Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2016
ReviewSepsis and septic shock-is a microcirculation a main player?
Shock, defined at a cellular level, is a condition in which oxygen delivery to the cells is not sufficient to sustain cellular activity and support organ function. The central role of microcirculation in providing oxygen to the cells makes it of prime importance in determining organ function. In sepsis and septic shock, macrocirculatory alterations and microcirculatory dysfunction participate concurrently in the pathophysiology of organ failure. ⋯ Septic shock is most frequently characterized by a lack of microcirculatory recruitment despite of macrocirculatory successful resuscitation. The lack of haemodynamic coherence between macrocirculation and microcirculation in septic patients results in treatment failure and increased mortality. The monitoring of microcirculation and the effects of its changes are an important area of future clinical research and treatment modification.
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Anaesthesiol Intensive Ther · Jan 2016
Randomized Controlled Trial Comparative StudyA comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section.
This study compared two types of sedation in pregnant women receiving subarachnoid anaesthesia for elective Caesarean section. ⋯ Midazolam and propofol induce effective and safe sedation in patients receiving subarachnoid anaesthesia for Caesarean section. Propofol appears to be more useful for Caesarean section sedation when compared with midazolam because of its shorter action, antiemetic effects and better maternal recall of foetal delivery.
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Anaesthesiol Intensive Ther · Jan 2016
Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis.
Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis. ⋯ It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.
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Anaesthesiol Intensive Ther · Jan 2016
Randomized Controlled TrialAnaesthesia for carotid endarterectomy. Ultrasound-guided superficial/intermediate cervical plexus block combined with carotid sheath infiltration.
Carotid endarterectomy carries a significant risk of intraoperative brain ischaemia. Various methods for intraoperative cerebral function monitoring can be utilized, but the assessment of the patient's consciousness remains the easiest and most available method, requiring that the patient remain awake and under local/regional anaesthesia. The aim of this study was to compare infiltration anaesthesia with an ultrasound-guided superficial/combined cervical plexus block for patient safety and comfort. ⋯ Compared with infiltration anaesthesia, an US-guided superficial/combined cervical plexus block is an effective method for improving the comfort of the patient and the surgeon. The technique is safe, relatively simple and easy to master and requires little time to perform.
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Anaesthesiol Intensive Ther · Jan 2016
Comparative StudyA comparison of BIS recordings during propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia in obese patients.
Intraoperative awareness is a rarely occurring phenomenon. Obesity is considered as one of the factors increasing the probability of intraoperative awareness due to problems with the dosing of anaesthetics. In a randomized prospective study we compared bispectral index (BIS) recordings during propofol-based total intravenous anaesthesia (TIVA) and sevoflurane-based inhalation anaesthesia in morbidly obese patients as a sign of possible intraoperative awareness. ⋯ Although the incidence of BIS > 60 are very common in obese patients, true awareness during anaesthesia infrequent in this group of patients despite the type of anaesthesia, whether intravenous or inhalation.