia , Apoptose/efeitos dos fármacos , Citocinas/metabolismo , Leucócitos/efeitos dos fármacos , Monócitos/efeitos dos fármacos , Monócitos/metabolismo , Adulto , Anestesia Epidural , Feminino , Humanos , Leucócitos/metabolismo , Masculino , Éteres Metílicos/farmacologia , Pessoa de Meia-Idade , Fenótipo , Propofol/farmacologia , Sevoflurano
6.
J Anesth ; 31(2): 225-236, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27864621

RESUMO

PURPOSE: Headache is an important cause of minor postoperative morbidity. In this study we evaluated the association of anesthesia and surgery with the occurrence of postoperative headache in elective surgery patients. METHODS: After obtaining ethical approval, 446 patients were enrolled in this prospective, single-centre cohort study. Participants were interviewed preoperatively, and for five days postoperatively, regarding the appearance of headache, while demographics, lifestyle, type of anesthesia and surgery, the anesthetic drugs administered and intraoperative adverse effects were recorded. Multiple logistic regression analysis was conducted in order to identify independent factors associated with postoperative headache, both in the total sample and in patients without previous history of headache. RESULTS: The observed overall frequency of postoperative headache was 28.3% (N = 126) in the total sample. In patients with previous history of headache, the frequency of postoperative headache was 41% (N = 89), while in those with no history the frequency of postoperative headache was 16.2% (N = 37). Female gender [p = 0.024; odds ratio (OR) = 2.1], sevoflurane administration (p < 0.001; OR = 3.66), intraoperative hypotension (p = 0.008; OR = 2.12) and smoking (p = 0.006; OR = 1.74) were independently associated with postoperative headache. In patients without previous history, female gender (p = 0.005; OR = 4.77), sevoflurane administration (p = 0.001; OR = 6.9), intraoperative hypotension (p = 0.006; OR = 6.7) and caffeine consumption (p = 0.041; OR = 5.28) presented greater likelihood for postoperative headache, while smoking revealed no association. CONCLUSION: Female gender, sevoflurane, smoking and intraoperative hypotension were documented as independent risk factors for postoperative headache. In patients with no previous history of headache, caffeine consumption was an additional independent factor for postoperative headache, while smoking revealed no association.


Assuntos
Anestesia/efeitos adversos , Cefaleia/epidemiologia , Éteres Metílicos/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Adulto , Anestesia/métodos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Sevoflurano
7.
Middle East J Anaesthesiol ; 23(5): 509-15, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27487636

RESUMO

BACKGROUND: People with special needs undergoing dental surgery frequently require general anesthesia. We investigated the effect of remifentanil vs fentanyl on stress response and postoperative pain in people with special needs undergoing day-case dental surgery. METHODS: Forty-six adult patients with cognitive impairment undergoing day-case dental surgery under general anesthesia were allocated to receive intraoperatively either fentanyl 50 µg iv bolus (group F, n = 23) or continuous infusion of remifentanil 0.5-1 µg/kg/min (group R, n = 23). Iintraoperative hemodynamic parameters were recorded and serum inflammatory mediators [tumor necrosis factor-α, substance-P], stress hormons (melatonin, cortisol) and ß-endorphin were measured. Postoperative pain was assessed during the first postoperative 12 hours with the Wong-Baker faces pain-rating scale. RESULTS: Demographics were similar in two groups. The two groups did not differ regarding their effects on inflammatory mediators, stress hormons and postoperative pain scores. However, the use of remifentanil prevented intraoperative increases of arterial blood pressure and heart rate. CONCLUSIONS: Remifentanil and fentanyl did not affect differently stress and inflammatory hormones during day-case dental surgery, although remifentanil may render intraoperative management of hemodynamic responses easier. Both opioids are equally efficient for postoperative pain management following dental surgery in people with special needs.


Assuntos
Analgésicos Opioides/uso terapêutico , Fentanila/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Piperidinas/uso terapêutico , Estresse Psicológico/prevenção & controle , Adulto , Procedimentos Cirúrgicos Ambulatórios , Transtornos Cognitivos/fisiopatologia , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Projetos Piloto , Remifentanil
8.
J Anesth ; 29(3): 352-359, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25266794

RESUMO

PURPOSE: Fluid loading attenuates the hypotensive response to spinal anesthesia (SA). This study aimed to compare the preload efficacy of 0.5 L hydroxyethyl starch (HES) versus 1 L Ringer's lactate (R/L) in the prevention of hypotension after SA for elective cesarean delivery (CD). Assessment of maternal hemodynamic variables using FloTrac/Vigileo™ and neonatal outcome constituted secondary outcomes. METHODS: Thirty-two ASA I/II parturients scheduled for elective CD were preloaded with either 1 L R/L (Group R/L, n = 16) or 0.5 L HES 6% 130/0.42 (Group T, n = 16) approximately 25 min before SA. Hypotension, defined as a 20% decrease of systolic arterial pressure (SAP) from baseline or SAP <100 mmHg, was treated with vasopressors according to a predetermined algorithm. The overall duration of hypotensive episodes and the total amount of vasopressors administered determined the severity of the hemodynamic instability. RESULTS: The incidence of hypotension was 73.3% in Group R/L and 46.7% in Group T. HES compared to R/L preload was associated with a shorter overall duration of hypotensive episodes (p < 0.001), a significantly less usage of ephedrine and phenylephrine (p = 0.015 and p = 0.029, respectively) and a greater impact, although not statistically significant, on cardiac index (CI) and stroke volume index (SVI). Although no statistical difference was detected between groups over time, there was a significant drop in CI, SVI and SAP within groups (p < 0.001) up to 14 min after SA. No difference was recorded in neonatal outcome. CONCLUSIONS: Preloading with 0.5 L HES 130/0.42 produced more stable hemodynamics compared to 1 L R/L solution in obstetric patients.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/métodos , Cesárea/métodos , Hipotensão/prevenção & controle , Adulto , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Efedrina/administração & dosagem , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Derivados de Hidroxietil Amido/administração & dosagem , Hipotensão/epidemiologia , Soluções Isotônicas/administração & dosagem , Fenilefrina/administração & dosagem , Gravidez , Estudos Prospectivos , Lactato de Ringer , Método Simples-Cego , Fatores de Tempo , Vasoconstritores/administração & dosagem
9.
J Anesth ; 29(5): 790-3, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25847614

RESUMO

The purpose of this imaging study was to investigate whether the musculocutaneous nerve could be visualized ultrasonographically in childhood and to assess how its visualization changes with age. Forty-two children participated in this prospective imaging study. The musculocutaneous nerve was sought both proximally (near the axillary artery) and distally (within the coracobrachialis muscle) by use of an linear ultrasound probe. Location of the musculocutaneous nerve was good (93 %) for all the children, both proximally and distally. For school-aged children, distal visualization of the musculocutaneous nerve reached 100 %. The musculocutaneous nerve is detectable in childhood by use of ultrasonography; success of detection was high for all the age groups examined.


Assuntos
Músculo Esquelético/inervação , Nervo Musculocutâneo/diagnóstico por imagem , Braço , Criança , Pré-Escolar , Humanos , Lactente , Estudos Prospectivos , Ultrassonografia
10.
Risk Manag Healthc Policy ; 17: 1323-1338, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38784961

RESUMO

Purpose: The short-term impact of the Covid-19 pandemic on patients with chronic pain has been under the microscope since the beginning of the pandemic. This time-lag design study aimed to track changes in pain levels, access to care, mental health, and well-being of Greek chronic pain patients within the first year of the Covid-19 pandemic. Patients and Methods: 101 and 100 chronic pain patients were contacted during the Spring of 2020 and 2021, respectively. A customized questionnaire was used to evaluate the perceived impact of the pandemic on pain levels and healthcare access. Psychological responses, personality characteristics, and overall well-being were evaluated using the Depression, Anxiety, and Stress Scale (DASS-42), the Ten-Item Personality Index (TIPI) and the Personal Wellbeing Index (PWI). Results: The perceived effect of the pandemic and the Covid-related restrictions affected significantly access to healthcare, pain levels and quality of life. Differences were detected in the PWI sub-scales regarding Personal Safety, Sense of Community-Connectedness, Future Security, Spirituality-Religiousness, and General Life Satisfaction. Marital status, parenthood, education and place of residence were associated with differences in pain levels, emotional and psychological responses. Conclusion: Changes in chronic pain levels, emotional responses, and overall well-being took place throughout the year. Also, an evident shift took place in the care delivery system. Both tendencies disclose an ongoing adaptation process of chronic pain patients and healthcare services that needs further monitoring.

11.
Exp Ther Med ; 28(4): 377, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39113910

RESUMO

Despite technical advances in recent decades and a decrease in hospital mortality (<5%), pancreaticoduodenectomy (PD) is still associated with major postoperative complications, even in high-volume centers. The present study aimed to assess the effect of a modified reconstruction technique on postoperative morbidity and mortality. A cohort study of all patients (n=218) undergoing PD between January 2010 and December 2019 was performed at Attikon University Hospital (Athens, Greece). Several variables were studied, including demographic data, past medical history, perioperative parameters, tumor markers and pathology, duration of hospitalization, postoperative complications, 30-day-survival, postoperative mortality and overall survival using multivariate logistic regression and survival analysis techniques. In this cohort, 123 patients [modified PD (mPD) group] underwent a modified reconstruction after a pylorus-preserving pancreaticoduodenectomy, which consisted of gastrojejunostomy and pancreaticojejunostomy on the same loop and an isolated hepaticojejunostomy on another loop. In the standard PD (StPD) group, 95 patients underwent standard reconstruction. The median age was 67 years, ranging from 25 to 89 years. Compared with in the StPD group, the mPD group had significantly lower rates of grade B and C pancreatic fistula (4.9% vs. 28.4%), delayed gastric emptying (7.3% vs. 42.1%), postoperative hemorrhage (3.3% vs. 20%), intensive care unit admission (8.1% vs. 18.9%), overall morbidity (Clavien-Dindo grade III-V: 14.7% vs. 42.0%), perioperative mortality (4.1% vs. 14.7%), and shorter hospitalization stay (11 days vs. 20 days). However, no difference was noted regarding median survival (35 months vs. 30 months). In this single-center series, a modified reconstruction after PD appears to be associated with improved postoperative outcomes. However, further evaluation in larger multi-center trials is required.

12.
J Cardiothorac Vasc Anesth ; 27(6): 1246-52, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23725684

RESUMO

OBJECTIVE: To examine the antioxidant role of propofol in ischemia-reperfusion during carotid endarterectomy (CEA) and its influence on cognitive dysfunction after CEA. DESIGN: A randomized prospective study. SETTING: Single-center study in a university hospital. PARTICIPANTS: Forty-four patients. INTERVENTIONS: Patients underwent elective CEA under general anesthesia with either sevoflurane (group S, n = 21) or propofol (group P, n = 23). MEASUREMENTS AND MAIN RESULTS: Cognitive function was assessed with the Mini-Mental State Examination (MMSE) before CEA, 1 hour after CEA, and 24 hours after CEA. Blood samples from the radial artery and the internal jugular vein were drawn before carotid clamping and 5 minutes following unclamping, and peripheral blood was obtained 24 hours postoperatively. Samples were analyzed for lactate, S100B, and P-selectin concentrations and for the antioxidative markers malondialdehyde/low-density lipoprotein ratio and nitrate + nitrite concentrations. Compared with group S, patients in group P exhibited a greater increase in their MMSE values 24 hours postoperatively. Patients who had their MMSE performance reduced at 24 hours also were significantly fewer in group P (13% v 43% in group S, p<0.05). Significantly lower levels of lactate and S100B were observed in arterial and jugular vein samples in group P. In addition, the jugular vein-arterial differences of malondialdehyde-to-low-density lipoprotein ratio and nitrates + nitrites concentrations were lower during propofol anesthesia. CONCLUSIONS: Propofol seemed to improve cognitive performance after CEA. This improvement was associated with decreased indices of ischemic cerebral damage and seemed to be due to antioxidative effect in the ischemic cerebral circulation.


Assuntos
Anestesia por Inalação , Anestesia Intravenosa , Anestésicos Inalatórios , Anestésicos Intravenosos , Cognição/fisiologia , Endarterectomia das Carótidas/efeitos adversos , Éteres Metílicos , Estresse Oxidativo/fisiologia , Propofol , Idoso , Feminino , Humanos , Isquemia/etiologia , Ácido Láctico/sangue , Peroxidação de Lipídeos/efeitos dos fármacos , Lipoproteínas LDL/sangue , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Monitorização Intraoperatória , Testes Neuropsicológicos , Nitratos/sangue , Nitritos/sangue , Selectina-P/sangue , Proteínas S100/sangue , Sevoflurano
13.
Arch Orthop Trauma Surg ; 133(11): 1607-12, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24036613

RESUMO

PURPOSE: Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA. METHODS: Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively. RESULTS: Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p < 0.05), but did not differ between infiltration and epidural group. There was no difference in adverse events in all groups. At 24 h, MAP was higher in the PCA group (p < 0.05) and blood loss was lower in the infiltration group (p < 0.05). CONCLUSIONS: In our study periarticular infiltration was clearly superior to PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Anestesia Local/métodos , Artroplastia de Quadril , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Feminino , Articulação do Quadril , Humanos , Masculino , Morfina/administração & dosagem
14.
Cureus ; 15(6): e39888, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37404401

RESUMO

A 36-year-old woman with no significant medical history was in active labour and requested labour analgesia. While the epidural technique was performed at the L4-L5 interspace, using the loss of resistance to air technique (LORA), inadvertent dural puncture occurred. Since the patient reported no headache or discomfort, the same procedure was repeated at the L3-L4 interspace successfully. Loss of resistance was reported at 3 cm and the epidural catheter was advanced uneventfully at 8 cm. Aspiration was negative for blood or cerebrospinal fluid (CSF) and a test dose of 2 ml lidocaine 2% was administered epidurally. Within five minutes the patient exhibited a mild hypotensive episode successfully treated with 2.5 mg ephedrine IV, a sensory blockade up to T6 level, and a motor blockade up to T10 level. Both the woman's and the baby's vital signs remained stable, no further drugs were administered epidurally and labour progressed painlessly and uncomplicated for 90 minutes with subsequent vaginal delivery of a healthy newborn. During the episiotomy incision repair, the patient complained of light dizziness and nausea. Her vital signs and the arterial blood gases (ABGs) ordered were within normal range, but the neurological examination revealed an isolated Babinski on the right foot. The head CT scan requested indicated a considerable quantity of air within the subarachnoid region. The patient was treated conservatively; symptoms showed steady improvement with total resolution on the sixth day, and the woman was discharged. This case reemphasizes the possibility of pneumocephalus, which may, in reality, occur more frequently than is commonly recognized without a CT confirmation.

15.
Cureus ; 15(8): e43605, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37719587

RESUMO

We present the first documented case of achieving surgical anesthesia for a vascular surgery using the suprainguinal approach of the fascia iliaca compartment block (SFICB), in a patient with severe comorbidities from the cardiovascular system. More specifically, a male elderly patient with a history of cardiac amyloidosis, severe aortic stenosis, and coronary artery disease, was in need of emergent thrombectomy due to acute lower limb ischemia. During the evaluation of this patient, general and neuraxial anesthesia were both considered. However, the former would expose him to the risk of myocardial ischemia and other complications due to cardiovascular instability caused by the general anesthetic agents while the latter was absolutely contraindicated due to recent clopidogrel use and the specific pathophysiology changes induced by cardiac amyloidosis. Thus, a peripheral nerve block was deemed to be the best option in this case. SFICB, despite being challenging, could offer adequate analgesic results so it was the anesthetic technique of choice. The surgery was completed and the patient recovered appropriately. The aim of this report is to discuss the specific anesthetic considerations of this case, highlight the ability of SFICB to achieve surgical anesthesia in vascular surgeries, and increase familiarity with the procedure.

16.
Psychiatriki ; 34(3): 193-203, 2023 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-37212802

RESUMO

COVID-19 pandemic resulted in an unprecedented crisis with extreme distress for the frontline physicians and increased risk of developing burnout. Burnout has a negative impact on patients and physicians, posing a substantial risk in patient safety, quality of care and physicians' overall wellbeing. We evaluated burnout prevalence and possible predisposing factors among anaesthesiologists in the COVID-19 referral university/tertiary hospitals in Greece. In this multicenter, cross-sectional study we have included anaesthesiologists, involved in the care of patients with COVID-19, during the fourth peak of the pandemic (11/2021), in the 7 referral hospitals in Greece. The validated Maslach Burnout Inventory (MBI) and Eysenck Personality Questionnaire (EPQ) were used. The response rate was 98% (116/118). More than half of the respondents were females (67.83%, median age 46 years). The overall Cronbach's alpha for MBI and EPQ was 0.894 and 0.877, respectively. The majority (67.24%) of anaesthesiologists were assessed as "high risk for burnout" and 21.55% were diagnosed with burnout syndrome. Almost half participants experienced high levels of all three dimensions of burnout; high emotional exhaustion (46.09%), high depersonalization (49.57%) and high levels of low personal accomplishment (43.49%). Multivariate logistic analysis revealed that neuroticism was an independent factor predicting "high risk for burnout" as well as burnout syndrome, whereas the "Lie scale" of EPQ exhibited a protective effect against burnout. Burnout prevalence in Greek anaesthesiologists working in COVID-19 referral hospitals during the fourth peak of the pandemic was high. Neuroticism was predictive of both "high risk for burnout" and "burnout syndrome".

17.
Middle East J Anaesthesiol ; 21(5): 685-92, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23265031

RESUMO

BACKGROUND: The aim of this study was to compare the effects of analgesia with remifentanil versus anesthesia with propofol and alfentanil on in vitro fertilization outcome. METHODS: The study included 58 women undergoing ultrasound transvaginal oocyte retrieval, who were randomized to receive either analgesia with remifentanil (n = 29) or anesthesia with propofol and alfentanil (n = 29). The subjects were compared for number of collected and matured oocytes, fertilization rate, cleavage rate, implantation rate, pregnancy rate, and embryo quality. Anesthesia related side effects and both patient and gynecologist satisfaction were recorded. RESULTS: There were no significant differences in collected oocytes, matured oocytes, fertilization and cleavage rate, embryo quality and implantation and pregnancy rate between the two groups. There was no difference regarding side effects and both patient and gynecologist satisfaction. CONCLUSIONS: Analgesia with remifentanil compared with anesthesia with propofol and alfentanil, provided equally effective and safe anesthesia during ultrasound transvaginal oocyte retrieval.


Assuntos
Alfentanil/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Intravenosos/administração & dosagem , Fertilização in vitro , Recuperação de Oócitos/métodos , Piperidinas/uso terapêutico , Propofol/administração & dosagem , Adulto , Analgesia , Anestesia , Feminino , Humanos , Gravidez , Taxa de Gravidez , Remifentanil , Resultado do Tratamento
18.
Anesth Pain Med ; 12(1): e122094, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35433375

RESUMO

Background: Postoperative cognitive dysfunction (POCD) is a complication that mainly occurs in adult patients and refers to a new-onset decline in cognitive function after anesthesia and surgery. The literature lacks evidence regarding opioid-free anesthesia and its impact on mental function postoperatively. Objectives: The effect of opioid-free anesthesia on POCD following urological surgery has not been previously reported. Accordingly, we present a case series of 15 adult patients undergoing transurethral urological surgery under general anesthesia using an opioid-free protocol with dexmedetomidine, ketamine, and lidocaine. Methods: Patients that underwent simple transurethral elective urological procedures under general opioid-free anesthesia were included. This case series is part of a prospective clinical study regarding opioid-free anesthesia and served as a pilot sample. The mini-mental state examination (MMSE) test, performed preoperatively and 12 hours postoperatively, was applied to assess POCD. Results: Fifteen patients with a mean age of 68 years old were included in the study. The opioid-free protocol was associated with non-statistically significant changes of the MMSE test after minor urological procedures. Conclusions: In our study, an opioid-free protocol of general anesthesia, using a mixture of dexmedetomidine, ketamine, and lidocaine, did not seem to have a negative impact on postoperative cognitive function in patients undergoing transurethral urological surgery. Further studies specifically designed to identify this effect are certainly required to further prove such an effect.

19.
J Clin Med ; 11(19)2022 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-36233419

RESUMO

Intraoperative hypotension is common and has been associated with adverse events. Although association does not imply causation, predicting and preventing hypotension may improve postoperative outcomes. This review summarizes current evidence on the development and validation of an artificial intelligence predictive algorithm, the Hypotension Prediction (HPI) (formerly known as the Hypotension Probability Indicator). This machine learning model can arguably predict hypotension up to 15 min before its occurrence. Several validation studies, retrospective cohorts, as well as a few prospective randomized trials, have been published in the last years, reporting promising results. Larger trials are needed to definitively assess the usefulness of this algorithm in optimizing postoperative outcomes.

20.
Mol Clin Oncol ; 17(4): 148, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36157314

RESUMO

The efficacy and safety of pancreaticoduodenectomy (PD) has not been yet studied in octogenarians in Greece. The present study reviewed records of all consecutive patients that underwent PD at the 4th Surgical Department of Attikon University Hospital (Athens, Greece) between January 1st, 2010 and December 31st, 2019. Differences between two age groups (group Y <80 years; group O >80 years) were analyzed. Study endpoints were length of stay, overall morbidity, 30-day mortality and overall survival (OS). There were 198 patients in Group Y (mean age, 65 years) and 20 patients in Group O (mean age, 82 years). Octogenarians had worse American Society of Anesthesiology score (>2; 31.3 vs. 65%; P=0.018). Median stay was not significantly different between the two groups (14 days vs. 16 days; P=0.307), neither was the 30-day mortality (6.1 vs. 5.0%; P>0.99). Median OS was similar between the two groups (35 months vs. 28 months; P=0.577). In a tertiary center in Greece, morbidity and mortality rates after PD were similar between the two groups. Patients should not be denied a PD, solely based on advanced age.

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