Unilateral bupivacaine-fentanyl or bupivacaine-sufentanil spinal anaesthesia for arthroscopic knee surgery

Background and purpose: Unilateral spinal anaesthesia provides high cardiovascular stability and short ambulatory stay. Intrathecal coadministration od local anaesthetics and opioids has potent synergistic analgesic effect. We compared unilateral hyperbaric bupivacaine spinal anaesthesia with fentanyl or sufentanil in patients undergoing knee arthroscopy. Materials and methods: 40 ASA I-II adults received unilateral spinal anaesthesia with hyperbaric bupivacaine 4mg coadministered with either fentanyl 20μg (Group F,n=20) or sufentanil 2 μg (Group S, n=20). Sensory and motor block, hemodynamic data, side-effects and time to first analgesic were recorded. Results: Anaesthesia was successful in all 40 patients. Upper level of sensory block on operative leg was Th12 (Th12-Th8) in Group F and Th12 (Th11-Th9) in Group S, P=0.89. Complete motor block had 5 (25%) Group F and 3 (15%) Group S patients, P=0.69. uration of motor block was 78 ± 15 and 77 ± 13 min in Group F and Group S, respectively, P=0.89. Maximum decrease of baseline systolic arterial pressure was 16 ± 9 in Group F and 17 ± 7% in Group S, P=0.81 and of HR 16 ± 7 and 16 ±8%, P=0.90, respectively. Time to first analgesic was 285 ± 123 min in Group F and 355 ± 110 min in Group S, P=0.04. Pruritus had 7 (35%) Group F and 5 (25%) Group S patients, P=0.73. Conclusions: Unilateral hyperbaric bupivacaine spinal anaesthesia with fentanyl or sufentanil resulted in similar sensory and motor block and cardiovascular stability but bupivacaine-sufentanil combination provided prolonged first analgesic tim

Comparison of general and spinal anaesthesia in patients undergoing open ventral hernia repair

Background and Purpose: Ventral hernioplasty is common intervention that can be performed under general or regional anaesthesia. We compared TIVA and spinal anaesthesia in patients undergoing elective open ventral hernia repair. Materials and Methods: Forty ASA I–II adults received either TIVA with propofol, midazolam, fentanyl and rocuronium (group GA, n=20) or spinal anaesthesia (L3–L4) with hyperbaric bupivacaine 0.5% 10mg+ sufentanil 10 mg (group SPA, n=20).Hemodynamic data, pain scores, time to first analgesic and side-effects were recorded. Results: Ventral hernia was umbilical in 6, supraumbilical in 6 and infraumbilicall in 8 group GA and in 7, 6 nad 7 group SPA patients, respectively, P>0.05. Maximum decrease of systolic arterial pressure (SAP) was 10±6 inGA and 21±6% in SPA group, P0.05, respectively. Pain scores at 0, 2, 4 and 8 h after surgery were 4 (2–6), 5 (2–7), 5 (1–6) and 4 (2–6) in GA and 0, 0, 0 (0–2) and 1 (0–3) in SPA group, respectively, P0.05. Time to first analgesic was 28±10 inGA and 580±138 min in SPA group, P<0.001. Postoperative nausea and vomiting (PONV) had 7 (35%) group GA and 1 (5%) group SPA patients, P<0.05. Conclusions: General anaesthesia resulted in more stable hemodynamic profile but spinal anaesthesia provided better postoperative pain control and less PONV in patients undergoing open ventral hernia repair

Unilateral spinal anaesthesia for varicose vein surgery: a comparison of hyperbaric bupivacaine 7.5 mg versus hyperbaric bupivacaine 5 mg + fentanyl 25 μg

Background and Purpose: Unilateral spinal anaetshesia restricts the distrubution of spinal block preferentially to the operative side. Intrathecal coadministration of opioids increases sensory block without enhancing motor or sympathetic block. In this study we compared unilateral hyperbaric bupivacaine spinal anaesthesia with or without fentanyl in patients undergoing varicose vein surgery. Material and Methods: 40 ASA I-II adults randomly received unilateral spinal anaestehsia with hyperbaric bupivacaine 7.5 mg (Group B, n=20) or hyperbaric bupivacaine 5 mg+ fentanyl 25mg (Group BF, n=20). Sensory and motor block, hemodynamic data and side-effects were recorded. Results: Maximum level of sensory block on operative leg was Th11 (Th12-Th8) in Group B and Th12 (Th12-Th10) in Group BF, P=0.09. Complete motor block had 12 (60%) Group B and 4 (20%) Group BF patients, P=0.02. Total regression of motor block required 127 ± 31 min in Group B and 87 ± 18 min in Group BF, P<0.001. Maximum decrease of systolic arterial pressure from start value was 19 ± 9% in Group B and 16± 6% in Group BF, P=0.32 and of heart rate 23 ± 10% and 17 ± 7%, P=0.06, respectively. Pruritus had 9 (45%) Group BF patients, P=0.001. Conclusion: Unilateral hyperbaric bupivacaine 5mg+fentanyl 25 mg spinal anaesthesia provides adequate intraoperative sensory block in operated leg and results in similar cardiovascular stability, less intense motor block and faster motor recovery than unilateral hyperbaric bupivacaine 7.5 mg spinal anestehesia in patients undergoing varicose vein surgery

Učinak niske doze preemptivnog intravenskog magnezij sulfata na ranu poslijeoperacijsku bol nakon laparoskopske kolecistektomije

As an N-methyl-D-aspartate antagonist, magnesium sulfate has analgesic properties and reduces noxious input during surgery. The aim of the study was to determine the effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. In this prospective, randomized study, 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were assigned to three groups (n=20 each). After anesthesia induction, prior to surgical incision, patients received magnesium sulfate 5.0 mg/kg (group A), magnesium sulfate 7.5 mg/kg (group B) or saline intravenously (group C). General anesthesia was performed with the same drugs in all three groups. Postoperative pain intensities at rest, according to the visual analog scale (VAS 0-10), were evaluated at 1, 3, 6, 9 and 24 hours after surgery. According to the VAS scores, patients intravenously received metamizol 2.5 g (VAS 3-4), diclofenac 75 mg (VAS 5-7) or tramadol 1 mg/kg (VAS 8-10). VAS scores at 1 hour postoperatively were significantly lower in groups A (4.7±1.7; p<0.05) and B (3.2±1.8; p<0.01) than in group C (5.2±2.0). At 3 hours postoperatively, VAS score was significantly lower in group B (2.4±1.5) than in group A (3.7±1.8) or group C (3.8± 2.3) (p<0.05). After 6, 9 and 24 hours postoperatively, there were no differences in VAS scores among the groups. In conclusion, preemptive intravenous administration of both 5.0 mg/kg and 7.5 mg/kg of magnesium sulfate significantly reduced early postoperative pain after laparoscopic cholecystectomy, but 7.5 mg/kg was found to be more effective. There was no effect on pain reduction at 6, 9 and 24 hours after surgery and no adverse effects were recorded.Magnezij sulfat kao antagonist N-metil-D-aspartata ima analgetski učinak i smanjuje osjet boli tijekom operacijskog zahvata. Cilj ove studije bio je odrediti učinak preemptivne intravenske primjene male doze magnezij sulfata na bol u ranom poslijeoperacijskom tijeku nakon laparoskopske kolecistektomije. U ovom prospektivnom randomiziranom istraživanju 60 bolesnika ASA I-II koji su podvrgnuti laparoskopskoj kolecistektomiji podijeljeno je u tri skupine po 20 bolesnika. Nakon uvoda u anesteziju, a prije kirurškog reza, bolesnici su intravenski dobili 5 mg/kg magnezij sulfata (skupina A), 7.5 mg magnezij sulfata (skupina B) ili fiziološku otopinu (skupina C). Intenzitet poslijeoperacijske boli je ocijenjen vizualnom analognom skalom (VAS 0-10) 1, 3, 6, 9 i 24 sata nakon operacijskog zahvata. Na osnovi zbroja VAS bolesnici bi intravenski primili metamizol 2,5 mg (VAS 3-4), diklofenak 75 mg (VAS 5-7) ili tramadol 1 mg/kg (VAS 8-10). Zbrojevi VAS su prvog poslijeoperacijskog sata bili značajno niži u skupini A (4,7±1.7; p<0,05) i skupini B (3,2±1,8; P<0,01) nego u skupini C (5,2±2,0). Tri sata nakon operacijskog zahvata zbroj VAS u skupini B (2,4±1,5) je bio značajno niži nego u skupini A (3,7±1,8) ili skupini C (3,8±2,3) (P<0,05). Nakon 6, 9 i 24 sata nije bilo razlike među skupinama. U zaključku, preemptivna intravenska primjena 5,0 i 7,5 mg/kg magnezij sulfata značajno smanjuje poslijeoperacijsku bol nakon laparoskopske kolecistektomije, ali je 7,5 mg/kg bilo učinkovitije

Experiences and attitudes of medical professionals on treatment of end-of-life patients in intensive care units in the Republic of Croatia: a cross-sectional study

BACKGROUND: Decisions about limitations of life sustaining treatments (LST) are made for end-of-life patients in intensive care units (ICUs). The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia. METHODS: A cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor analysis was conducted to reduce data to a smaller set of summary variables. Mann–Whitney U test was used to analyse the differences between two groups and Kruskal–Wallis tests were used to analyse the differences between more than two groups. RESULTS: Less than third of participants (29.2%) stated they were included in the decision-making process, and physicians are much more included than nurses (p < 0.001). Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that ‘do-not-attempt cardiopulmonary resuscitations’ orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient’s wishes then nurses with high school education (p = 0.038). Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs (p < 0.001, p = 0.005, p = 0.023 respectively). Male participants in comparison to female (p = 0.002), and physicians in comparison to nurses with high school and college education (p < 0.001) displayed more liberal attitudes about LST limitation. CONCLUSIONS: DNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia’s geographical location in Southern Europe. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12910-022-00752-5

Nonelective surgery at night and in-hospital mortality - Prospective observational data from the European Surgical Outcomes Study

BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care. DESIGN A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study). SETTING Four hundred and ninety-eight hospitals in 28 European countries. PATIENTS Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure. INTERVENTION None. MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission. RESULTS Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)]. CONCLUSION In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed