Comparison of Different Anesthetic Regimens in Patients Undergoing Laparoscopic Adjustable Gastric Banding Operations: A Prospective Randomized Trial

Background and Objective. Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations. Material and Methods. In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m2), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO2) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO2 in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting. Results. The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3) Conclusions. Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study

Neinvazinė smegenų oksimetrija miego arterijos endarterektomijos metu: pritaikymas ir rezultatai

Background. Cerebral monitoring during carotid endarterectomy allows to detect brain hypoperfusion following carotid clamping and hyperperfusion after restoring the blood flow. Immediate corrections of these changes have the potential in reducing adverse neurologic outcomes. In this study we share our experience using cerebral oximetry in carotid endarterectomy surgery, as well as finding a connection between comorbidities and baseline cerebral oxygenation values. Materials and methods. A non-randomised perspective study was performed at Vilnius University Hospital Santariškių Clinics. During 2012–2013 all consecutive elective patients undergoing carotid surgery were enrolled in the study. Results. No difference was found in the baseline values on the operative and control sides (71.15% vs 76.76%, p = 0.15). After carotid clamping regional brain saturation decreased by 4.34% of the baseline on the operative side. During the clamping cerebral oxygenation was lower on the operative side (68.06% vs 77.32%, p = 0.03). Following carotid declamping the difference between operative and control side oxygenation diminished (73.57% vs 79.30%, p = 0.16). Neither diabetes nor peripheral atherosclerosis had influence on baseline cerebral oxygen saturation values. There was a tendency towards the lower cerebral oxygenation baseline for smokers (70.12% vs 76.54%, p = 0.103). Conclusions. Cerebral oximetry is a valuable method of cerebral monitoring reflecting changes in brain perfusion during carotid endarterectomy. Certain comorbidities might have a role in affecting baseline oximetry values

Causes of suboptimal preoxygenation before tracheal intubation in elective and emergency abdominal surgery

Optimal preoxygenation (PO) prior to tracheal intubation reduces the risk of arterial desaturationand prolongs the period of safe apnoea. The common methods of PO are mask ventilation with100% O2for 3–5 minutes or, alternatively, asking the patient to take eight deep breaths in aminute. Our study group conducted a prospective study to assess the impact of the most com-mon risk factors on PO and to compare the efficiency of PO in patients undergoing elective andemergency abdominal surgery without premedication. PO was performed using mask ventilationwith 6 l/min of 100% oxygen for 5 minutes. End-tidal oxygen (EtO2) was documented in 30-second increments. We found that optimal PO (EtO2> 90%) was not achieved by almost half ofthe patients (46%) and that this was more common in the elective surgery group. Effective POwas not impacted by any of the evaluated risk factors for suboptimal oxygenation. Despite thesefindings, we believe that the identification of potential risk factors is crucial in the pre-anaesthesiastage, given the benefits of optimal PO

Epidural anesthesia in obstetrics: feelings of pregnant women, information sources and willingness to change pain relief method during next childbirth

Objective. The goal of the trial is to evaluate the influence of epidural analgesia on women’s general condition during labour; to determine if women’s level of fear and the amount of information about the pain control are important in choosing the method; to find out women’s opinion about the hospital. Methods. 100 women, who gave birth in the VULSK Obstetrics and Gynecology Centre during Dec. 2013 and Mar. 2014, were asked to fill out an antenatal satisfaction questionnaire. 41 of 100 were given epidural analgesia (1st group) and 59 received intravenous analgesia with fentanyl (2nd group). The following data were collected: women’s age, place of residence, number of births, pain relief method, strength of fear before labour, strength of pain during labour, general condition after giving birth, adverse effects, information sources of pain relief, women’s wishes to change analgesia during next labour..

Use of Magnetic Resonance Imaging in Evaluating Fetal Brain and Abdomen Malformations during Pregnancy

Magnetic resonance imaging (MRI) is used as a clarifying technique after a high-resolution ultrasound examination during pregnancy. Combining ultrasound with MRI, additional diagnostic information is obtained or ultrasound diagnosis is frequently corrected. High spatial resolution provides accurate radiological imaging of internal organs and widens possibilities for detecting perinatal development disorders. The safety of MRI and the use of intravenous contrast agent gadolinium are discussed in this article. There is no currently available evidence that MRI is harmful to the fetus, although not enough research has been carried out to prove enduring safety. MRI should be performed when the benefit outweighs the potential side effects. The narrative review includes several clinical cases of fetal MRI performed in Vilnius University Hospital Santaros Clinics

Sevoflurane and desflurane effects on early cognitive function after low‐risk surgery: A randomized clinical trial

Background and objectives: Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study,we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. Materials and methods: Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia,were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. Results: Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (–2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlatedwith total postoperative score (r = –0.35, p = .007). Conclusions: Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance

Factors affecting return visits to the emergency department within 30 days

Background and Objectives: The goal of this study is to determine the factors associated with the admission to hospital on a return visit to the ED. The reasons of return visits to the ED are complex and involve such causes as disease progression, medical errors, delayed diagnosis, or misdiagnosis. Materials and methods: A retrospective study was conducted in Vilnius University Hospital Santaros Klinikos. All the emergency visits from 1 January 2018 through 20 May 2019 were included. The patients were divided into two groups: the patients who visited the ED only once within a month were attributed to group 1, while those who paid two or more visits to the ED within 30 days belonged to group 2. The demographic data, the triage category, the number of laboratory and radiology tests, specialist consultations, diagnoses and the time spent in the ED were evaluated. The statistical analysis was performed using R statistical software package, non-parametric statistical methods were used. Results: 32,215 patients were included in the analysis, 3,243 patients (10.05%of all the initial visits) returned to the ED within 30 days. The number of laboratory tests had a statistically significant impact on admission to the ward both the first and the return visits. The triage category was associated with the admission on the return visit to the ED. Age, gender, number of consultations and radiology tests had no medium or large impact. Among the diagnoses, cardiovascular, gastrointestinal and renal diseases were related to the admission on return visit. Conclusions: Patients with cardiovascular, gastrointestinal and renal system diseases in all age groups, patients with medical conditions and advanced investigation (the increased number of laboratory testing and the time spent in the ED) have an increased risk for a return visit over a 30-day time frame and an increased rate of hospital admissions

The impact of the pandemic on acute ischemic stoke endovascular treatment from a multidisciplinary perspective: a nonsystematic review

Background: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. Methods: A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. Results: The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. Conclusions: Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients

Current recommendations for airway management techniques in COVID-19 patients without respiratory failure undergoing General anaesthesia: a nonsystematic literature review

Background. Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged, many articles have been published on airway management for coronavirus disease 2019 (COVID-19) patients. However, there is a lack of clear and concise conceptual framework for working with infected patients without respiratory failure undergoing general anaesthesia compared to noninfected patients. The aim of this article is to review current literature data on new challenges for anaesthesia providers, compare standard airway management techniques protocols with new data, and discuss optimisation potential. Materials and methods. Literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: anaesthesia, preoxygenation, airway management, difficult airway, SARS-CoV-2, COVID-19. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 41 articles were chosen for detailed analysis. Summarised and analysed data are presented in the article. Results. SARS-CoV-2 has unique implications for airway management techniques in patients without respiratory failure undergoing general anesthesia. Main differences with the standard practice include: institutional preparedness, team composition principles, necessary skills, equipment, drugs, intubation and extubation strategies. Failed or difficult intubation is managed with predominance of emergency front of neck access (FONA) due to increased aerosol generation. Conclusions. Airway management techniques in COVID-19 patients without respiratory failure are more challenging than in noninfected patients undergoing general anaesthesia. Safe, accurate and swift actions avoid unnecessary time delay ensuring the best care for patients, and reduce risk of contamination for staff. Appropriate airway strategy, communication, minimisation of time for aerosol generating procedures and ramped-up position aid to achieve these goals. During the pandemic, updated available literature data may change clinical practice as new evidence emerges