Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have immediate access ...to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management.
An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021.
Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use.
Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.
The Quality of Recovery-40 (QoR-40) questionnaire is a psychometric instrument designed to quantify postoperative recovery. It has been translated and validated in several countries but not in ...Croatia. The aim was to translate, cross-culturally adapt, and validate Croatian version of the QoR-40. The QoR-40 was translated from English by two independent translators, back-translated by a native speaker, and approved by an expert committee. The questionnaire was administered to 106 patients who underwent general anesthesia before elective spinal surgery, post-surgery in the operating room, and 30 days after surgery. Internal consistency was assessed using the Cronbach's alpha coefficient. Construct validity was assessed by evaluating correlation between the QoR-40 and hand grip strength. The mean preoperative global QoR-40 score was 177.6 (95% CI 174.9-180.3) and postoperative 168.9 (95% CI 165.8-171.9); the mean change was -8.8 (95% CI -11.9 to -5.6). Internal consistency was good for global QoR-40 score (Cronbach alpha=0.896), acceptable across all domains (8>alpha>7). There was a significant correlation between grip strength and total QoR-40 score, pain, and physical independence, but not with other domains. In conclusion, the Croatian version of the QoR-40 has acceptable properties and can be used in the assessment of postoperative recovery in Croatian patients. Key words: Anesthesia; Croatian; QoR-40 questionnaire; Validation
Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and ...neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients.
We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1β, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups.
Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.
Introduction Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have ...immediate access to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management. Materials and methods An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021. Results Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use. Conclusion Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.
Aim To compare the effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on pro-inflammatory cytokine concentrations in patients with ...non-ruptured brain aneurysms undergoing elective open surgery. Methods This parallel, randomized, controlled, open-label trial was conducted at Clinical Hospital Center Zagreb between March 2019 and March 2020. At the beginning of anesthesia, lidocaine group received 40 mg of 2% lidocaine for laryngotracheal topical anesthesia and 4 mg/kg for the scalp block. Control group underwent general anesthesia only. Plasma concentrations of IL-6, TNF-alpha, and IL-1beta were measured before anesthesia (S0); at the incision (SI); at the end of surgery (S2); 24 hours postoperatively (S3). Cerebrospinal fluid (CSF) cytokine concentrations were measured at the incision (L1) and the end of surgery (L2). Results Forty patients (each group, 20) were randomized; 37 were left in the final analysis. IL-6 plasma concentrations increased significantly compared with baseline at S3 in lidocaine group, and at S2 and S3 in control group. In both groups, changes in TNF-alpha and IL-1beta were not significant. CSF cytokine concentrations in lidocaine group did not change significantly; in control group IL-6 and IL-1beta were significantly higher at L2 than at L1. CSF IL-6 in control group significantly increased at L2, but TNF-alpha and IL-1beta did not. No differences in clinical outcome and complication rates were observed. Conclusion Adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia might attenuate CSF IL-6 concentration increase in patients with brain aneurysm. Trial registration Clinical Trials NCT03823482
Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance.
We performed an internet-based survey to ...investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. The survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey® platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with χ2 and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research.
The 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4–11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001).
Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally.
Title:tAcute onset severe thrombocytopenia after brain tumor resection under total intravenous anesthesiaAuthor(s):tMatas M., Sekuliu0107 A., Mikliu0107-Bubliu0107 M.Institute(s):tUniversity Hospital ...Zagreb, Dept of Anaesthesiology & Intensive Care, Zagreb, CroatiaText:tBackground: Drug induced thrombocytopenia can be easily overlooked (1). Postoperative drop in platelet count, after brain tumor surgery, can cause hematoma formation (2) and significant mortality.Case report: ASA II 70-year neurosurgical patient, without focal signs, was scheduled for left frontal lobe tumor resection. Preoperative platelet count was 180x109. Laboratory tests were normal. Two prior surgeries were uneventful. Infection prophylaxis included cefazoline 2 g iv. Premedication consisted of midazolam 5 mg im. Anesthesia with fentanyl, propofol and rocuronium was induced and maintained with infusions of propofol and fentanyl. Haemoglobin levels during surgery were stable. Anesthesia went uneventful.After transfer to ICU, the first postoperative finding was thrombocytopenia of 4 x109 platelets. Twenty minutes later platelet count was 8 x 109. Both the citrate and EDTA tests showed similar low platelet count. Five hours after the admission to the ICU new left hemiplegia was the reason for an emergency MSCT. After transfusion of 8 units of platelets in site hematoma was evacuated. The second anesthesia was performed with midazolam and ketamine. The patient fully recovered with no new neurologic deficits. Platelet count remained normal. Heparin induced thrombocytopenia antibodies were not found. Specific drug antithrombocyte antibodies test wasnu00b4t available.Discussion: Possible causes of acute postoperative thrombocytopenia in our patient were: dilutional effect of fluid rescucitation, unrecognized platelet pathology, nonimmune and immune thrombocytopenia not related to medications, heparin induced thrombocytopenia, pseudothrombocytopenia and other drug induced thrombocytopenias. Heparin induced thrombocytopenia and pseudothrombocytopenia were excluded. The diagnosis of drug induced thrombocytopenia was the most probable. For the second surgery we decided to avoid cefazoline, propofol, fentanyl and rocuronium. The platelet count remained stable during and after the second surgery.References: 1. Aster RH, Bougie DW Drug-Induced Immune Thrombocytopenia N Engl J Med 2007; 357:580-587. 2. Chan KH, Mann KS, Chan TK. The significance of thrombocytopenia in the development of postoperative intracranial hematoma. J Neurosurg. 1989;71(1):38-41 Learning points: Platelet count after brain tumor surgery in total intravenous anesthesia should be monitored in short intervals during first hours.
Sitting position in neurosurgery: Does venous air embolism prolongue lenght of stay in ICU?Sitting position in neurosurgery is used in posterior cranial fossa and medulla oblongata surgery. One of ...the most common and most severe complication of operations in this position is venous air embolism (VAE). Incidence varies depending on the method used to detect VAE, being as high as up to 76% when transesophageal echocardiography monitoring is used.The aim of this study was to determine the difference in duration of stay in neurosurgical ICU for patients operated in sitting position with and without venous air embolism.In our study we included 114 patients of all ages operated in sitting position from January 2011 to May 2015. All patients underwent total intravenous anesthesia with thiopental/propofol and fentanyl, and they all had central venous catheter. VAE monitoring included clinical acknowledgement (sudden decrease in end-tidal CO2, sudden decrease in mean arterial pressure, increase in difference between end.tidal and arterial CO2). VAE was observed in 26 out of 114 patientsin sitting position. The duration of their stay in NICU was in range of 1 to 13 days (2,65u00b12,62) versus patients without VAE, range 1 to 29 days (2,60u00b13,47). To test our hypothesis we used t-test (t=0,0679, P=0,9460).We have found no statistical difference in the length of stay in the NICU between patients who have suffered from VAE during sitting position neurosurgery and those who have not.
PDF
