Przemysław Jałowiecki

Sole Use of Dexmedetomidine Has Limited Utility for Conscious Sedation during Outpatient Colonoscopy

Background:This study evaluated the ability of dexmedetomidine to provide analgesia and sedation for outpatient colonoscopy, examining outcomes including cardiorespiratory variables, side effects, and discharge readiness. Methods:Sixty-four patients were randomly assigned to one of three treatment regimens. In group D, patients received 1 &mgr;g/kg dexmedetomidine over 15 min followed by an infusion of 0.2 &mgr;g · kg−1 · h−1. Group P received meperidine (1 mg/kg) with midazolam (0.05 mg/kg), and group F received fentanyl (0.1–0.2 mg intravenous) on demand. The assessment included measurements of heart rate, blood pressure, oxygen saturation, respiratory rate, quality of sedation/analgesia, and an evaluation of the recovery time. Results:The study was terminated before the planned 90 patients had been recruited because of adverse events in group D. In all groups, negligible hemoglobin oxygen saturation and respiratory rate variations were observed. In group D, there was a significantly larger decrease in heart rate (to approximately 40 beats/min in 2 of 19 cases) and blood pressure (to less than 50% of the initial value in 4 of 19 patients). Supplemental fentanyl was required in 47% of patients receiving dexmedetomidine to achieve a satisfactory level of analgesia (vs. 42.8% of patients in group P and 79.2% of patients in group F). Vertigo (5 patients), nausea/vomiting (5 patients), and ventricular bigeminy (1 patient) were observed only in group D. Time to home readiness was longest in group D (85 ± 74, 39 ± 21, and 32 ± 13 min in groups D, P and F, respectively; P = 0.007). Conclusions:The use of dexmedetomidine to provide analgesia/sedation for colonoscopy is limited by distressing side effects, pronounced hemodynamic instability, prolonged recovery, and a complicated administration regimen.

Penetrating brain injury: a case report

BACKGROUND Gunshot wounds as a result of attempted suicide, criminality or warfare comprise a significant group among penetrating injuries of the brain. A prognosis in such cases is based mainly on an initial score on the Glasgow Coma Scale (GCS). According to the literature, the mortality rate among patients with initial GCS ranging from 3 to 5 points is very high, up to 98.5%. Although there are also many other prognostic factors for high mortality, such as damage to the ventricular system or the involvement of two or more lobes, GCS score seems to be the most important determinant. The treatment in an ICU which is focused on decreasing the risk of secondary brain damage can significantly improve the prognosis and final outcome. CASE REPORT The authors present the case of a 27-year-old man who suffered a gunshot wound to the right temporal region, self-inflicted from an air-gun. On admission to the intensive care unit he received a score of 3 points on the GCS. There were also other negative prognostic factors - the pellet penetrated two lobes and damaged the third ventricle. Despite the serious prognosis, the appropriate multiprofile treatment and rehabilitation resulted in unexpectedly good recovery. Two years after the trauma the patient was conscious, maintained logical verbal contact, and was able to walk using a walking-aid. CONCLUSION Rapid transport to a major trauma center is essential for patients with penetrating brain injury. Among all interventions it seems essential to provide the prevention of posttraumatic nervous tissue damage and associated neurological dysfunction.

Abnormally low bispectral index and isoelectric electroencephalogram observed after administration of small doses of propofol during induction of anesthesia.

We describe a case in which an unexpectedly, abnormally low bispectral index value (BIS = 4) and an almost isoelectric electroencephalogram (EEG) pattern were observed during typical induction of anesthesia with propofol. Starting 2 min after the beginning of propofol administration (1.26 mg kg−1), the EEG recordings showed burst and suppression pattern for the next 12 min. The EEG during this period was characterized by gradual prolongation of suppression periods until the appearance of the isoelectric line. After that, burst activity returned and eventually the burst suppression pattern disappeared. We excluded the possibility of ischemic brain damage, and the evidence increasingly points toward a greater sensitivity to propofol. The findings described in this case report support the thesis that there is a wide variability in the responses of patients to propofol that cannot be detected without continuous monitoring of cortical electrical activity.

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

BACKGROUND Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared. METHODS This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed. RESULTS There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups. CONCLUSIONS Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.

Estimation of the propagation direction and spectral properties of the EEG signals registered during sevoflurane anaesthesia using Directed Transfer Function method

Estimation of the propagation direction and spectral properties of the EEG signals registered during sevoflurane anaesthesia using Directed Transfer Function method The aim of this study was to estimate spectral properties and propagation of the EEG signals registered during sevoflurane anaesthesia between individual EEG recording channels. The intensities of activity flows were calculated for delta, theta, alpha and beta waves using the Directed Transfer Function integration procedure. It was found that delta waves played the dominant role in the EEG signal propagation during anesthesia and it was suggested that theta and alpha waves propagation could be related to the processes participating in the wakefulness control. Data obtained with DTF method were compared with data received from the analysis of cerebral blood flow with the use of PET in other laboratory. This study showed that analysis of the EEG signal propagation is useful for better understanding and thus safer induction of anaesthesia procedure.

Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial

BACKGROUND Horners syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateral sympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinal anaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of this randomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB) technique on the occurrence rate of Horners syndrome and identify contributing risk factors. METHODS 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. The patients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation (PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU). RESULTS We observed that Horners syndrome developed in 12% of the N group, 6% of the NU group, and 9% of the U group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used to induce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patients to the development of Horners syndrome. Interestingly, our results showed that NU patients with Horners syndrome were significantly younger than NU patients without Horners syndrome. CONCLUSION The precision of IBPB by use of the dual guidance technique may reduce the rate of Horners syndrome. The higher water concentration in the prevertebral spaces of younger patients may create better conditions for the diffusion of ropivacaine, which may result in a statistically significant higher HS rate.

Familiarity with first-aid rules by attendees at rock-music festivals in Poland.

European countries, including Poland, follow the European esuscitation Council (ERC) Guidelines that were put into effect in 010 and that govern the rules of basic life support (BLS) activities.1 espite the guidelines, national laws also impact the use of firstid skills.2 In Poland, Clause 162 of the Criminal Code imposes the bligation to render first aid to victims of accidents by all the citiens, and failure to undertake first-aid measures to injured persons nder circumstances of direct hazard to lives is prosecuted by the enalty of imprisonment up to 3 years. We surveyed attendees at two rock music festivals held in oland in 2009. This group of individuals is frequently associated ith overuse of alcohol and recreational drugs. This can lead to incients that require first-aid interventions during concerts. Of 1129 uestionnaires, 1110 were correctly completed (98.5%). Eightyine percent of respondents said they would provide first aid ithout hesitation even if it were not mandatory by law. This high ate of respondents willing to help compares very favourably with revious studies by other groups.3 Polish laws requiring individuals o help in an emergency may contribute to this high response. Of the responders, who declared that they can correctly check hether the victim keeps breathing correctly or not (94.78% of the nterrogated people), 83.2% demonstrated correct knowledge on ow to clean the upper respiratory tract. Almost two-thirds (65.5%, = 729) of respondents said they had the ability to give first aid but nly 48.3% correctly answered questions on first aid. Among those ho believed they had the ability to give first aid, 44.2% thought that heir knowledge of first-aid topics was sufficient, whilst only 7.3% of hose without first-aid abilities believed so (Table 1). The difference etween an individual’s declared and actual knowledge may result rom lack of awareness of how the relevant guidelines vary. One eason is that the Polish Resuscitation Council guidelines are based