Risk factors for intraoperative hypotension during thyroid surgery.

BACKGROUND: Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension. MATERIAL AND METHODS: The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH. RESULTS: IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000). CONCLUSIONS: IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.

Preoperative considerations for patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is a risk factor for development of intraoperative and postoperative pulmonary complications. Regarding the type and the extent of surgical procedure, patients with COPD are at risk of aggravation of pulmonary function which leads to complicated perioperative course. In order to reduce perioperative complications, preoperative evaluation and preoperative patient preparation are of great importance. Goals of preoperative preparation and anesthesia in patients with COPD are maintaining ventilation-perfusion ratio, preventing development of hipoxemia, intraoperative brochospasm, pneumothorax and disturbances of cardivascular system.

Preoperative preparation for patients with nutritional disorders.

Eating disorders are very common today. An increasing number of patients that undergo anesthesia and surgery have some nutritional disorder. These disorders are very versatile starting from obesity to anorexia. Significant changes in all organ systems are present. These pathophysiological changes are increased with the duration of the disease. There are many changes in the functioning of the cardiovascular system in all these diseases and there are significant. Respiratory and ventilatory functions are changed too. There are also many endocrine disorders. As a final result, there are many serious biochemical and coagulation disorders. These patients are often under some drug treatment. Patients could be under psychiatric therapy (psychiatric drugs) and/or could take drugs for relieving symptoms related to the pathophysiological changes in different organ systems. Preoperative preparation of patients must be detailed. All changes must be improved to optimal condition. In addition, it is necessary to think about the possible influence of used drugs on the anesthesia.

Preoperative evaluation of patients with history of allergy.

The prevalence of allergic reactions in general opulation shows a constant rise. It has been estimated that up to 40% of surgical patients have a positive history of some kind of allergy. These patients represent a challenge during perioperative evaluation, since they can be exposed to a large variety of drugs and substances during surgery and anesthesia. A lot of adverse drug reactions show similar clinical presentation with allergic reactions. The latter are usually poorly explored since preoperative allergology testing is performed in a limited number of patients. Management of patients with history of allergy is impeded by the fact that most of allergens cross-react in a manner that is not always easy to predict. Allergies can manifest themselves with a broad spectrum of clinical symptoms, ranging from mild skin symptoms such as itch and urticaria, to a life-threatening anaphylactic reactions followed by hypotension, bronchospasm and cardiovascular collapse. Prevention of allergic reactions during perioperative period requires detailed history taking in order to identify patients at risk, optimization of anesthesia strategy, pharmacological premedication and further allergology diagnostic work-up in selected cases.

[Characteristics of neuromuscular block after administration of rocuronium bromide in patients with end-stage renal failure].

INTRODUCTION: Anaesthesia affects kidney function by reducing the renal blood flow and glomerular filtration rate. As chronic renal failure (CRF) significantly influences drug metabolism and elimination, we studied the effects of rocuronium bromide (RB) in patients with CRF. OBJECTIVE: The aim of the study was to examine whether, when using RB in patients with CFR, there are differences regarding the onset time of neuromuscular block (NMB) development, duration time, speed of recovery and cumulative effects of RB. METHODS: Prospective study included 60 patients who underwent urologic surgery procedures. The patients were divided into 3 groups: the first group (G1)--20 patients with CRF and residual dieresis, the second group (G2)--20 patients with CRF and without dieresis, and third group (G3)--20 patients with normal renal function (control group). During surgery RB was administrated for muscle paralysis in all patients. Train-of-four (TOF) Guard acceleromyography was used for NMB monitoring. RESULTS: Onset time in three groups was 132.3 s; 139.5 s and 113.2 s (p < 0.01). Duration of intubation dose was the same in G1 and G2 (28.9 minutes), while in the third group it was 27.2 minutes (p > 0.05).The number of RB repeated doses was 3-8, 3-7 and 4-8 (p > 0.05). The duration time until spontaneous recovery was 31.8, 31.6 and 29.8 minutes (p > 0.01). The recovery index was 16.8,16.7 and 10.6 minutes (p < 0.001). The duration time from the last dose of RB to extubation was 74.5, 74.8 and 58.9 minutes (p < 0.001). CONCLUSION: In patients with CRF the cumulative effect of the drug was registered, with a prolonged recovery time from NMB in relation to the patients with normal renal function.