[Tobacco addiction in pregnant women and parturients--anesthetic considerations]. / Uzaleznienie od tytoniu u ciezarnych i rodzacych--implikacje anestezjologiczne.

A global increase in addictions also affects pregnant women. In mothers-to be most frequent is tobacco dependence, despite broad spread of information on negative influence of smoking on the mother and infant. Other substance misuse as ethanol but also illicit drugs may additionally coexist in pregnancy. Smoking cigarettes underlies complications of pregnancy and parturition and babies of smoking mothers present with lower birthweight. As a disorder involving a number of pathologies tobacco dependence in pregnant women and parturients implicates an increased peripoerative risk, especially for respiratory and cardiac complications. Anesthetic management of choice is neuraxial blockades, both for labor analgesia and surgery. On contact with tobacco dependent pregnant and parturient patient an anesthetist should also take an advantage for smoking cessation consulting.

[Smoking cessation as regards anesthesia and surgery]. / Zaprzestanie palenia tytoniu w aspekcie znieczulenia i zabiegu operacyjnego.

Smoking cessation in the perioperative period allows a substantial reduction of a number of anesthetic and surgical complications. They primarily include pathology and adverse reactions of respiratory, cardiovascular and nervous systems and also alterations in wound and bone healing. There is no doubt that long-term (several months) tobacco abstinence reduces the complication risk; however, the significance of short-term smoking cessation is being discussed. Additionally, due to increased patient motivation surgical operation poses a "teachable moment" to be captured for quitting permanently. Interventions for preoperative smoking cessation effectively change smoking behavior and should be widely offered to surgical patients. Oral recommendations should possibly be supported by pharmacotherapy. Nicotine replacement therapy and bupropion proved to be effective and safe in the perioperative period.

[Smoking cigarettes and pain--implications for the postoperative period]. / Palenie papierosów a ból--implikacje w okresie pooperacyjnym.

Smoking cigarettes poses a number of relevant medical and social problems. Impact of smoking on pain threshold and tolerance may be of significance for surgical patients, who are prompted to abstain from cigarettes before operation. Association between smoking and pain perception is complex. Experimental data bring evidence for analgesic action of nicotine and tobacco smoke acting via nicotinic acetylochline receptors (nAChR). However, clinical studies are unequivocal. Smoking is connected with some pain syndromes. Smokers take much more analgesics than non-smokers and probability of developing opioid dependence is increased in this group of patients. Smokers also present with altered mechanism of stress-induced analgesia and both gender and pain modalities influence their pain perception. Some studies demonstrate increased requirements for postoperative opioid analgesia in smoking patients. Strategies for postoperative pain treatment in smokers should involve regional techniques and clonidine.

[An association between tobacco smoking and basic haemodynamic parameters during induction of anaesthesia in gynecologic patients--a pilot study]. / Zwiazek miedzy paleniem tytoniu a podstawowymi parametrami hemodynamicznymi w okresie wprowadzenia do znieczulenia u pacjentek ginekologicznych--doniesienie wstepne.

Cardiovascular risk is increased in cigarette smokers in the perioperative period and smoking cessation results in its decrease. The pilot study has been designed to assess an association between smoking and arterial blood pressure and heart rate during induction of anaesthesia in gynecologic patients. Significance of smoking cessation before operation in this respect should be also assessed. Systolic, diastolic and mean arterial blood pressures and heart rate were assessed before and after the induction of anaesthesia in gynecologic patients subjected to hysterectomy: 27 smokers and 27 non-smokers. Anxiety level and intraoperative fentanyl use were also analyzed. Examined parameters were compared between smokers who were abstinent for at least one day before operation and those who continued smoking. Arterial blood pressure and heart rate were comparable in both smokers and non-smokers and also in both groups before and after the induction of aneasthesia. Smoking did not result in any modulation of anxiety level and intraoperative fentanyl dosage. Smoking cessation was connected with lower mean arterial pressure before the induction (P = 0,037). Cigarette smoking does not modify values of basic haemodynamic parameters during induction of anaesthesia in gynecologic patients. Smoking abstinence for at least one day before surgery may be connected with a lower mean arterial blood pressure before the induction.

[Significance of smoking and cigarette abstinence regarding anxiety in gynecologic patients in a perioperative period]. / Znaczenie palenia papierosów i jego zaprzestania w aspekcie leku u pacjentek ginekologicznych w okresie okolooperacyjnym.

Smoking cigarettes adds to risk of anesthesia and surgery, and also may influence anxiety. However, cigarette abstinence may increase preoperative stress. The study aimed at exploring the relationship between smoking and anxiety in gynaecologic patients in the perioperative period, and also finding out whether the abstinence and history of unsuccessful cessation attempts are connected with an anxiety pattern at that time. A relationship between anxiety and postoperative pain should be also examined. In 24 smokers and 24 non-smokers subjected to hysterectomy the anxiety level was examined by means of both Spielberger's state and trait inventory (STAI) and visual-analog scale (VAS) before and following surgery; maximal pain on the first postoperative day was also assessed by VAS scale. Smokers additionally completed an inventory of smoking behavior. Pre- and postoperatively the anxiety level was comparable in both groups. Before surgery but not after it, state anxiety overtopped the trait in both smokers and non-smokers. Postoperatively state anxiety was connected with the trait and morphine consumption. Cigarette abstinence before surgery did not influence anxiety; however, state anxiety correlated with the length of abstinence. In smokers with the history of smoking cessation attempts, preoperative state anxiety was higher. Between smokers and non-smokers no differences in postoperative pain and no significant relationship with the anxiety could be found, Conclusions: 1) Perioperative anxiety is comparable in both smoking and non-smoking gynaecologic patients. 2) Cigarette abstinence before surgery is not connected with any significant anxiety differences. Smokers with the history of unsuccessful cessation attempts preoperatively present with higher state anxiety.

[Perioperative anxiety in female smokers subjected to gynaecological surgery--a preliminary report]. / Poziom leku w okresie okolooperacyjnym u pacjentek ginekologicznych a nalóg palenia tytoniu--doniesienie wstepne.

UNLABELLED: Anxiety constitutes one of the most important psychological factors influencing body reaction to surgical injury; in gynecological patients anxiety ratings appear especially high. Cigarette smoking belongs to essential risk factors in the perioperative period and may result in increased levels of anxiety. A pilot study has been carried out with the aim of evaluating the impact of smoking habit on the perioperative anxiety level and postoperative pain in women undergoing gynecological surgical procedures. In 9 smokers and 10 non-smokers, anxiety was assessed by means of the State Anxiety Score of the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale (VAS), preoperatively and on the second day after surgery. Additionally, intraoperative and postoperative opioid analgesic uses were analyzed and on the second day after surgery patients rated their recall of postoperative pain with the use of the VAS. Postoperative State anxiety was lower than that reported preoperatively only in non-smokers (median: 53.0-40.0, p=0.02, Wilcoxon p=0.02). Smoking did not significantly influence intra- and postoperative opioid analgesic requirements and postoperative pain. CONCLUSIONS: This study suggests that in female smokers subjected to gynaecological surgery cigarette smoking may contribute to altered anxiety kinetics in the perioperative period.

[Laparoscopic management during pregnancy--own material (1996-2002)]. / Analiza postepowania laparoskopowego w ciazy na materiale wlasnym w latach od 1996 do 2002.

OBJECTIVE: Utility of laparoscopic procedures in pregnant women. Is laparoscopy safe for the foetus? MATERIAL AND METHODS: Between 1996 an 2002 14 pregnant patients were admitted and laparoscopy was performed. RESULTS: In 10 cases laparoscopic cyst enucleation (6 simplex, 1 endometrial, 3 dermoidal), in 1 case myomectomy and in 2 adnexectomy was performed. There were no complications during surgery. In one case miscarriage occurred 3 weeks after laparoscopic surgery and 9 healthy babies were delivered. DISCUSSION: There is no doubt that laparoscopy is well accepted in gynecological surgery and is going to be more and more accepted in obstetrics. Due to several differences between non-pregnant and pregnant women laparoscopic procedures in pregnancy require special attention. All papers show good foetal outcome even with preterm labour. In our material all babies were born healthy. CONCLUSIONS: Laparoscopic procedures during pregnancy are feasible and safe. Nevertheless they have to be performed by experienced gynecological-surgical teams.

[Pregnancy duration and mode of delivery in patients with cardiac insufficiency on the material of Jagiellonian University OB/GYN Clinic in the years between 1986-1999]. / Czas trwania ciazy i sposób rozwiazania w grupie pacjentek z wadami serca w materiale Kliniki Ginekologii i Poloznictwa Colegium Medicum Uniwersytetu Jagiellonskiego.

OBJECTIVES: Recent progress in cardiology and cardiac surgery lead many patients with cardiac disease in the procreative age. DESIGN: To asses the influence of cardiac disease on pregnancy and delivery. MATERIAL AND METHODS: 232 subjects with congenital and acquired cardiac anomalies, hospitalized in the Jagiellonian University OB/GYN Clinic between 1986-1999. Patients were divided according to NYHA classification depending on kind and grade of cardiovascular insufficiency. Acquired data were compared with data in the control group consisted of 424 subjects without any complications during pregnancy and delivery. RESULTS: We proved shortening of the pregnancy duration in more advanced NYHA classes. Percentage shave of preterm deliveries in 3rd and 4th class was 31.15%, what equals to 3 times preterm delivery rate in the control group. Preterm delivery rate in groups of NYHA I and II was similar to the rate in the control group. Acquired data reveal extremely high cesarean section rate in the material of patients with cardiac anomalies. Cesarean section rate in the group of NYHA I and II was 3 times higher (30%) than in control group (rate of 10%). NYHA III and IV groups has a cesarean section rate of 93%. Vaginal delivery rate in the NYHA I and II groups equals to 58.5%, what is 10 times higher than in NYHA III and IV groups (equals to 6.6%). CONCLUSIONS: 1. Pregnancy duration depends on cardiovascular sufficiency and is significantly shorten in NYHA III and IV groups. 2. Extremely high cesarean section rate in the analyzed group is due to decreased cardiac sufficiency.

[Management of analysis in case of ectopic pregnancy--own material]. / Analiza postepowania diagnostyczno-terapeutycznego w przypadku ciazy ektopowej w materiale wlasnym.

INTRODUCTION: Apart from increasing frequency of ectopic pregnancy occurrence during recent years there is still a need to diagnose and treat these pathology as early as possible. Delay in diagnosing subsequently cause severe threat to patients life. Recognition improvement means equally decrease in mortality connected to ectopic pregnancy. AIM: The aim of the study was diagnosis and treatment efficiency evaluation in cases of ectopic pregnancy. MATERIAL AND METHODS: In this paper 68 cases of women hospitalised between May 1999 and September 2002 in our Clinic with suspicion of ectopic pregnancy were analysed. Diagnostic procedures included clinical examination, biochemical assessment of beta HCG level, sonography and diagnostic laparoscopy. Therapeutic management included salpingotomy with evacuation of gestational sac, salpingectomy and uterine cornu excision. RESULTS: In 11 cases the presence of pregnancy was excluded according to non-invasive diagnostics. Laparotomy was performed in two cases. Laparoscopy was performed in 50 cases what equals to 73% of all subjects. Laparoscopy was negative in 7 cases. Misdiagnosis resulted from pathologies in adnexal area. The most frequent ectopic pregnancy localisation was oviduct, one case of cervical and one intramural localisation was diagnosed. In one case two salpingostomies were performed in two years apart period. CONCLUSIONS: Complex diagnostic management is the only diagnostic way in case of ectopic pregnancy. Any confusion should be solved by immediate invasive diagnostics. In our opinion the most efficient method in ectopic pregnancy diagnosing and treatment is early laparoscopy.

[Effect of recombinant activated factor VII (RFVIIA; NovoSeven) in a patient in haemorrhagic shock after obstetrical hysterectomy]. / Efekt zastosowania rekombinowanego aktywowanego czynnika VII. (RFVIIA; NovoSeven) u pacjentki we wstrzasie krwotocznym po histerektomii polozniczej.

Perinatal bleeding may lead to a fatal outcome in about 10% of cases. We present a case of a 29 year old woman in childbirth, in whom a preparation of recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) was used with success to control intraoperative bleeding during haemorrhagic shock after caesarean section and obstetrical hysterectomy, in the course of the patient's third abdominal cavity revision for continuing blood loss. Administration of the preparation enabled for quick intraoperative control of haemorrhage, which allowed safe and clear identification and elimination of the cause of bleeding. No significant clotting abnormalities were noted at postoperative monitoring of the coagulation system. rFVIIa seems to be an effective alternative treatment of life-threatening haemorrhages in obstetrics, allowing for quick arrest of bleeding, and thus safe control of intraoperative local hemostasis.