Znieczulenie do cięcia cesarskiego u rodzących z łożyskiem przodującym z/bez łożyska wrośniętego – badanie retrospektywne

Objectives: The aim of this retrospective study was to review placenta previa cases and determine the prognostic factors effective on morbidity and mortality and to evaluate the strategy of anesthetic management. Material and methods: 65 women with placenta previa scheduled for elective or emergency cesarean sections from 2004 to 2009 were examined. Patient demographic data, surgery and obstetric characteristics, anesthetic techniques, blood transfusions, the values of hemoglobin and complications were recorded. Results: Mostly, general anesthesia was preferred in the parturients with placenta previa (86.2%, 56/65). 9 patients (13.8%), 2 of whom were converted to general anesthesia due to bleeding and prolonged surgery, received regional anesthesia. 37 of 65 women (56.9%) with placenta previa had had cesarean sections previously. More than half of these patients (21/37, 56.7%) had abnormally invasive placentation and 16 of 21 cases underwent cesarean hysterectomy. The incidence of complications in women with previous cesarean section with abnormally invasive placentation was higher than in the other women (pCel pracy: Celem tego retrospektywnego badania była analiza przypadków łożyska przodującego pod kątem oceny czynników prognostycznych wpływających na zachorowalność i śmiertelność oraz ocena postępowania anestezjologicznego. Materiał: Przeanalizowano 65 przypadków kobiet z łożyskiem przodującym zakwalifikowanych do elektywnego lub pilnego cięcia cesarskiego w latach 2004-2009.Zebrano następujące dane: demograficzne, wywiad operacyjny i położniczy, techniki anestezjologiczne, transfuzje krwi, poziomy hemoglobiny i powikłania. Wyniki: Preferowaną metodą znieczulenia u rodzących z łożyskiem przodującym było znieczulenie ogólne (86,2%; 56/65). Przewodowe znieczulenie otrzymało 9 pacjentek (13,8%) ale u 2 z nich trzeba było przejść na znieczulenie ogólne z uwagi na krwawienie i przedłużony czas operacji. 37 z 65 kobiet (56,9%) z łożyskiem przodującym miało cięcie cesarskie w poprzedniej ciąży. Więcej niż połowa tych pacjentek (21/37, 56,7%) miała nieprawidłowo utworzone łożysko a 16 z 21 przeszło histerektomię położniczą. Częstość powikłań u kobiet po cięciu cesarskim w wywiadzie i z nieprawidłowo utworzonym łożyskiem w analizowanym materiale była wyższa niż u innych pacjentek (

Investigation of Cancer Patients' Information Sources, Information Needs and Expectations of Health Professionals

Objectives: The aim of this study is to investigate cancer patients' information sources, information needs and expectations from health care professionals.Methods: This is a descriptive study. The most commonly used cancer blog users in Turkey participated in the study. The sample of study consisted of 120 cancer patients. Patients' expectations from health care form, which was composed by investigators based on literature, was used for data collection instrument.Results: While 82.5% of the participants obtained disease-related information from physicians, 70.8% obtained it from the internet. However, 97.5% of the patients wanted to get information from physicians, and 39.2% wanted to get information from nurses. Of the patients, 19.2% considered the medical staff's communication with patients as sufficient, 45.8% as partially sufficient, and 35.0% as insufficient. The patients expected physicians to provide information about the disease and treatment, to understand them to communicate with them better, to provide emotional support, to be helpful during the decision-making process about the disease and treatment, to respect them and to allocate more time to listen to them. The patients expected nurses to understand them, to respect them, to communicate with them better, and to provide better care and emotional support. The patients wanted the healthcare professionals to inform them about treatment and its side effects, the probability of recurrence of the disease, the effects of the disease on their psychological state, prognosis, duration of the treatment and what the disease is and what causes the disease.Conclusion: It is important to give information and support to the patients at all stages of disease. To determine information needs and requirements of the patients and to plan education can reduce the anxiety of patients during treatment process. Health care personnel must pay more attention to communicate with patients in the care of cancer patients. In addition, health professionals should be aware of the information sources used by patients

The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain for gynecologic laparoscopic surgery: A Prospective Randomized Study

Laparoscopy surgery has been associated with less postoperative pain, less systemic immunological depression, less wound infection, shorter hospital stays and earlier return to normal activities. However, the hemodynamic changes caused by pneumoperitoneum, patient's position and hypercarbia have always been a concern for surgeon and anesthesiologists. Hypercarbia and increased intraabdominal pressure affect cardiac output, central venous pressure, heart rate (HR), mean blood pressure (MBP) and systemic vascular resistance through various mechanisms in laparoscopic surgery. The hemodynamic effects of mild hypercarbia are less serious than the mechanical effects of increased intraperitoneal pressure, although moderate and severe hypercarbia lead to significant hemodynamic changes, both directly by the cardiovascular system and indirectly by the autonomic system. Its effects on the sympathetic nervous system cause increased blood pressure, heart rate and risk of arrhythmia. Especially, patients with cardiac or pulmonary diseases are at increased risk because of reduced cardiac output, increased central venous pressure, respiratory pressure and acidosis [1-4]. Standard carbon dioxide (CO2) is often preferred at room temperature (20–25°C) and dry (at 0-5% relative humidity) in laparoscopic surgery [5,6]. Recent years have witnessed devices that provide heat (35-37°C) and humidity (95-98%) to prevent postoperative pain and intraoperative hypothermia. However, the number of studies on the effects of heated CO2 on hemodynamic and respiratory parameters is limited [7-9], and these studies do not include humidified CO2. We aimed to test whether heated (37°C)-humidified (95%) CO2 would diffuse more easily into the blood from the abdomen and cause more hypercarbia compared to standard CO2 in cases with constant intraabdominal pressure and whether it would affect hemodynamic, given the vasodilation that could occur, and respiratory parameters. Although laparoscopy surgery is known to cause less systemic inflammation, some studies have reported that the use of standard CO2 during laparoscopy led to a higher local or systemic inflammatory response compared to heated-humidified CO2. This response has been stated to be particularly due to drying and damage in the peritoneum and has been associated with postoperative pain [4,5,10]. The second aim of this study was to examine simple indicators of inflammation, i.e., leukocyte and their subtype (neutrophil and lymphocyte counts) and neutrophil-lymphocyte ratios (NLRs) [11-14] in standard CO2 and heated-humidified CO2 and to evaluate their correlation with postoperative pain., and to evaluate their correlation with postoperative pain

The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain for gynecologic laparoscopic surgery: A Prospective Randomized Study

Laparoscopy surgery has been associated with less postoperative pain, less systemic immunological depression, less wound infection, shorter hospital stays and earlier return to normal activities. However, the hemodynamic changes caused by pneumoperitoneum, patient's position and hypercarbia have always been a concern for surgeon and anesthesiologists. Hypercarbia and increased intraabdominal pressure affect cardiac output, central venous pressure, heart rate (HR), mean blood pressure (MBP) and systemic vascular resistance through various mechanisms in laparoscopic surgery. The hemodynamic effects of mild hypercarbia are less serious than the mechanical effects of increased intraperitoneal pressure, although moderate and severe hypercarbia lead to significant hemodynamic changes, both directly by the cardiovascular system and indirectly by the autonomic system. Its effects on the sympathetic nervous system cause increased blood pressure, heart rate and risk of arrhythmia. Especially, patients with cardiac or pulmonary diseases are at increased risk because of reduced cardiac output, increased central venous pressure, respiratory pressure and acidosis [1-4]. Standard carbon dioxide (CO2) is often preferred at room temperature (20–25°C) and dry (at 0-5% relative humidity) in laparoscopic surgery [5,6]. Recent years have witnessed devices that provide heat (35-37°C) and humidity (95-98%) to prevent postoperative pain and intraoperative hypothermia. However, the number of studies on the effects of heated CO2 on hemodynamic and respiratory parameters is limited [7-9], and these studies do not include humidified CO2. We aimed to test whether heated (37°C)-humidified (95%) CO2 would diffuse more easily into the blood from the abdomen and cause more hypercarbia compared to standard CO2 in cases with constant intraabdominal pressure and whether it would affect hemodynamic, given the vasodilation that could occur, and respiratory parameters. Although laparoscopy surgery is known to cause less systemic inflammation, some studies have reported that the use of standard CO2 during laparoscopy led to a higher local or systemic inflammatory response compared to heated-humidified CO2. This response has been stated to be particularly due to drying and damage in the peritoneum and has been associated with postoperative pain [4,5,10]. The second aim of this study was to examine simple indicators of inflammation, i.e., leukocyte and their subtype (neutrophil and lymphocyte counts) and neutrophil-lymphocyte ratios (NLRs) [11-14] in standard CO2 and heated-humidified CO2 and to evaluate their correlation with postoperative pain., and to evaluate their correlation with postoperative pain

Students' Locus of Control and Problem-Solving Skills

Purpose The purpose of this study is to compare the locus of control and problem-solving skills of nursing students studying with the problem-based learning method with those of nursing students studying with the traditional method. Methods This is a descriptive and comparative study. For data collection, the Problem-Solving Skills Inventory and the Locus of Control Scale were used. The study sample included 680 nursing students. Conclusions It was determined that the problem-based learning method was more effective in the development of problem-solving skills and internal locus of control than was the traditional method. Amac Bu calmann amac probleme dayal orenme modeliyle ve geleneksel yontemle eitim goren hemirelik orencilerinde problem cozme becerileri ve kontrol odann karlatrlmasdr. Yontem Aratrma tanmlayc ve karlatrmaldr. Veri toplamada Problem Cozme Becerileri Envanteri ve Kontrol Oda olcei kullanlmtr. Aratrmann orneklemini 680 hemirelik orencisi oluturmutur. Sonuc Probleme dayal orenme modelinin geleneksel modele gore problem cozme becerilerini ve ic kontrol odan gelitirilmesi yonunden daha etkili olduu belirlenmitir

A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean ection: Prospective, double-blinded study

PubMed ID: 21298294Purpose Levobupivacaine may produce a sensory and motor block different from that produced by bupivacaine, which is the most popular local anesthetic in parturients undergoing cesarean section. The aim of this study was to investigate the block characteristics, the clinical efficacy, surgeon and patient satisfaction, and hemodynamic effects of using different doses of intrathecal plain levobupivacaine combined with fentanyl. Methods One hundred twenty women undergoing elective cesarean section with a combined spinal-epidural technique were enrolled. The parturients were randomly assigned to receive one of the following: levobupivacaine 5 mg (group 5), 7.5 mg (group 7.5) or 10 mg (group 10), all combined with fentanyl 25, 15 or 10 µg, respectively. Results Anesthesia was effective in 60, 82.5 and 100% of the patients in the levobupivacaine 5, 7.5 and 10 mg groups, respectively. Levobupivacaine 10 mg provided longer durations of analgesia and motor block and greater patient and surgeon satisfaction, although the incidence of hypotension was lower in groups 5 and 7.5 than in group 10 (12.5, 17.5 and 42.5%, respectively). Intraoperative epidural supplementation was higher in group 5 than in group 7.5 (40 and 17.5%, respectively), whereas no patients in group 10 were given an epidural bolus dose. Conclusions The incidence of hypotension was higher in the levobupivacaine 10 mg group, even though this group presented more effective anesthesia and greater patient and surgeon satisfaction compared with the levobupivacaine 5 and 7.5 mg groups. As a result, we believe that levobupivacaine 7.5 mg combined with fentanyl 15 µg is suitable for combined spinal-epidural anesthesia in elective cesarean section. © 2011 Japanese Society of Anesthesiologists