Michał Kowalczyk

Emotional sequelae among survivors of critical illness: a long-term retrospective study.

Context Treatment in an ICU can be stressful and traumatic for patients, and can lead to various physical, psychological and cognitive sequelae. Objectives The aim of the study was to assess the influence of the social, economic and working status of individuals in regard to long-term anxiety and depression among ICU convalescents. Design Retrospective, cross-sectional, 5-year survey between 2005 and 2009. Setting The general ICUs of two hospitals in Lublin (Poland): the Teaching Hospital, Medical University of Lublin and the District Hospital. Patients All adults surviving an ICU stay of more than 24 h were eligible. In December 2010, 533 questionnaires were sent to discharged ICU survivors, and 195 (36.6%) were returned. One hundred and eighty-six patients were enrolled in the study. Patients with brain injuries were excluded. Main outcome measures The questionnaire consisted of the Hospital Anxiety and Depression Scale (HADS); questions defining social, economic and working status before and after intensive care stay, health status before intensive care stay, as well as questions about memories and readmissions to intensive care were included. Results According to HADS, 34.4% patients had an anxiety disorder and 27.4% were depressed. There was a strong positive correlation between anxiety and depression (r = +0.726, P < 0.001). Better material and housing conditions correlated with lower anxiety and depression rates. Acute Physiology and Chronic Health Evaluation II scores on admission positively correlated with both anxiety (r = +0.187; P = 0.011) and depression (r = +0.239; P = 0.001). A negative correlation between health status before intensive care admission and HADS scores was observed (anxiety rs = −0.193; P = 0.008; depression rs = −0.227; P = 0.002); better health resulted in less anxiety and depression disorders. Conclusion Adverse social and economic status is associated with higher rates of anxiety and depression following ICU stay.

The differential effects of green tea on dose-dependent doxorubicin toxicity

Background Doxorubicin (DOX) is an anticancer drug displaying cardiac and hepatic adverse effects mostly dependent on oxidative stress. Green tea (GT) has been reported to play a protective role in diseases resulting from oxidative stress. Objective The objective of this study was to evaluate if GT protects against DOX-induced oxidative stress, heart and liver morphological changes, and metabolic disorders. Methods Male Wistar rats received intraperitoneal injection of DOX (1.0 or 2.0 mg/kg b.w.) for 7 weeks or concomitantly GT extract soluble in drinking water. Results There were multidirectional effects of GT on blood metabolic parameters changed by DOX. Among all tested biochemical parameters, statistically significant protection of GT against DOX-induced changes was revealed in case of blood fatty acid–binding protein, brain natriuretic peptide, and superoxide dismutase. Conclusion DOX caused oxidative stress in both organs. It was inhibited by GT in the heart but remained unchanged in the liver. DOX-induced general toxicity and histopathological changes in the heart and in the liver were mitigated by GT at a higher dose of DOX and augmented in rats treated with a lower dose of the drug.

New generation pulse oximetry in the assessment of peripheral perfusion during general anaesthesia — a comparison between propofol and desflurane

BACKGROUND A pulse oximeter is a standard device for perioperative monitoring. It is well known that the early detection of tissue hypoxia is of great importance. It has been made easier due to a new generation pulse oximetry device from Masimo. This enables measurements of the peripheral perfusion index (PI) in real time. It has been found that volatile anaesthetics such as sevoflurane and desflurane increase the perfusion index. As we know, no data is available about perfusion index during propofol/remifentanil total intravenous anaesthesia. METHODS ASA I and II class women scheduled for elective gynaecological surgery were eligible for the study. Patients were divided into two groups: group P receiving propofol/remifentanil intravenous anaesthesia and group D receiving desflurane/fentanyl general anaesthesia. PI was noted before anaesthesia, after remifentanil/fentanyl injection, after endotracheal intubation, at the beginning of surgery, during the procedure at ten minute intervals, at the end of the procedure, after awakening, after extubation and before discharge to the ward. RESULTS Eighty-three patients were enrolled to the study. In both groups, PI increased significantly from the start to the end of surgery. There was a significant correlation between PI and end-tidal desflurane concentration (r = 0.807; P = 0.001). No correlation was found between propofol or remifentanil concentrations and PI. CONCLUSION Both intravenous propofol/remifentanil and desflurane/fentanyl general anaesthesia increase peripheral perfusion. An increase in end-tidal desflurane concentration raises peripheral perfusion.

Carotid surgery affects plasma kynurenic acid concentration: a pilot study.

Background An increase in plasma kynurenic acid (KYNA) concentration has been observed following surgery, inflammation, and cerebral pathologies. The aim of the present study was to analyze the changes in plasma KYNA concentration in patients undergoing carotid surgery (CS). Material/Methods Adult patients undergoing elective carotid endarterectomy (CEA) or carotid angioplasty with stent placement (CAS) were studied. Plasma KYNA concentrations were analyzed before surgery and at 4 time points after CS. The amount of inflammation was measured as neutrophil-lymphocyte ratio (NLR). Results Forty patients (10 female and 30 male) aged 55–86 years of age were evaluated in this study. In patients with unstable carotid plaque, the plasma KYNA concentration was higher than in patients with stable carotid plaque. Moreover, the NLR was significantly higher in patients with unstable carotid plaque undergoing CEA than in patients undergoing CAS. Plasma KYNA concentration increased after surgery in patients undergoing CEA and CAS. There was a strong correlation between plasma KYNA concentration and NLR in patients with postoperative neurological disorders. Conclusions CS increases plasma KYNA concentration, and changes in plasma KYNA concentration can indicate neurologic outcomes in patients undergoing CS.

Tirapazamine has no Effect on Hepatotoxicity of Cisplatin and 5‐fluorouracil but Interacts with Doxorubicin Leading to Side Changes in Redox Equilibrium

Tirapazamine is a hypoxia‐activated prodrug which was shown to exhibit up to 300 times greater cytotoxicity under anoxic in comparison with aerobic conditions. Thus, the combined anticancer therapy of tirapazamine with a routinely used anticancer drug seems to be a promising solution. Because tirapazamine undergoes redox cycle transformation in this study, the effect of tirapazamine on redox hepatic equilibrium, lipid status and liver morphology was evaluated in rats exposed to cisplatin, doxorubicin and 5‐fluorouracil. Rats were intraperitoneally injected with tirapazamine and a particular cytostatic. The animals were killed, and blood and liver were collected. Hepatic glucose, total cholesterol, triglycerides, NADH, NADPH glutathione and the activity of glucose‐6‐phosphate dehydrogenase were determined. Liver morphology and the immune expression of HMG‐CoA‐reductase were also assessed. Glucose, total cholesterol, triglycerides, bilirubin concentrations and the activity of aspartate and alanine aminotransferases were determined in the plasma. Tirapazamine displayed insignificant interactions with cisplatin and 5‐fluorouracil referring to hepatic morphology and biochemical parameters. However, tirapazamine interacts with doxorubicin, thus leading to side changes in redox equilibrium and lipid peroxidation, but those effects are not severe enough to exclude that drug combination from further studies. Thus, tirapazamine seems to be a promising agent in successive studies on anticancer activity in similar schedules.

Intraoperative awareness – comparison of its incidence in women undergoing general anaesthesia for Caesarean section and for gynaecological procedures

BACKGROUND Intraoperative awareness (IA) is diagnosed when patients can recall their surroundings or an event related to the surgery that occurred while they were under general anaesthesia. The female gender and Caesarean section are considered to be contributing factors. The aim of the present study was to analyse the frequency of IA in patients undergoing general anaesthesia either for Caesarean section or gynaecological procedures. METHODS ASA I and II women were included into the study. Patients were randomly allocated to 4 groups: A, B and C included patients qualified for elective gynaecological surgery, and group D comprised Caesarean section patients. Premedication was not given. Group A received total intravenous anaesthesia with TCI, and groups B, C and D received balanced anaesthesia. The depth of anaesthesia was monitored with an AEP monitor. Blinded structured interviews were conducted 2 hours after anaesthesia and on postoperative days 7 and 30. RESULTS 337 patients were enrolled into the study. 45 patients reported diverse sensations connected to the anaesthesia (Group A - 7 patients, B - 9 patients, C - 2 patients, D - 28 patients). There were mainly dream sensations, but IA was present in 3 cases. In all of the cases, IA was recognised during the first interview. One episode of awareness appeared in group B, and the other two appeared in group D. One Caesarean section was complicated by intraoperative haemorrhage. The patient from group B had similar sensations during previous anaesthesia. Two women enrolled in the study reported awareness in the past, which did not occur this time. CONCLUSION Awareness during general anaesthesia occurs occasionally. The frequency of occurrence in a group of patients undergoing general anaesthesia for uncomplicated Caesarean section is not higher than for other procedures. The anaesthesia for Caesarean section, as well as for other procedures, may be accompanied by pleasant dreams.

Stress prevalence and stressors among anaesthesiology and intensive care unit workers: A multicentre survey study

BACKGROUND High stress levels have been commonly reported among ICU workers. Currently, anaesthesiology is safer for the patient but more stressful for the staff working in this branch of medicine. ICU and anaesthesiology personnel are prone to stress because of the specific character of their work. OBJECTIVES Our objectives were to assess stress prevalence among anaesthesiology and ICU workers to compare this stress prevalence in relation to professional groups, sex, job seniority, and type of hospital and describe the importance of major stressors at work. METHODS The ICU and anaesthesiology workers of 15 randomly selected Polish hospitals were surveyed. To assess stress prevalence, the Perceived Stress Scale (PSS-10) was used. The analysis included 544 surveys. RESULTS The examined population was divided into two groups. Group N consisted of 406 nurses (74.60%) and group P of 138 physicians (25.40%). The mean result in the PSS-10 scale for the N group was 19.00 and for the P group 17.00. Both group results were related to a 6 sten score, which implied a medium level of stress. In the N group, the PSS-10 results were significantly higher than in the P group. Women showed higher levels of stress than men. CONCLUSIONS Stress levels among ICU and anaesthesiology personnel were of a medium range. Nurses showed significantly higher levels of stress than physicians. Female personnel showed higher levels of stress than male personnel. Age, job seniority and type of hospital did not have an influence on stress levels. The most stressful circumstances for anaesthesiology and ICU personnel included night shifts and duty overload.

Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.

Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications.

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

Introduction Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device’s utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position. Materials and methods 69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance. Results Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patients position. Conclusions We report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.