Anestezjologia intensywna terapia
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Anestezjol Intens Ter · Oct 2011
Review[Effects of parenteral lipid emulsions on immune system response].
Lipid solutions used in parenteral nutrition (PN) are generally well tolerated. Recent studies reporting their effects on the immune system indicate that various compositions can modulate the immune response, thus affecting the response to pathogens and autoaggressive diseases. In this review, we discuss the compositions of various commercially available lipid solutions and their effects on the immune response to various pathologies. ⋯ Mixtures of medium chain triglycerides and soybean oil are better tolerated. 3. Olive oil-based mixtures are neutral and are especially recommended for burned patients, premature infants and for long term PN. 4. Fish oil-based emulsions are beneficial in inflammatory conditions and in patients after major abdominal surgery.
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Coagulopathies of various origins have been mentioned among the leading causes of morbidity in hospitals all over the world. Time-consuming coagulation assays delay the diagnosis and response to a dynamic pathology. The need to analyse whole blood for the accurate identification of coagulopathies has led to a revival of interest in thromboelastography (TEG). ⋯ TEG has been widely used in research, but poor understanding of the technique has limited its clinical use. Controversies regarding the relationship between traditional tests and TEG have made the bedside use of TEG less popular than it should be. In the review, the authors discuss details of the process and practical aspects of its use in clinical settings.
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Anestezjol Intens Ter · Jul 2011
Review[Is suxamethonium still useful for paediatric anaesthesia?].
Suxamethonium is the only depolarising neuromuscular blocking agent, which is still being widely used during general anaesthesia. Some of its unique properties rank suxamethonium as an ideal neuromuscular blocking agent i.e. the fast onset of muscle paralysis and spontaneous neuromuscular block reversal. However, the agent may trigger malignant hyperthermia, hyperkaliaemia, severe bradycardia and other complications, which have to be considered. ⋯ Nowadays, in rapid sequence induction of anaesthesia, suxamethonium may be replaced with rocuronium - a non-depolarising muscle relaxant which provides the intubating conditions similar to suxamethonium. The rocuronium-induced neuromuscular blockade, which lasts longer than blockade following suxamethonium, is reversed with sugammadex - a new selective relaxant binding agent. Despite new agents and methods, suxamethonium still remains the drug of choice for muscle relaxation for intubation in children.
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Patients with cardiac diseases undergoing non-cardiac surgery experience more perioperative problems than the others. The prevention of these problems includes proper preoperative evaluation of patients, careful intraoperative management and postoperative surveillance. Preoperative examination of such patients, including echocardiography if necessary, is crucial. ⋯ Intraoperative management requires goal-directed haemodynamic monitoring and therapy as well as proper fluid infusion. There are no data confirming the superiority of general over regional anaesthesia in such patients. However, lower incidence of pulmonary complications and lower mortality rates were observed after regional blocks.
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Anestezjol Intens Ter · Apr 2011
Review[Significance of measuring family satisfaction in the intensive therapy unit].
Recently, numerous studies have been devoted to the issues of satisfaction of ITU patients and their families. Good relationships between the medical personnel and family members are essential for interpersonal communication built by both parties. ⋯ To date, neither the medical curriculum nor additional training have focused on this issue. Good communication between the patients` families and physicians, thus the feeling of safety and satisfaction with the intensive care provided, should be based on controlled paternalism, provision of reliable information, confidence moulded, by mutual understanding and respect, elimination of impulsive reactions.