The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures - part II.

OBJECTIVES: The second part of the study was to assess the effects of the types of anaesthesia along with multimodal analgesia on the stability of vital functions at the critical moment of awakening from anaesthesia. MATERIAL AND METHODS: The material comprised the medical records at the Department of Anaesthesiology and Intensive Care in Szczecin. The anaesthesia record forms and recovery room observation charts of 150 patients from the Gynaecology Clinic who had undergone category III and IV surgical procedures between October 2018 and January 2019 were selected for analysis. The patients were divided into three groups: 1. Patients given multimodal analgesia with non-opioid and opioid analgesics. 2. Patients given multimodal analgesia with non-opioid analgesics and adjuvants. 3. Patients given multimodal analgesia with non-opioid and opioid analgesics, as well as neuraxial anaesthesia. RESULTS: The average minimum heart rate in the operating room was 63.92 in group I, 61.48 in group II, and 62.34 in group III. The most common cause of bradycardia during surgery was insufflation. The average SBP prior to surgery was similar in groups I and II - 128.74 and 128.66, respectively. The average maximum values during surgery were 135.24 in group I, 139.34 in group II, and 142.32 in group III. At the time of discharge from the post-anaesthetic care unit, all the patients from the study group had achieved an Aldrete score of 10. Following the anaesthesia, 24% of the patients in group I, 22% in group II, and 28% in group III required oxygen therapy. CONCLUSIONS: When using multimodal analgesia, the time required to fully awaken even after extensive surgical procedures was no longer than two hours.

The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures - part I.

OBJECTIVES: Pain and postoperative nausea and vomiting are among the most unpleasant sensations experienced after surgery. Patients after gynaecological surgery are at higher risk for both complications. Former methods of pain management based mainly on opioid administration were much less safe, especially for elderly patients. In addition, they generated an even greater increase of postoperative nausea and vomiting. Multimodal therapies in anesthesiology are currently being used more and more often. These include both multimodal postoperative pain management and multimodal prophylaxis of postoperative nausea and vomiting. The aim of the study was to assess the benefits of the methods used for gynaecological patients in the immediate postanesthetic period. MATERIAL AND METHODS: The research material is an analysis of medical documentation of 150 patients from the gynaecology clinic who underwent surgical procedures of categories III and IV from October 2018 and until January 2019, carried out in one of the clinical hospitals in Szczecin at the Anesthesiology and Intensive Care Clinic. Patients were divided into 3 groups: 1. Patients who received multimodal analgesia using non-opioid and opioid analgesics. 2. Patients who received multimodal analgesia using non-opioid and opioid analgesics and adjuvants. 3. Patients who received multimodal analgesia using non-opioid and opioid analgesics and central blockade. RESULTS: The highest age was in the third group at 57.48 years of age, 50.86 in the second group, and 47.8 in the first group. Healthy patients classified as ASA 1 accounted for 14% of group I, 18% of group II and 10% of group III. Patients with severe systemic disease (ASA 3) constituted 30% of group III 18%, of group II and 8% of group I. Upon leaving the operating room, as many as 80% of the patients from groups II and III did not feel any pain. In group I was 52%. When entering the recovery room, 26% of the patients in group I, 10% in group III, and 8% in group II rated their pain as higher than 5. The most used antiemetic medication in the studied facility was ondansetron. In group II it was given to 36 (72%) patients, in group III to 23 (46%) patients, and 13 (26%) patients in group I. In the postanaesthetic care unit, 9 (18%) patients in group III, 6 (12%) patients in group I, and 3 (6%) patients in group II received ondansetron. Metoclopramide was given only to patients in group III - one intraoperatively, and the other in the recovery room. CONCLUSIONS: Multimodal analgesia is effective in pain treatment. The use of PONV prevention is used for gynaecological patients. The analysis of the surgical records facilitated the recognition of patient needs.

[Tobacco smoking among students]. / Palenie tytoniu wsród studentów.

Tobacco smoking is accompanying people for many years. Last century it accompanied inseparable not only adult part of our society--3 of young people smoked. They attempted one or many times to smoke, and this way they often started regular smoking. The aim of this study was analysis of spread of tobacco smoking among 90 first year midwifery students. The study was conducted in the University of Medical Sciences in Poznan. The questionnaire included 13 questions, The Fagerstom- and the Schneider-Tests. The results show that only 3 (3.33%) persons regularly smoke cigarettes. Most of the students are conscious (aware) of threat of nicotine dependence.

[Students of midwifery and nicotine dependence]. / Studenci poloznictwa a nikotynizm.

Tobacco smoking is one of the principal public health problems. Therefore, at present, many new methods of prevention are being introduced. That is why education programs in Universities of Medical Sciences are very important. The aim of the study was to evaluate tobacco smoking among students of Midwifery. The study was performed among 73 students. They answered 16 questions concerning smoking and knowledge about nicotine dependence.

[Students of nursing and nicotine dependence]. / Studenci pielegniarstwa a nikotynizm.

Tobacco smoking is a significant part of life stile and the factor, which determinates state of health in a high rate. It is a very important social problem in Poland, because in spite of relative extensive knowledge about tobacco influence on bio-, psycho-, socio-well being, percentage of smokers is still high. These remarks should lead to creation "the fashion of no smoking" among future health care workers. According to organized activity cycle in the first stage this research we decided to diagnose the environment of the students and then to plane and implement health promotion and disease prevention activities, and finally evaluate them. The aim of the study was to analyze tobacco smoking among students of Nursing. The problems concerned level of dependence, readiness to stop smoking and knowledge about harmfulness of nicotine.

[The parents' awareness about threats for adolescents caused by tobacco smoking]. / Swiadomosc rodziców na temat zagrozen dla mlodego organizmu spowodowanych paleniem tytoniu.

Avoiding of children's and young people staying in smoky rooms and by adult people's consciousness of harmfulness of tobacco smoking is one of the most important factors affecting correct psychophysical development, physical activity, emotional state and mood of the young organism. The purpose of the paper was the estimation of consciousness of family, particularly parents, threats to the young organism caused by tobacco smoking by adult people and children's staying in the rooms full of the tobacco smoke. The group of 590 families of lower Silesian province dwellers, possessing basic, average and professional education was examined. A questionnaire was the basic research method, containing 25 of shut questions which parents were filling in. Obtained effects showed that parents who smoke cigarettes present the very low standard of knowledge for the subject of unfavourable consequences of the tobacco smoke on young organism development and functioning.

[Economic status of smoking family]. / Ksztaltowanie sie statusu materialnego rodzin palacych.

The tobacco smoking is a common phenomenon contributing not only to the occurrence of serious system diseases but before everything seriously depleting the budget of family. The paper presents the effects of the analysis of the material status of 605 families in which at least single one of its members is a habitual smoker. In examinations were participating only the lower-Silesian country provinces dwellers families' possessing basic, average and professional education. A questionnaire was the basic research method, containing 25 of shut questions was filled by accidentally present at home members of the family. Obtained effects showed that smokers' family were presenting the very low material status in the majority spending more than once around 1/3 of all one's monthly income (single persons) for cigarettes. However they are still lacking the motivation to discontinue smoking.

[Analysis of smoking among women with breast tumours]. / Analiza palenia tytoniu wsród kobiet z rozpoznanymi zmianami chorobowymi w obrebie gruczolu piersiowego.

Smoking is a very serious problem and it is wide spread among young and middle aged people. It is one of the social factors which act disadvantageous for the health of women. The aim of the study was to asses smoking among women with benign and malignant tumours. There were 280 28-59 year's old women hospitalised in surgical wards in Wielkopolska Oncology Centre in Poznan. In survey questionnaire the women were asked about the count of cigarettes smoked every day. The collected data let to define statistical dependence between the count of smoked cigarettes and place of living, age, education and time between diagnosis and qualification for operation. Results showed that the count of daily smoked cigarettes significant grows in 28-38 years old women that were waiting for the operation no longer than 3 weeks. Similar results were found in analysis of dependence between education and place of living and presumptive diagnosis and kind of operation. Women with benign tumours (no radical operation) and high and middle education, living in big cities smoked significantly more cigarettes then women with basic or professional education living in small cities and villages. Maybe it is connected with their anxiety of result of operation and mistrust of presumptive diagnosis. Comparable results were found in young women with diagnosed malignant tumours who were prepared to radical mastectomy.