chronic kidney disease.

In a traditional epiglottis biopsy surgery, the operator performs the direct laryngoscopy to visualise an operating field. However, in patients with tumour-altered epiglottis, this procedure can be unsuccessful, because of difficult laryngeal exposure (DLE). This term refers to an insufficient visualisation of larynx, according to anatomical and pathological lesions. A CASE REPORT: The aim of paper was to present a video laryngoscopy performed for surgical purpose in patient with tumour-altered epiglottis. Woman 52 year old was admitted to hospital for planned surgical epiglottis biopsy under general anesthesia. We utilised McGrath video laryngoscope to provide a successful larynx visualisation during an epiglottic tumour biopsy procedure, when a rigid diagnostic laryngoscope failed. McGrath appeared to provide an excellent view of the larynx, which enable the operator to perform the biopsy of the tumour. The operation proceeded without any complications. CONCLUSIONS: In case of shared airway procedure, such as epiglottis biopsy examination, video laryngoscopy appeared to be an effective method to expose the entrance to larynx and enable the surgical manipulation at the same time.

Neuromuscular blockade in the elderly.

The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.

Assessment of Ventilation Distribution during Laparoscopic Bariatric Surgery: An Electrical Impedance Tomography Study.

Introduction. The aim of the study was to assess changes of regional ventilation distribution at the level of the 3rd intercostal space in the lungs of morbidly obese patients as a result of general anaesthesia and laparoscopic surgery as well as the relation of these changes to lung mechanics. We also wanted to determine if positive end-expiratory pressure of 10 cm H2O prevents the expected atelectasis in the morbidly obese patients during general anaesthesia. Materials and Methods. 49 patients completed the examination and were randomized to 2 groups: ventilated without positive end-expiratory pressure (PEEP 0) and with PEEP of 10 cm H2O (PEEP 10) preceded by a recruitment maneuver with peak inspiratory pressure of 40 cm H2O. Impedance Ratio (IR) was utilized to examine ventilation distribution changes as a result of anaesthesia, pneumoperitoneum, and change of body position. We also analyzed intraoperative respiratory mechanics and pulse oximetry values. Results. In both groups general anaesthesia caused a ventilation shift towards the nondependent lungs which was not further intensified after pneumoperitoneum. Reverse Trendelenburg position promoted homogeneous ventilation distribution. Respiratory system compliance was reduced after insufflation and improved after exsufflation of pneumoperitoneum. There were no statistically significant differences in ventilation distribution between the examined groups. Respiratory system compliance, plateau pressure, and pulse oximetry values were higher in PEEP 10. Conclusions. Changes of ventilation distribution in the obese do occur at cranial lung regions. During pneumoperitoneum alterations of ventilation distribution may not follow the direction of the changes of lung mechanics. In the obese patients PEEP level of 10 cm H2O preceded by a recruitment maneuver improves respiratory compliance and oxygenation but does not eliminate atelectasis induced by general anaesthesia.

Assessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography.

Mechanical ventilation in acute respiratory distress syndrome (ARDS) incurs a risk of ventilator-associated lung injury (VALI) from inhomogeneous conditions and different properties of dependent and non-dependent lung regions at risk of atelectasis and overdistension, respectively. Electrical impedance tomography (EIT) offers regional ventilation assessment to optimise treatment with mechanical ventilation. This article provides an overview of scientific literature on the application of impedance tomography in acute respiratory distress syndrome. It also presents the results of EIT studies in different clinical situations that may be of use in implementing impedance tomography for treating ARDS.

Life satisfaction and work-related satisfaction among anesthesiologists in Poland.

UNLABELLED: The aim of the study was to assess the level of life and job satisfaction of Polish anesthesiologists and to explore the impact of extrinsic-hygiene and intrinsic-motivating determinants. MATERIALS AND METHODS: A cross-sectional questionnaire study was conducted among consultant anesthesiologists in Lodz region. The questionnaire concerned patient care, burden, income, personal rewards, professional relations, job satisfaction in general, and life satisfaction. Respondents were asked to rate their level of satisfaction for each item on a seven-point Likert scale (1: extremely dissatisfied; 7: extremely satisfied). RESULTS: 86.03% of anesthesiologists were satisfied with their economic status, 77.94% found their health status satisfactory, and 52.21% viewed their personal future optimistically. In general, 71.32% of anesthesiologists were satisfied with their current job situation. Among the less satisfying job aspects were work-related stress (2.49; SD = 1.23), administrative burden (2.85; SD = 1.47), workload (3.63; SD = 1.56), and leisure time (3.09; SD = 1.44). CONCLUSIONS: Considerable work-related stress leads to job dissatisfaction among anesthesiologists. There is an association between job satisfaction and health status, social life, and economic status. Working for long hours by anesthesiologists results in a high risk of burnout.

Intubation by paramedics using the ILMA or AirTraq, KingVision, and Macintosh laryngoscopes in vehicle-entrapped patients: a manikin study.

Four devices were compared in a simulated scenario of a vehicle-entrapped patient: standard Macintosh laryngoscope, intubating laryngeal mask (ILMA), AirTraq optical laryngoscope, and KingVision videolaryngoscope. A group of 30 final-year paramedic students intubated a manikin placed in a sitting position under a desk simulating the roof of a car. Time of endotracheal intubation and success ratio were recorded. The baseline time of intubation was measured in a manikin lying down flat on the ground. The mean time to intubation was 13.9±6.6, 24.7±4.7, 25.2±3.7, and 23.9±4.2 s; the first attempt success ratios for devices were 29/30, 18/30, 6/30, and 18/30; and the baseline time of intubation was 14.3±6.5, 16.7±4.7, 22.9±12.6, and 18.1±5.0 s for ILMA, Macintosh laryngoscope, Airtraq, and KingVision, respectively. In emergency situations with very limited access to the patient, ILMA is the most effective device for intubation by paramedics.

A comparison of conventional tube and EndoFlex tube for tracheal intubation in patients with a cervical spine immobilisation.

BACKGROUND: The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet. The aim of this study was to compare a standard endotracheal tube with the EndoFlex tracheal tube for intubation in patients with simulated cervical spine injury. METHODS: A group of 60 patients without any kind of the cervical spine injury, classified as the ASA physiological scale I or II and qualified for elective surgery procedures were intubated with the use of classical Macintosh laryngoscope, and either a standard endotracheal tube with the intubation stylet in it or EndoFlex tube without stylet. The subjects were randomized into two subgroups. All patients have had the cervical collar placed on their neck for the simulation of intubation procedure in case of the spinal injury. RESULTS: The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs). Time of intubation with the use of EndoFlex tube was similar to that with a the use of standard endotracheal tube and intubation stylet: Me (median) 19.5 s [IQR (interquatile range) 18-50] vs. Me 20 s [IQR 17-60] respectively (p = 0.9705). No significant additional maneuvers were necessary during intubation with the use of EndoFlex tube in comparison with standard endotracheal tube (70% vs. 56.6%) (p = 0.4220). Subjective assessment of the usability of both tubes revealed that more anesthesiologists found intubations with the use of EndoFlex more demanding than intubation with conventional tracheal tube and intubation stylet. The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively. CONCLUSION: In conclusion we asses, that the EndoFlex tube does not improve intubation success rate, in fact it requires more maneuvers facilitating intubation and was found to be more difficult to use.

Comparison of haemodynamic effects of noninvasive ventilation delivered via ResQGARD and CPAP boussignac masks.

UNLABELLED: Noninvasive ventilation (NIV) is a technique of mechanical ventilation which does not require invasive airway management, i.e. intubation or tracheostomy. In emergency medicine Continuous Positive Airway Pressure (CPAP) is used often. A new method of NIV is Impedance Threshold Device (ITD). Breathing through an ITD is utilized to raise blood pressure in hypotensive patients. AIM OF THE STUDY: was to compare haemodynamic effects of NIV ITD and NIV CPAP. MATERIAL AND METHODS: This study involved a group of 25 healthy volunteers. NIV was performed using ResQGARD ITD and CPAP Boussignac. Ventilation time was 25 minutes for each mask in each participant. Every three minutes parameters were collected: SpO2, BP and HR. There was a one hour interval in between ventilation with each mask. CPAP pressure was set at a level of 8 cm H2O and the mean inspiratory resistance of the ITD was 7cm H2O. Collected parameters were subjected to ANOVA statistical analysis. RESULTS: Absolute comparison of BP, HR and SpO2 values did not reveal statistically significant differences between the masks. However considering blood pressure levels at entry, ventilation through an ITD significantly raised BP. Ventilation with NIV CPAP did not change significantly BP. CONCLUSION: Ventilation through an ITD device significantly improve haemodynamic function, whereas CPAP ventilation had no significant effect on it.