The influence of dexmedetomidine on opioid consumption in radical prostatectomy

Objective. Multimodal analgesia and analgesics with different modes of action can reduce perioperative opioid demand and their undesirable side effects. In our study we presumed that patients anesthetised with additional perioperative dexmedetomidine infusion, during radical prostatectomy, would need less opioids during and after surgery compared to the control group. Materials and methods. 40 patients, 18-80 years of age, ASA class 1-3 (American Society of Anesthesiologists), scheduled for radical prostatectomy, were included in the study. Patients were randomly divided into two groups (20 pts in each group). In both groups, fentanyl in repeated boluses was used as an analgesic; in the studied group, an additional infusion of dexmedetomidine (0.3 μg/kg/h) was started with intravenous line insertion and continued until the beginning of wound closure. Analgesic consumption during the operation, in the post-anaesthesia care unit, in the Intensive Care Unit on the day of the operation and on the first postoperative day was recorded. Results. The patients with perioperative dexmedetomidine infusion were slightly younger (p=0.007), also the duration of their surgery was shorter (p =0.05). Differences in opioid consumption between the groups were not found. Also, pain assessment, by visual analogue scale (VAS) after 12, 18, 24, 30, 36 and 42 hours, was not statistically different between groups. Conclusion. In our study, perioperative dexmadetomidine did not reduce periand postoperative opioid consumption. Also, undesirable dexmedetomidine side effects, such as bradycardia and hypotension, were not observed

Influence of conjugated linoleic acid on the porcine immune response and morbidity: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Conjugated linoleic acid (CLA) has diverse influences on the immune response in different experimental models. In the present study we investigated the effect of CLA feeding on inflammatory and immune responses in a piglet model. We studied the duration of this effect and possible detrimental effects of CLA feeding. After 12 weeks of CLA and control supplementation and washout, animals were sacrificed and parenchymal organs were histologically examined.</p> <p>Results</p> <p>In activated peripheral mononuclear cells interferon-γ was significantly (p = 0.008) lower in the CLA group by the end of the feeding period. This effect disappeared as soon as supplementation was stopped. No differences were found in the tumour necrosis factor-α, interleukin-10 production, serum immunoglobulin-G levels and fat infiltration of the liver, except that fat storage cell infiltration was significantly (p < 0.04) higher in the CLA-fed group. The effect of time for interferon-γ, interleukin-10 and immunoglobulin-G levels was statistically significant.</p> <p>Conclusion</p> <p>At the end of the feeding period the interferon-γ response was depressed. However, the maturation of the piglet immune system in our young pig model probably outweighs the impact of CLA feeding on the immune response, even though liver fat storage cell infiltration, which plays an important role in liver regeneration, increased during CLA feeding of the piglets.</p

Fluid optimisation in pancreas surgery

Background. Optimal intravascular blood volume, cardiac output and sufficient oxygen supply is a mainstay in major abdominal surgery. Adequate haemodynamic management can improve a favourable outcome and shorten the duration of hospital stay. Our study anticipated different fluid and vasoactive drug consumption and less complications during the pancreatic surgery in the group of patients where extended haemodynamic monitoring was applied. Materials and methods. 59 adult patients, ASA 2-3, undergoing elective pancreas surgery, were included in the study. In 29 patients in the study group (SG – extended haemodynamic monitoring), cardiac index (CI), mean arterial pressure (MAP) and nominal stroke index (SI) were maintained within 80% of baseline values with actions following study protocol. Patients’ groups were homogenous, even when divided into 4 subgroups (control group (CG) and without epidural catheter (EC), CG and with EC, SG and without EC, SG and with EC). Intraoperative variables (amount of fluids, vasopressors, surgery duration) and hospitalisation duration, wound healing, reoperation, mortality and other complication were recorded on the postoperative days 3, 5, 8, 15 and on hospital discharge. Results. There was no difference in ASA health status, intraoperative management and duration of hospitalisation in 4 subgroups. There is a significant difference in intraoperative use of vasopressor support between 4 subgroups (Fisher exact test, p=0,032). All patients in SG with EC required vasopressors. Number of patients with major complications were not statistically different between groups. Pulmonary embolism, postoperative food intolerance and myocardial infarction have occurred only in CG. Conclusion. In our study there was no difference in overall fluid and vasoactive drug demand. Although in the studied subgroup of patients with additional epidural anaesthesia there was significantly increased demand for vasoactive drugs. The incidence of complication was low in both groups, however, some of major complications occurred only in CG

Primjena rekombiniranog aktiviranog faktora VIIa u šestomjesečnog djeteta zbog opsežnog krvarenja tijekom elektivne operacije karcinoma koroidnog spleta: prikaz slučaja

We present the use of recombinant activated factor VIIa (rFVIIa) in a 6-month-old infant that suffered massive bleeding and subsequent coagulation disturbances during elective surgery for choroid plexus carcinoma in the lateral ventricle. The administration of rFVIIa resulted in good hemostasis. No intra- or postoperative thromboembolic complications were observed.U radu prikazujemo primjenu rekombiniranog aktiviranog faktora VIIa (rFVIIa) u šestomjesečnog djeteta koje je pretrpjelo opsežno krvarenje s posljedičnim poremećajem zgrušavanja tijekom elektivne operacije karcinoma koroidnog spleta lateralne moždane komore. Primjena rFVIIa rezultirala je dobrom kontrolom zgrušavanja. Tijekom operacije i u poslijeoperacijskom tijeku nisu primijećene tromboembolijske komplikacije

Primjena rekombiniranog aktiviranog faktora VIIa u šestomjesečnog djeteta zbog opsežnog krvarenja tijekom elektivne operacije karcinoma koroidnog spleta: prikaz slučaja

We present the use of recombinant activated factor VIIa (rFVIIa) in a 6-month-old infant that suffered massive bleeding and subsequent coagulation disturbances during elective surgery for choroid plexus carcinoma in the lateral ventricle. The administration of rFVIIa resulted in good hemostasis. No intra- or postoperative thromboembolic complications were observed.U radu prikazujemo primjenu rekombiniranog aktiviranog faktora VIIa (rFVIIa) u šestomjesečnog djeteta koje je pretrpjelo opsežno krvarenje s posljedičnim poremećajem zgrušavanja tijekom elektivne operacije karcinoma koroidnog spleta lateralne moždane komore. Primjena rFVIIa rezultirala je dobrom kontrolom zgrušavanja. Tijekom operacije i u poslijeoperacijskom tijeku nisu primijećene tromboembolijske komplikacije

Position statement of the Slovenian society of anaesthesiology and intensive care medicine on the use of sugammadex

We present our position statement for the use of sugammadex, a specific binder for aminosteroid muscle relaxants, in the most common clinical circumstances (in the case of an emergency intubation, when the patient cannot be ventilated or intubated; in patients with neuro-muscular disease, in patients with liver failure, in patients with renal failure, in patients with allergic reaction to sugammadex or to rocuronium, in cases of residual muscle relaxation and when we have to use a muscle relaxant short time after sugammadex application). Sugammadex is the drug of choice in cases of cardiac arhythmia, COPD, asthma, neuro-muscular diseases, pathological obesity, intraoperative use of continuous infusion of aminoglycoside muscle relaxants. It is therefore necessary to control the neuro-muscular block during surgery due to different response of patients to the muscle relaxant. Clinical tests alone are not an adequate substitute for objective control of muscular strength recovery

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Eksploracijska primerjava dveh metod invazivnega zdravljenja lumboishialgije

Izhodišča: Bolečina v križu je zelo pogosto stanje, vendar zanjo pogosto ne najdemo jasnega vzroka. Poleg farmakoloških in nefarmakoloških ukrepov jo zdravimo tudi z invazivnimi pristopi. Primerjali smo razlike glede jakosti, kakovosti bolečine, porabe analgetikov ter kakovosti življenja med skupinama bolnikov z blokado prožilnih točk in rentgensko vodeno blokado na dan posega, po enem in treh mesecih po blokadi. Metode: V prospektivno randomizirano raziskavo smo vključili 45 bolnikov s kroničnimi bolečinami v križu, pri katerih smo se odločili za invazivni pristop k zdravljenju. Bolnike smo razdelili v dve skupini glede na vrsto blokade. S pomočjo McGillovega vprašalnika o bolečini in Kratkega vprašalnika o bolečini smo na dan posega, nato po 1 mesecu in 3 mesecih ocenili kakovost bolečine, jakost bolečine, kakovost življenja in porabo analgetikov. Rezultati: Skupini sta primerljivi v demografskih podatkih, statusu zaposlenosti in porabi analgetikov. Pri bolnikih z ledveno blokado prožilnih točk je bil statistično pomembno nižji časovni potek bolečine po McGillovem vprašalniku po 1 mesecu in 3 mesecih (po 1 mesecu: 3,8 vs. 5,7; p = 0,01; po 3 mesecih 3,8 vs. 5,5; p = 0,01). Bolniki v tej skupini so po 1 mesecu statistično pomembno lažje hodili (5,9 vs. 7,4; p = 0,03). Vpliv bolečine na kakovost življenja je bil 1 mesec po blokadi prožilnih točk statistično pomembno manjši v primerjavi z rentgensko vodeno blokado (40,9 vs. 48,3; p = 0,04), po 3 mesecih pa se v obeh skupinah primerljivo pozna ugoden učinek blokade (40 vs. 45,6; p = 0,2). Kakovost spanja se je v skupini z rentgensko vodeno blokado pomembno izboljšala po 1 mesecu po blokadi (7,1 vs. 5,1; p = 0,01). Zaključek: Naša raziskava prvič v Sloveniji primerja učinkovitost blokade prožilnih točk in rentgensko vodene blokade mediane veje zadnje veje spinalnega živca. Tudi v literaturi nismo našli podobnih raziskav. V naši raziskavi smo ugotovili izboljšano kakovost spanja pri skupini z rentgensko blokado; v tej skupini je bil tudi manjši vpliv bolečine na kakovost življenja. Izboljšanje kakovosti življenja smo opazovali tudi pri skupini z blokado prožilnih točk