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.

Effects of unilateral PEEP on biomechanics of both lungs during independent lung ventilation in patients anaesthetised for thoracic surgery.

Background: Synchronous independent lung ventilation (ILV) is the treatment of choice for unilateral pathology of lung parenchyma. Numerous studies have documented the improved blood oxygenation and clinical efficacy of this procedure. The aim of the present study was to evaluate the effects of ILV on the selected biomechanical parameters of the lungs.

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.

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.

Independent lung ventilation for treatment of post-traumatic ARDS.

Background: Independent lung ventilation (ILV) has been recommended for unilateral pulmonary pathology. We describe a case of a multiple trauma patient treated with ILV for unilateral lung injury.

Case Report: Following a road accident, an 18 year-old male patient was referred to the university hospital with multiple organ failure, a ruptured liver and spleen, a fractured spine at the Th1-2 level, and left lung contusion.

Intraoperative awareness--recommendations of the Committee on Quality and Safety in Anaesthesia, Polish Society of Anaesthesiology and Intensive Therapy.

Modern general anaesthesia is complex and reversible.It involves a temporary loss of consciousness, analgesia,a decrease in muscle tension or complete muscle relaxation,suppressed reactions of the autonomic nervous system,and the provision of amnesia of events after its completion.

[Tricuspidal valve rupture after blunt chest trauma].

Background: Blunt chest trauma is frequently associated with cardiac contusion and structural damage, most cases only being recognized after death. We report a case of multiple organ trauma, where cardiac failure, caused by tricuspid valve rupture, was markedly delayed.

Case Report: A 21 yr old man was admitted to hospital after a car accident.

[Pre-emptive ketoprofen for postoperative pain relief after urologic surgery].

Background: Effective multimodal postoperative analgesia is one of determinants of patient satisfaction after successful surgery. Following the recommendations of non-steroidal antiinflammatory agents (NSAIDs) for pre-emptive analgesia, we assessed the efficacy of ketoprofen administered before urological surgery.

Methods: Fifty-two ASA I and II adult patients, scheduled for elective urologic procedures under general anaesthesia, were enrolled in this prospective, double blind study.

[Costs of subarachnoid vs. general anaesthesia for caesarean section].

Background: Modern medicine is becoming increasingly aware of economic-organizational aspects. In the field of anaesthesiology, the number of agents used markedly increases due to continuous pharmacological progress. A high proportion of them are expensive.

[Independent lung ventilation during general anaesthesia--preliminary report].

Background: Unitaleral lung pathology presents a serious challenge for the anaesthesiologist. Conventional ventilation usually leads to over distension of the non-affected lung and hypoventilation of the affected lung. The optimal ventilatory strategy in such situations, is intubation with a double lumen tube and independent lung ventilation with two respirators.

[Effects of cervical plexus block on lung ventilation].

Background: Carotid endarterectomy is a preventative operation to reduce the incidence of embolic stroke. The prime concern during surgery is the protection of the brain during carotid artery cross-clamping. Since blood flow to the brain is provided via the non-affected carotid artery and collateral circulation, it is essential to maintain consciousness in the patient during surgery, in order to assess the effects of cross-clamping.

[Classic laryngeal mask airway vs COBRA-PLA device for airway maintenance during minor urological procedures].

Background: In recent years, different supraglottic airway devices became popular and new constructions have been proposed. We compared a classic laryngeal mask airway (LMA-classic) with the COBRA-PLA device (a LMA of different design).

Methods: Fifty adult ASA 1 and 2 adult patients, scheduled for minor urological interventions were randomly allocated to receive the LMA-Classic or the COBRA-PLA.

[Perioperative risk in patients with sleep apnoea].

Patients with upper airway obstruction during sleep are at constant risk of hypoxic and hypercarbic episodes and are especially vulnerable during anaesthesia and sedation as the abnormal anatomy is compounded by drug-related respiratory depression. Elective procedures in patients with the obstructive sleep apnoea (OSA) should be usually delayed, allowing for the preoperative home treatment (diet, alcohol abstinence, nasal CPAP/BiPAP during night). Respiratory supportive techniques, started at home, should be continued in the hospital, both in preoperative and postoperative periods.

[Quality of life after intensive care].

Background: Nowadays, simple survival from a life threatening condition requiring treatment in an ICU, cannot be regarded as a sole indicator of the medical success. Patients expect to return to a more or less normal life, and to resume their daily activities. The aim of the study was to evaluate the health related quality of life (HRQOL) as a long-term indicator of successful outcome.

[The accidental cannulation of subclavian artery in a patient undergoing CABG].

Obtaining central venous access is a standard procedure necessary for safe anesthesia in patients undergoing surgery with extracorporeal circulation. It is well known that jugular way is safer and causes less complication than subclavian. The authors present a case of accidental left subclavian artery cannulation during left internal jugular vein catheterisation.

[Comparison of effectiveness of percutaneous embolization and microsurgery in the treatment of 60 patients with MCA berry aneurysms].

Surgical clipping has been considered for years a "golden standard" in the treatment of middle cerebral artery (MCA) aneurysms. The recent development of materials and endovascular techniques has permitted the use of embolization for the treatment of intracranial aneurysms regardless of their locations and size. In 30 patients with 32 MCA aneurysms (group I) the endovascular approach with GDC-10 coils was used, while in other 30 patients with 31 aneurysms (group II) surgical clipping was performed.

Intravascular thrombosis as a result of central venous access.

Central venous access represents one of the most basic therapeutic procedures in modern medicine. Unfortunately, numerous advantages that result from maintaining a central venous line are accompanied by some complications among which the venous thrombosis is the most significant clinically. The study was designed to assess frequency and natural history of this complication in the setting at a multi profile clinical hospital.

Use of drotrecorgin alfa--recombinant activated human protein C in treatment of septic shock in the course of therapy for nephrolithiasis.

Background: Septic shock is the most dangerous complication of nephrolithiasis management utilizing percutaneous methods.

Case Report: The patient, D.M.

Changes of propofol concentration in cerebrospinal fluid during continuous infusion.

Unlabelled: We studied the changes in the propofol concentration in the cerebrospinal fluid (CSF) in 14 patients, undergoing elective intracranial procedures, who were anesthetized with propofol administered by target-controlled infusion. During anesthesia, fentanyl and cisatracurium were administered as required. After intubation of the trachea, the lungs of the patients were ventilated to normocapnia with an oxygen-air mixture (FIO(2) = 0.

Investigation of propofol renal elimination by HPLC using supported liquid membrane procedure for sample preparation.

One of the least explored subjects in the research on the metabolism of a widely used anaesthetic, propofol, is its excretion in an unchanged form. According to literature, the estimated percentage of applied propofol eliminated intact via kidneys is lower than 0.3%.

The efficacy and safety of the tension-free vaginal tape procedure do not depend on the method of analgesia.

Objective: The original tension-free vaginal tape (TVT) method, described by Ulmsten et al., routinely uses local anaesthesia during the procedure. Since the anaesthetic effect after local application of lidocaine hydrochloride was not always satisfactory we decided to introduce the spinal anaesthesia during this operation.