Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2019
Complications associated with nasotracheal intubation and proposal of simple countermeasure.
To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial surgeries[1-3]. It provides an uninhibited access to the mouth and plays an important role when dealing with difficult airways[4-6]. It is also used in patients with cervical spine instability owing to injury[7] or in patients with a cervical spine fixation owing to a disease or previous operation[8]. ⋯ In conclusion, we suggest a simple countermeasure to avoid possible complications of nasotracheal intubation. It involves movement of a cleaned tracheal tube into the trachea of patient. Moreover, we suggest a possible ventilation technique in case the SpO2 falls beyond the permissible range during the nasotracheal intubation.
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Anaesthesiol Intensive Ther · Jan 2019
Randomized Controlled Trial Comparative StudyImpact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics.
Concern has been raised that Sprotte needles predispose to spinal anes-thesia failure. Nevertheless, these needles are associated with a low incidence of postdural puncture headache. The impact of the paramedian approach to postdural puncture headache remains controversial. The objective of this prospective randomized study was to compare Sprotte, Quincke and Atraucan needles as well as the midline and the paramedian approach in terms of postdural puncture headache and spinal anesthesia failure in patients undergoing Caesarean section. ⋯ Sprotte but not Atraucan needle design correlates with lower incidence of postdural puncture headache compared to Quincke design. Sprotte needles are not associated with a higher spinal anesthesia failure compared to Quincke needles. The incidence of postdural puncture headache by the paramedian approach is not significantly reduced whereas the spinal anesthesia failure rate is increased in comparison to the midline approach.
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Anaesthesiol Intensive Ther · Jan 2019
ReviewThe Jehovah's Witness obstetric patient - a literature review.
The patient's right to refuse blood transfusion must be honoured in case of its clear expression. Some special pharmacologic and/or surgical procedures can be useful in a Jehovah Witness (JW) parturient. ⋯ Only a few hospitals have equipment for blood salvage, and alternative oxygen carriers have potentially lethal side effects. Findings suggest that obstetric facilities should develop special algo-rithms of management in the case of the JW obstetric patient, with written declaration of which elements of blood are not acceptable for the patient, early diagnosis and intensive treatment of anaemia in pregnancy, administration of antifibrinolytic agents before surgery, use of electric surgical tools to restore haemostasis, early detection and aggressive treatment of excessive blood loss and, last but not least, close cooperation between obstetricians and anaesthesiologists, including sharing the information about the patient's refusal of blood transfusion.
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Anaesthesiol Intensive Ther · Jan 2019
Comparative StudyValidation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor.
Disease's severity classification systems are applied to measure the risk of death and to choose the best therapy for patients admitted to intensive care unit (ICU). The aim of the study was to verify risk of death calculated with APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II), SOFA (Sequential Organ Failure Assessment) and evaluate correlation between these scores. The usefulness of SOFA score as a sole scale also was assessed. ⋯ APACHE II and SAPS II scales have better discrimination, calibration and power to predict deaths on ICU than SOFA. Among these scales SOFA did not achieve expected results.
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Anaesthesiol Intensive Ther · Jan 2019
Clinical profile of patients with systemic autoimmune diseases treated in the intensive care unit who developed diffuse alveolar haemorrhage - an observational retrospective cohort study.
Patients with autoimmune diseases constitute a relatively low percentage of the intensive care unit (ICU) population but their prognosis is particularly poor, partially due to involvement of multiple organs as well as complications related to immunosuppressive treatment. Diffuse alveolar haemorrhage (DAH) is one of the most life-threatening presentations of autoimmune diseases, associated with worse outcomes. The aim of this study is to report about clinical factors associated with DAH in the ICU setting and to assess the survival in 5-year follow-up. ⋯ Patients who develop DAH in the course of autoimmune diseases and are treated in the ICU have a poor prognosis and often require advanced therapeutic measures.