Hanna Misiołek

The effect of dexmedetomidine sedation on brachial plexus block in patients with end-stage renal disease

Background and objective The study investigated the effect of intravenous dexmedetomidine on brachial plexus block in patients with end-stage renal disease sedated with dexmedetomidine or midazolam for the formation of arteriovenous fistula. Methods A supraclavicular brachial plexus block was performed in 68 patients scheduled for an arteriovenous fistula formation. A successful block was achieved in 64 patients (94%). Sixty-four patients received either dexmedetomidine (loading dose 1 μg kg−1 10 min−1 followed by infusion of 0.2–0.7 μg kg−1 h−1) or midazolam (bolus dose 0.04 mg kg−1 followed by infusion of 0.04–0.08 mg kg−1 h−1). Three patients were excluded during the study. Finally, 61 patients were analysed, 32 in the dexmedetomidine group and 29 in the midazolam group. Administration of the study drug was started after achievement of a complete block. The duration of the motor and sensory block was assessed. Results The motor and sensory block was longer in the dexmedetomidine group (11.9 ± 3.8 vs. 9.4 ± 3.4 h, P = 0.0085 and 9.4 ± 3.4 vs. 7.3 ± 2.8 h, P = 0.030, respectively). Conclusion A systemic administration of dexmedetomidine prolongs the duration of brachial plexus block.

The influence of laser arytenoidectomy on ventilation parameters in patients with bilateral vocal cord paralysis

Bilateral vocal cord paralysis is a symptom that may lead to serious breathing problems. The treatment of patients with vocal cord paralysis presents a challenge to otolaryngologists. Many techniques have been developed in an attempt to improve the patients airway insufficiency. The aim of the study was to evaluate the efficacy of the laser total unilateral arytenoidectomy with posterior cordectomy in patients with bilateral vocal cord paralysis. Thrity-six patients (33 females, 3 male) aged between 24 and 76 (mean 52) were treated by laser arytenoidectomy. The flow-volume loop and pletysmography were performed in all patients before and after the operation. Additionally, a group of 15 patients with unilateral vocal cord paralysis was introduced and analyzed as a special control. Based on the relative increase of the parameters after the surgery, the most useful of them were selected for the evaluation. Also, the character of the laryngeal obstruction was defined. Changes in the flow-volume loop before and after surgery were compared by planned comparison in univariate analysis ANOVA/MANOVA with an isolated control group. As the parameters AREAEX, FEF50, FEF75, PEF and MMEF75/25 increased most effectively, they appeared to be the most useful in the evaluation. FIV1/FEF1, FEF50/FIF50 and FEV1/FEV0,5 allowed the definition of the obstruction as an extrathoracic dynamically variable quantity. The resistances measured during pletysmography diminished significantly after surgery. The introduction of the special control group with unilateral vocal cord paralysis showed that despite the significant improvement after surgery, the patients who had been operated on still had a laryngeal obstruction worse than that of patients from the control group. The laser arytenoidectomy is shown to be a useful and efficacious procedure for bilateral vocal cord paralysis.

The prevalence of burnout syndrome in Polish anaesthesiologists

BACKGROUND Burnout syndrome is a psychological response to chronic work-related stress characterized by low enthusiasm towards the job, high psychological exhaustion, indolence and guilt. Being a medical doctor, both in Poland and in other countries, is one of the most stressful occupations and anaesthesiology is considered one of the most stressful specializations, which justify carrying out of the study on Polish anaesthesiologists. The aim of the study was to determine the prevalence of burnout syndrome in Polish anaesthesiologists METHODS Non-randomized cross-sectional study was carried out and data were gathered through a self-administrated questionnaire. The sample consisted of 373 Polish anaesthesiologists, 57.6% were women and 42.4% were men. A 66% response rate was achieved. The Burnout Syndrome was measured by the Spanish Burnout Inventory. RESULTS The prevalence burnout risk was almost 70%. The percentage of participants who indicated very high levels of burnout was 18%; 5.9% of whom fell into profile 2 considered to be clinical. The instrument applied was reliable with Cronbachs alphas exceeding 0.70. CONCLUSIONS The sample is characterized by high burnout risk with 5.9% of clinical cases. Participation in prevention programs is recommended.

Local Complications after Laser Arytenoidectomy due to Bilateral Vocal Cord Paralysis

Summary The total laser arytenoidectomy is currently one of the most frequent endoscopic procedures in bilateral vocal cord paralysis. The laser introduction in such cases in the early eighties resulted in great advancement. However, the best method – free of complications – does not exist yet. The aim of the study was to analyse the rate, character and reasons of local complications. 40 patients with bilateral vocal cord paralysis were treated in II ENT Department Silesian Medical University. All of them underwent total laser arytenoidectomy with posterior cordectomy due to persistent bilateral vocal cord paralysis. Vocal cord paralysis occurred in 38 patients after thyroidectomy and 2 cases were classified as idiopathic. Among 40 operated patients the local complications appeared in 3 of them (7,5%). After the complications were totally excised in re-operation, a histopathological analysis was done. The significant degree of inflammation responsible for prolonged healing and the appearance of granulation was shown. The presence of the tracheostomy during the healing process is suspected to be a potential reason of this complication. Also, the other factors influencing on healing process were analysed. The necessity of anti-inflammatory prevention during and after the surgery was emphasized. The only complication of laser surgery observed was granulation tissue appearence.

Health-care associated infection in the newly-opened intensive care unit.

BACKGROUND Health-care associated infections (HAI) are common complications in ICU patients as an effect of high invasive device utilization rate. The aim of the study was to analyze the epidemiology of ventilator - associated pneumonia (VAP), blood stream infections (BSI), urinary tract infections (UTI) and surgical site infections (SSI) in newly opened medical-surgical intensive care unit. METHODS VAP, BSI, UTI and SSI were detected and registered by hospital Infection Control Team according to CDC criteria during first 12 months following opening of new ICU. RESULTS During 12-month period HAI was diagnosed in 44 out of 168 patients (26%). The ventilator utilization rate was 72%. The incidence density of VAP was 15.5/1000 ventilator days. The central line utilization was 100%. The BSI rate was 5/1000 catheter days. The urinary catheter utilization was 95%. The UTI rate was 1.9/1000 catheterization days. In 8 out of 60 surgical patients SSI occurred (13%). The most common isolates were Gram negative bacteria. CONCLUSIONS The incidence of VAP was higher than the mean values reported for USA, western Europe and similar to the mean value reported for developing countries. BSI and UTI rate was comparable to those given in NNIS and HELICS reports. Effective prevention strategies should be introduced in order to reduce high VAP rates

Prevalence of burnout in Polish anesthesiologists and anesthetist nursing professionals: A comparative non-randomized cross-sectional study.

The purpose of the study was to assess the burnout levels in nurses (N = 161) versus physicians (N = 373). The levels of burnout were evaluated by the Polish adaptation of the Spanish Burnout Inventory (Cronbach’s alpha > .70). High burnout level was found in 18.63 percent nurses and 12.06 percent anesthesiologists, and critical level in 3.74 percent nurses and 5.90 percent anesthetists. There were statistically significant differences in Burnout global score, Enthusiasm toward the job, Psychological exhaustion, and Indolence subscales between nurses and physicians. No significant differences were found between sexes in any variable.

Objective assessment of pain-related stress in mechanically ventilated newborns based on skin conductance fluctuations

BACKGROUND In the process of intensive care, neonates are exposed to stress and pain related to the repeated therapeutic- diagnostic procedures. The aim of this study was the objective assessment of stress intensity pain while performing selected procedures in neonates in the intensive care unit. METHODS 32 neonates, with a mean body mass of 2,495 g, intubated and mechanically ventilated, and who underwent sedation and analgesia were qualified to the study. A stress reaction to suctioning from endotracheal tube and capillary blood taking for blood gas analysis was evaluated. For the pain stress evaluation, the conductance fluctuation method was used. RESULTS 0.20 oscillations per second during the mechanical ventilation were obtained; during the suctioning, the number of oscillations increased to 0.33. With finger tip puncture, the number of oscillations was 0.35. The mean values obtained in the cases of suctioning and puncture differed significantly from the ones obtained at mechanical ventilation (P < 0.001) and did not differ between one another (P = 0.558). The oscillation proportion ≥ 0.33 s-1 was the lowest during the ventilation and it was significantly different (P < 0.001) from the values obtained at suctioning and finger tip puncture. There were no significant differences between these values. CONCLUSION The measurement of conductivity of the skin as an objective tool to measure pain and discomfort during invasive procedures in neonatal intensive care shows that, despite the use of sedation and analgesia, neonates experience discomfort associated with the selected performance of therapeutic and diagnostic procedures.

Ipsilateral shoulder pain after thoracic surgery procedures under general and regional anesthesia - a retrospective observational study

Background Ipsilateral shoulder pain (ISP) is a common complication of mixed etiology after thoracic surgery (its prevalence is estimated in the literature at between 42% and 97%). It is severe and resistant to treatment (patients complain of pain despite effective epidural analgesia at the surgical site). Aim of the study The aim of this retrospective, observational study was to evaluate the prevalence of ISP in patients operated on in our facility and to determine the risk factors for ISP development. Material and methods 68 patients after thoracotomy or videothoracoscopy (video-assisted thoracic surgery – VATS) conducted under general and regional anesthesia were enrolled in the study and divided into two groups: group I without ISP and group II with postoperative ISP. We recorded age, sex, BMI, duration of surgery, type of surgery, type of regional anesthesia, and, in patients with epidural anesthesia, level of catheter placement. Results Statistically significant differences between the groups were obtained for BMI (24.67 and 27.68, respectively; p = 0.049), type of surgery (24% for thoracotomy and 0% for VATS, p = 0.026), and level of epidural catheter placement (4.35% for catheters placed at the level of Th5 or higher and 40.47% for catheters placed below Th5; p = 0.003). Conclusions The prevalence of ISP in our medical center amounts to 24% of thoracotomy patients. The fact that the difference in ISP prevalence was significantly related to the level of epidural catheter placement is consistent with the theory that ISP is related to phrenic nerve innervation. Moreover, epidural catheter placement is a modifiable factor, which can be used to reduce the prevalence of post-thoracotomy ISP.

Electrical impedance tomography for diagnosis and monitoring of pulmonary function disorders in the intensive care unit — case report and review of literature

The aim of this paper is to describe the possibility of using Electrical Impedance Tomography (EIT) as a treatment monitoring tool in the ICU. It was based on case report and literature review. A 19-year-old female was admitted to ICU due to severe acute respiratory distress syndrome. Despite aggressive treatment there was no improvement. We decided to use EIT in the monitoring of treatment because of difficulties in transporting the patient to the radiology department in order to perform a control CT scan. After identifying the causing factor (Pneumocyctis jiroveci), EIT monitoring was maintained to assess the effectiveness of targeted microbial treatment. In the following days, we observed an improvement of regional ventilation of the upper and middle segments of the left lung that corresponded well with laboratory test results, especially arterial blood gas analysis. The use of Electrical Impedance Tomography enables non-invasive, bedside, continuous assessment of regional lung ventilation. It is possible to use it in both mechanically ventilated and spontaneously breathing patients. It allows efficient and dynamic monitoring of the course of the therapeutic process. Interpretation of the results is relatively easy to learn and does not require specialist knowledge. Moreover, it is possible to use EIT in those cases where other methods are of high risk or contraindicated.

The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients

BACKGROUND While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses. OBJECTIVES The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period. MATERIAL AND METHODS The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales. RESULTS The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I). CONCLUSIONS The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.