Does standing or sitting position of the anesthesiologist in the operating theatre influence sevoflurane exposure during craniotomies?

BACKGROUND: Exposure of the OR staff to inhalational anesthetics has been proven by numerous investigators, but its potential adverse effect under the present technical circumstances is a debated issue. The aim of the present work was to test whether using a laminar flow air conditioning system exposure of the team to anesthetic gases is different if the anesthetist works in the sitting as compared to the standing position. METHODS: Sample collectors were placed at the side of the patient and were fixed at two different heights: at 100 cm (modelling sitting position) and 175 cm (modelling standing position), whereas the third collector was placed at the independent corner of the OR. Collected amount of sevoflurane was determined by an independent chemist using gas chromatography. RESULTS: At the height of the sitting position the captured amount of sevoflurane was somewhat higher (median and IQR: 0.55; 0.29-1.73 ppm) than that at the height of standing (0.37; 0.15-0.79 ppm), but this difference did not reach the level of statistical significance. A significantly lower sevoflurane concentration was measured at the indifferent corner of the OR (0.14; 0.058-0.36 ppm, p < 0.001). CONCLUSIONS: Open isolation along with the air flow due to the laminar system does not result in higher anesthetic exposure for the sitting anesthetist positioned to the side of the patient. Evaporated amount of sevoflurane is below the accepted threshold limits in both positions.

Preoperatively administered single dose of dexketoprofen decreases pain intensity on the first 5 days after craniotomy: A single-centre placebo-controlled, randomized trial.

Background and purpose: Headache attributed to craniotomy is an underestimated and under-treated condition. Previous studies confirmed the efficacy of preemptive analgesia with non-steroidal anti-inflammatory agents. The aim of the present work was to test the hypothesis of whether a single preoperatively administered dose of dexketoprofen (DEX) has the potency to decrease postcraniotomy headache (PCH) as compared to placebo (PL). Patients and methods: This is a single-centre, randomized, PL-controlled trial comparing the effect of a single oral dose of 25 mg DEX to PL on the intensity of PCH. Patients undergoing craniotomy were randomly allocated to DEX and PL groups. Patients rated their actual and worst daily pain using visual analogue scale (VAS) scores during intrahospital treatment (0-5 days) and 30 and 90 days postoperatively. Results: Two hundred patients were included. DEX decreased the worst daily pain intensity in the first 24 h only; the 5-days cumulative score of actual pain was 9.7 ± 7.9 cm for the DEX group and 12.6 ± 10.5 cm for the PL group, respectively (p = 0.03). This difference disappeared in the late, 30-, and 90-day follow-up period. No differences in VAS scores could be detected in supra- and infratentorial cases among the DEX and PL groups. Conclusions: A single preoperative dose of 25 mg of DEX slightly decreases the intensity of PCH in the first 5 days after craniotomy but it does not have an effect on chronic headaches and postoperative analgesic requirements.

Knowledge and Attitudes of Health Care Professionals and Laypeople in Relation to Brain Death Diagnosis and Organ Donation in Hungary: A Questionnaire Study.

OBJECTIVES: The aim of the present work was to assess the knowledge and attitudes of different health care workers and laypeople toward the donation and transplantation procedure. SUBJECTS AND METHODS: A survey consisting of questions regarding brain death diagnosis, legal organization or organ donation, and the transplantation procedure were sent to participants: 56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320 general practitioners (GPs). Laypeople were also asked to complete the survey. RESULTS: The majority of participants reported being aware of legal regulations for organ donation in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses (34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs (22.4%) and medical students (20%) performed even worse on this item. The willingness of ICU specialists (57%) and ICU nurses (45%) to support donating their own organs was moderate. CONCLUSIONS: The results of this survey indicate a need for graduate and postgraduate education and regular teaching programs regarding organ donation and transplantation. More active use of modern media is proposed to improve public awareness and acceptance of organ donation.

The relative exposure of the operating room staff to sevoflurane during intracerebral surgery.

BACKGROUND: Our primary aim in this study was to investigate whether escape of the volatile anesthetic sevoflurane from the surgical site during craniotomy for tumor resection increases the exposure of the neurosurgeon to the anesthetic when compared with the anesthesiologist. METHODS: Initially, the release of sevoflurane from the surgical site was measured during 35 tumorectomies starting from opening to closure of the dura. Volatile anesthetic absorbers were placed at three detection sites: 1) the surgeon's breathing zone, 2) the anesthesiologist's breathing zone, and 3) the farthest corner of the operation room. In the second sampling series that included 16 patients, the detector that had been in the corner of the operating room in the first series was now placed in the vicinity of the patient's mouth (within 5 cm). Sevoflurane captured by the absorbers was quantified by an independent chemist using chromatography. RESULTS: Absorbers in the surgeon's breathing zone (0.24 +/- 0.04 ppm) captured a significantly lower amount of sevoflurane compared with absorbers in the anesthesiologist's breathing zone (1.40 +/- 0.37 ppm) and comparable with that in the farthest corner of the operation room (0.25 +/- 0.07 ppm). There was no correlation between the amount of absorbed sevoflurane and the size of craniotomy window, even when adjusting for the variation in duration of surgery. In the second series of sampling, absorbers in the proximity of the patient's mouth captured the highest amount of sevoflurane (1.54 +/- 0.55 ppm), followed by the anesthesiologist's (1.14 +/- 0.43 ppm) and the surgeon's (0.15 +/- 0.05 ppm) breathing zones. CONCLUSIONS: The close proximity of the surgeon's breathing zone to the craniotomy window does not appear to be a source of increased exposure to sevoflurane. The observed higher exposure of the anesthesiologist to sevoflurane in the operating room environment warrants further exploration.