Inhalational anesthetic agents are chemical substances that are administered into the body via lungs and distributed to organs and tissues by blood circulation. The main site of their action is the ...brain, but they also affect other parts of central nervous system. Volatile and intravenous anesthetics alike have nearly reached the characteristics of an ideal anesthetic, but at a first glance, the increase in use of intravenous anesthetics could likely push out their volatile counterparts. Looking at the situation more thoroughly, positive side effects of volatile anesthetics that are not found in their intravenous counterparts, still give them a place in modern anesthesia practice. It is also possible to combine both techniques to reduce negative adverse effects, while making use of the positive ones.
Izhodišča: Bolečina v križu je zelo pogosto stanje, vendar zanjo pogosto ne najdemo jasnega vzroka. Poleg farmakoloških in nefarmakoloških ukrepov jo zdravimo tudi z invazivnimi pristopi. Primerjali ...smo razlike glede jakosti, kakovosti bolečine, porabe analgetikov ter kakovosti življenja med skupinama bolnikov z blokado prožilnih točk in rentgensko vodeno blokado na dan posega, po enem in treh mesecih po blokadi. Metode: V prospektivno randomizirano raziskavo smo vključili 45 bolnikov s kroničnimi bolečinami v križu, pri katerih smo se odločili za invazivni pristop k zdravljenju. Bolnike smo razdelili v dve skupini glede na vrsto blokade. S pomočjo McGillovega vprašalnika o bolečini in Kratkega vprašalnika o bolečini smo na dan posega, nato po 1 mesecu in 3 mesecih ocenili kakovost bolečine, jakost bolečine, kakovost življenja in porabo analgetikov. Rezultati: Skupini sta primerljivi v demografskih podatkih, statusu zaposlenosti in porabi analgetikov. Pri bolnikih z ledveno blokado prožilnih točk je bil statistično pomembno nižji časovni potek bolečine po McGillovem vprašalniku po 1 mesecu in 3 mesecih (po 1 mesecu: 3,8 vs. 5,7; p = 0,01; po 3 mesecih 3,8 vs. 5,5; p = 0,01). Bolniki v tej skupini so po 1 mesecu statistično pomembno lažje hodili (5,9 vs. 7,4; p = 0,03). Vpliv bolečine na kakovost življenja je bil 1 mesec po blokadi prožilnih točk statistično pomembno manjši v primerjavi z rentgensko vodeno blokado (40,9 vs. 48,3; p = 0,04), po 3 mesecih pa se v obeh skupinah primerljivo pozna ugoden učinek blokade (40 vs. 45,6; p = 0,2). Kakovost spanja se je v skupini z rentgensko vodeno blokado pomembno izboljšala po 1 mesecu po blokadi (7,1 vs. 5,1; p = 0,01). Zaključek: Naša raziskava prvič v Sloveniji primerja učinkovitost blokade prožilnih točk in rentgensko vodene blokade mediane veje zadnje veje spinalnega živca. Tudi v literaturi nismo našli podobnih raziskav. V naši raziskavi smo ugotovili izboljšano kakovost spanja pri skupini z rentgensko blokado; v tej skupini je bil tudi manjši vpliv bolečine na kakovost življenja. Izboljšanje kakovosti življenja smo opazovali tudi pri skupini z blokado prožilnih točk.
Perioperativni čustveni stres je za bolnika slaba izkušnja, ki ima negativne posledice. Zmanjšamo ga lahko s farmakološkimi ali nefarmakološkimi metodami. Medicinska hipnoza je nefarmakološka metoda, ...ki zmanjša perioperativni stres in bolečino. Hipnosedacija je anestezijska tehnika, pri kateri se medicinska hipnoza uporablja kot dodatek k lokalni ali področni anesteziji ob sedaciji ali analgeziji. Izboljša udobje med posegom, zmanjša občutek tesnobe, bolečine, porabo anksiolitikov in analgetikov, izboljša pogoje za operacijo in skrajša čas okrevanja. Uporablja se le pri določenih kirurških posegih in pri izbranih bolnikih. Multimodalna strategija zdravljenja vključuje tako farmakološke kot nefarmakološke pristope. Medicinska hipnoza se lahko uporablja kot sredstvo, ki učinkovito dopolnjuje perioperativno zdravljenje.
We report a case of severe accidental hypothermia (core body temperature of 26.8 °C) in a five-year-old boy due to submersion in freezing lake water. The child was brought to the hospital intubated, ...in cardiac arrest rhythm of pulseless electrical activity and with dilated and nonreactive pupils. We continued with cardiopulmonary resuscitation and administrated adrenaline in boluses (10 μg/kg) and infusion (0.2 μg/kg/min). Spontaneous circulation returned after 50 minutes. Rewarming was performed with minimally invasive techniques. Post resuscitation he was admitted to the intensive care unit, where he required venovenous extracorporeal membrane oxygenation due to respiratory failure. He was discharged from the hospital neurologically intact and without organ damage on day 17 post arrest.
Surgical procedure causes tissue damage which activates systemic inflammatory response and leads to changes in endocrine and metabolic system. Anaesthesia and pain can further disrupt immune ...performance. Regional anaesthesia causes afferent nerve blockade and in this way mediates immune protection. Thoracic epidural analgesia is the cornerstone of pain relief in thoracic and abdominal surgery. Alternatively thoracic paravertebral block can be used with less side effects and good analgesic properties. Drugs that interfere with blood coagulation obstruct the use of central regional blocks. Surgery has also changed recently from open to minimally invasive. Also pain treatment for this procedures has changed to less aggressive, systemic or locoregional techniques. It was shown that transversus abdominis plane block and epidural analgesia have the same effect on postoperative pain, but transversus abdominis plane block was better regarding hemodynamic stability and hospital stay. Multimodal approach combining regional and systemic analgesia is currently the most appropriate perioperative pain management strategy. More studies should be done to give recommendations.
Kirurški zahvat uzrokuje tkivno oštećenje koje aktivira sistemski upalni odgovor i dovodi do promijena u endokrinom i metaboličkom sustavu pacijenta. Anestezija i bolovi mogu još dodatno utjecati na ...imunološki sustav. Regionalna anestezija uzrokuje aferentnu blokadu živaca i time dovodi do zaštite imunološkoga sustava. Torakalna epiduralna analgezija je zlatni standard za liječenje bolova u torakoabdominalnoj kirurgiji. Alternativna tehnika je torakalni paravertebralni blok koji ima manje nuspojava i dobar analgetski učinak. Antikoagulantni lijekovi ograničavaju upotrebu centralnih živčanih blokova. Kirurške se tehnike mijenjaju u smjeru minimalno invazivnih kirurških tehnika. Isto tako tehnike liječenja bolova se mijenjaju prema upotrebi manje agresivnih sistemskih i lokoregionalnih tehnika. Studije su pokazale da su “transversus abdominis block” (TAP) i epiduralna analgezija jednako učinkoviti u liječenju postoperativnih bolova, s tim da se kod TAP blokova puno rjeđe pojavljuje pad krvnoga tlaka i da je vrijeme hospitalizacije kraće. Multimodalni pristup s kombinacijom regionalne i
sistemske analgezije je trenutno najbolja tehnika za liječenje perioperativnih bolova. Potrebna su dodatna istraživanja da bi se izradile smjernice.
The influence of anaesthesia on cancer growth Potocnik, Iztok; Kerin-Povsic, Milena; Markovic-Bozic, Jasmina
Radiology and oncology,
03/2024, Letnik:
58, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Oncological patients make up a large proportion of all surgical patients. Through its influence on the patient's inflammatory and immune system, the choice of anaesthetic technique has an indirect ...impact on the health of the individual patient and on public health. Both the specific and the non-specific immune system have a major influence on the recurrence of carcinomas. The pathophysiological basis for growth and metastasis after surgery is the physiological response to stress. Inflammation is the organism's universal response to stress. Anaesthetics and adjuvants influence perioperative inflammation in different ways and have an indirect effect on tumour growth and metastasis.
studies have shown how individual anaesthetics influence the growth and spread of cancer, but clinical studies have not confirmed these results. Nevertheless, it is advisable to use an anaesthetic that has shown lesser effect on the growth of cancer cells
.
In this review, we focus on the area of the effects of anaesthesia on tumour growth. The field is still relatively unexplored, there are only few clinical prospective studies and their results are controversial. Based on the review of new research findings we report on recommendations about anaesthetics and anaesthetic techniques that might be preferable for oncological surgical procedures.
Aim To evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with ...dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery. Methods Patients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n = 21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n = 19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis. Results The level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon's, anesthesiologist's, and patients' satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range. Conclusions For patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone. Clinical trial number: NCT 03251222
BACKGROUND: Goal-directed fluid therapy (GDFT) with hemodynamic monitoring may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in enhanced ...recovery after surgery protocols (ERAS) setting. AIMS: We predicted different fluid and vasoactive drug consumption during the procedure and less complications in the group of patients, where invasive hemodynamic monitoring was used. METHODS: Two groups of patients undergoing elective laparoscopic colorectal surgery were compared: A control group (CG), with standard hemodynamic monitoring, and a study group, (SG) with invasive hemodynamic monitoring and appropriate intraoperative interventions. We compared differences in intraoperative fluid consumption, length of hospital stay (LOS) and post-operative morbidity. RESULTS: A group of 29 patients in SG had similar average intraoperative fluid balance (+438 mL) as 27 patients in CG (+345 mL) p = 0.432. Average LOS was 8 days (±4) in SG and 6 days (±1) in CG (p = 0.124). Acute renal failure, anastomotic dehiscence, and indication for antibiotic treatment were predictors of statistically significant prolongation of hospital stay 3rd day after surgery, but independent of SG. CONCLUSION: Since no differences between the groups were shown in overall fluid and vasoactive drug consumption, we conclude that GDFT is not needed in laparoscopic colorectal surgery, when ERAS is followed.
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