Romanian journal of anaesthesia and intensive care最新文献

{"title":"Efficacy and duration of ultrasound guided fascia iliaca block for hip fracture performed in the emergency departments.","authors":"Béres Zsolt Levente, Monica Nicoleta Filip, Nicoleta Romaniuc, Szilagyi Gheorghe","doi":"10.21454/rjaic.7518.242.ber","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.ber","url":null,"abstract":"Delirium is one of the most frequent complications during hospitalization in elderly patients with a hip fracture. The correlation between this complication and the efficacy of pain relief is demonstrated also in cogni-tively intact patients [1]. The pain level is frequently underestimated and the likelihood of an ineffective pain management is more pronounced in regional hospitals with overcrowded emergency departments [2]. This situation is similar to what is happening in our hospital. In settings where a long waiting time for hip fracture surgery may occur, the introduction of an effective and long lasting alternative for analgesia is imperative","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"167-169"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642857/pdf/rjaic-24-2-167.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35565103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To block or not to block?","authors":"Gabriella Iohom","doi":"10.21454/rjaic.7518.242.ioh","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.ioh","url":null,"abstract":"Contemporary joint replacement surgery has shown dramatic technical development in recent years. It is one of the most commonly performed procedures and is predicted to increase exponentially over the next decade. This has led to the development of enhanced recovery after surgery (ERAS) consisting of multimodal, multidisciplinary perioperative care pathways designed to reduce hospital length of stay through reduced morbidity and early ambulation. An essential prerequisite for the success of an accelerated care pathway is early ambulation facilitated by the provision of dynamic pain relief (i.e. pain relief during movement). To achieve a shorter hospital length of stay, it is necessary that the pathway includes optimization and standardization of the preoperative, intraoperative, and postoperative pain management components. An optimal multimodal pain therapy should be initiated in the preoperative period by the identification of patients who are at risk of greater pain intensity. Patient counselling and expectation management has been shown to improve pain relief and patient satisfaction [1]. Patients with high severity of preoperative pain are more likely to report chronic pain after both total hip and knee replacement and this association is five times stronger in patients undergoing total knee arthroplasty (TKA) compared to total hip arthroplasty (THA) [2]. Preoperative pain-on-movement is the strongest predictor of chronic pain-on-movement at 12 months in patients undergoing TKA. Preoperative pain-at-rest is weakly predictive of chronic pain-at-rest at 12 months in patients undergoing THA. Interestingly, acute postoperative pain-on-movement has not been associated with chronic pain after TKR or THR after adjusting for preoperative pain; however, acute painat-rest was associated with chronic pain after THR but not TKR after adjusting for preoperative pain [2]. Intraand postoperative analgesia: the requirement for procedure specificity is now well recognized and universally accepted. DOI: http://dx.doi.org/10.21454/rjaic.7518.242.ioh","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"83-85"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642859/pdf/rjaic-24-2-83.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35564164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Romanian Journal of Anaesthesia and Intensive Care - now on PubMed Central.","authors":"Iurie Acalovschi","doi":"10.21454/rjaic.7518.242.aca","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.aca","url":null,"abstract":"","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"81-82"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642858/pdf/rjaic-24-2-81.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35564163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving operating room productivity and efficiency - are there any simple strategies?","authors":"Anthony J Cunningham","doi":"10.21454/rjaic.7518.242.cnn","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.cnn","url":null,"abstract":"Rising costs and diminishing reimbursements require hospitals to continually find ways to improve efficiency and productivity. The operating room (OR) is a costintensive environment requiring efficient and effective management. The power of performance of the OR is crucially dependent on the cooperation of the surgical, anaesthesia, nursing and allied health professionals involved. Dr O’Donnell and colleagues from the Department of Anaesthesia, Cork University Hospital, Ireland studied the effects of a number of work practice changes, including modification of patient processing and additional manpower, on non-operating time, number of cases performed and patient cancellations in a dedicated soft-tissue trauma surgical unit [1]. Work practice changes included a transition from sequential patient processing to parallel patient processing and increased use of regional anaesthesia, when feasible. The study findings were disappointing because, despite additional anaesthesia input and limited work practice changes, there was no increased operating room capacity or reduction in non-operative time. A remarkable average 2 hours of operating room time was lost daily due to avoidable delays. Not unexpectedly, the expansion of regional anaesthesia use for upper extremity surgery reduced the duration of recovery room utilization and stay. Why did the context-specific work practice changes adopted in this study design fail so spectacularly to achieve the desired primary and secondary patient outcomes? Study design and methodology limitations included an anaesthesia rather than a surgeon team DOI: http://dx.doi.org/10.21454/rjaic.7518.242.cnn","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642860/pdf/rjaic-24-2-87.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35564165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rash decision. The hazards of the wrongful use of adrenaline.","authors":"Madalena Coutinho Cruz,&nbsp;Ramiro Sá Carvalho,&nbsp;Pedro Modas Daniel,&nbsp;Rui Cruz Ferreira","doi":"10.21454/rjaic.7518.242.crz","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.crz","url":null,"abstract":"<p><p>Anaphylaxis is life-threatening and should be addressed urgently. Its treatment is not without side effects and an accurate diagnosis must be made to prevent potential harm by the wrongful use of medication. A 46-year-old woman with hypertension treated with angiotensin converting enzyme inhibitor (ACEI) presented to the emergency department with non-pitting oedema of the face and limbs. A hasty diagnosis of anaphylaxis was made and intravenous adrenaline administered. The patient developed a myocardial infarction caused by coronary artery spasm that required invasive intervention. The initial clinical picture was resolved when the ACEI was discontinued unmasking a case of ACEI-induced angioedema. The correct differentiation of these two apparently similar clinical entities is of utmost importance in the management of emergency department patients.</p>","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"163-166"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642856/pdf/rjaic-24-2-163.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35565102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conus medullaris trauma: is there a greater risk in parturients?","authors":"Julie Verkooijen,&nbsp;Hilde Coppejans,&nbsp;Els Mertens,&nbsp;Vera Saldien,&nbsp;Marcel Vercauteren","doi":"10.21454/rjaic.7518.242.ver","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.ver","url":null,"abstract":"<p><strong>Background: </strong>There is some evidence that anaesthetists often perform neuraxial blocks at a higher lumbar interspace than intended. It may be questioned whether parturients are at greater risk for neurological damage when the dura is perforated at a more cephalad interspace than L2-L3.</p><p><strong>Methods: </strong>Thirty-six patients scheduled for elective Caesarean delivery under CSE anaesthesia were selected for study. Using a B-D Durasafe Adjustable needle combination, the skin-to-epidural distance and the width of the epidural space were measured and matched with 36 female patients undergoing the same anaesthetic technique for orthopaedic procedures.</p><p><strong>Results: </strong>Pregnant patients had a higher bodyweight (77 vs. 67 kg, p = 0.007) than those scheduled for orthopaedic surgery. The skin-to-epidural distance was similar in both groups (5.3 vs. 5.1 cm, p = 0.3). The width of the epidural space was 1.1 mm larger in parturients (8.2 vs. 7.1 mm, p = 0.04). More patients in this group had tip-to-tip distances exceeding 10 mm (25 vs. 12%).</p><p><strong>Conclusion: </strong>The greater epidural space or tip-to-tip distance between the epidural and spinal needle points in term parturients results in a lower margin of safety with respect to the distance from the dura to spinal cord or conus medullaris. Puncturing the correct interspace is, therefore, of crucial importance in pregnant patients.</p>","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"107-110"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21454/rjaic.7518.242.ver","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35564168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of method agreement between two minimally invasive hemodynamic measurements in septic shock patients on high doses of vasopressor drugs. A preliminary study.","authors":"Oana Antal,&nbsp;Mihai Mărginean,&nbsp;Natalia Hagău","doi":"10.21454/rjaic.7518.242.min","DOIUrl":"https://doi.org/10.21454/rjaic.7518.242.min","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive hemodynamic monitoring is still controversial among the methods used to assess the hemodynamic profile of the septic shock patient. The aim of this study was to test the level of agreement between two different devices.</p><p><strong>Methods: </strong>We collected 385 data entries during 12-hour intervals from four critically ill patients with septic shock and high doses of vasoactive therapy using two minimally invasive methods at the same time: Vigileo™ device which uses the pulse contour principle, and EV1000™ monitoring platform which uses the transpulmonary thermodilution principle. The studied parameters were Stroke Volume (SV), Cardiac Output (CO) and Mean Arterial Pressure (MAP). We tested the agreement by performing the visual examination of data patterns using graphs and studying the bias, limits of agreement and creating Bland-Altman plots. For assessing the systematic, proportional and random differences, we computed a Passing-Bablock regression with the CUSUM test for linearity.</p><p><strong>Results: </strong>The one sample t-Test for the differences between the two methods against the null value was statistically significant for the studied parameters (p < 0.0001). The Bland-Altman analysis found no agreement between the data obtained using the two techniques, with calculated error percent as high as 88.28% for SV, 82.02% for CO and 42.06% for MAP. The Passing-Bablock regression analysis tested positive for systematic differences, but this could not be accounted for.</p><p><strong>Conclusion: </strong>We found no agreement between data obtained from the studied devices; therefore, these cannot be used interchangeably for critically ill septic shock patients on high doses of vasoactive substances.</p>","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 2","pages":"89-100"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21454/rjaic.7518.242.min","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35564166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of operating room throughput in a stand-alone soft-tissue trauma operating theatre.","authors":"Brian D O'Donnell,&nbsp;Ken Walsh,&nbsp;Aileen Murphy,&nbsp;Brendan McElroy,&nbsp;Gabriella Iohom,&nbsp;George D Shorten","doi":"10.21454/rjaic.7518.241.wal","DOIUrl":"https://doi.org/10.21454/rjaic.7518.241.wal","url":null,"abstract":"<p><strong>Background: </strong>Operating room time is a limited, expensive commodity in acute hospitals. Strategies aimed at reduction of non-operative time improve operating room throughput and capacity. We conducted a prospective study to evaluate and augment operating room throughput and capacity using context-specific work practice changes.</p><p><strong>Methods: </strong>Following institutional and ethical approval, an interdisciplinary group designed and introduced a series of work practice changes specific to a stand-alone soft tissue trauma theatre, comprising modifications to patient processing, staff behaviours and additional anaesthesiologist hours. Time intervals relating to each patient were measured during a 16 week period before and after implementing work practice changes. The primary outcome measure was non-operative time, with daily caseload and cancellations amongst secondary outcome measures.</p><p><strong>Results: </strong>251 procedures were included over 58 working days (8 to 17 Monday to Friday). Non-operative time [55.6 (31.1) vs 52.3 (9.8) minutes, p = 0.48], daily caseload [4 [1-9] vs 4 [2-7], p = 0.56], and the number of daily cancellations [3 [0-11] vs 5 [0-8], p = 0.38], did not differ between baseline and study phases. Regional anaesthesia for upper limb surgery increased during the study phase [26/59 (44.0%) vs 10/63 (15.9%), p = 0.014] with resultant decrease in mean duration of recovery room stay [20.7 (17.7) vs 30 (20.5) minutes, p = 0.0001] and increased recovery room bypass [26/116 (22.4%) vs 6/135 (4.4%), p = 0.0002]. Avoidable delays accounted for 124.8 (72.2) minutes of theatre time lost each day.</p><p><strong>Conclusion: </strong>In conclusion, additional attending anaesthesiologist hours combined with work practice changes did not impact on measures of theatre throughput and capacity. The study identified important variables that contribute to avoidable delays, and points the way for future research.</p>","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 1","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555422/pdf/rjaic-24-1-13.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35515533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality trends in healthcare and their impact on anesthesiology.","authors":"Teodora O Nicolescu","doi":"10.21454/rjaic.7518.241.qty","DOIUrl":"10.21454/rjaic.7518.241.qty","url":null,"abstract":"<p><p>The new approach of a patient-centred, appropriate and timely care that was at the heart of the Institute of Medicine (IOM) initiative is changing the face of the healthcare industry in general and, in particular, of anesthesiology as a speciality. The drivers of this change are better quality and decreased healthcare costs, since despite a large expenditure for healthcare, the quality of care has not changed tremendously. Metrics have been identified, derived from the cybernetic model first described by the quality \"parent\". Donabedian and each of those metrics have both advantages as well as disadvantages. Ultimately the outcome measures are the ones that CMS will hold hospitals accountable for financially as well as from a safety standpoint. The culture of safety and quality as well as methodologies to improve that culture will shape the future of quality of care and improve outcomes and patient satisfaction.</p>","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 1","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555427/pdf/rjaic-24-1-47.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35411068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthesiologists' simulation training during emergencies in obstetrics.","authors":"Volodymyr V Artyomenko,&nbsp;Volodymyr M Nosenko","doi":"10.21454/rjaic.7518.241.dym","DOIUrl":"https://doi.org/10.21454/rjaic.7518.241.dym","url":null,"abstract":"<p><strong>Background and aims: </strong>Methods of simulation training and quality assessment during obstetric emergencies are still ambiguous. The aim of this study was to evaluate the effectiveness of anaesthesiologists' simulation training for emergency situations in obstetrics.</p><p><strong>Methods: </strong>We conducted a prospective, descriptive, and comparative study to evaluate the anaesthesiologists' simulation training effectiveness during obstetrical emergencies. Data of 109 obstetrical anaesthesiologists trained over two years for invasive procedures and cardiopulmonary resuscitation, high-fidelity scenarios and medical personnel teamwork included were analyzed. We used the two-sided t-test (p < 0.05 considered significant).</p><p><strong>Results: </strong>We noted during the fifth training sessions, the anaesthesiologists had a significant manipulation time decrease for all skills compared to the ones assessed during their first training session (p < 0.01). The 100-grade scale scores for all invasive techniques significantly improved during the anaesthesiologists' training (p < 0.01). Cardiopulmonary resuscitation effectiveness and team work also improved significantly during the fifth session (p < 0.01).</p><p><strong>Conclusions: </strong>As a result of simulation training, significant improvement of speed and quality indicators, for invasive techniques in obstetrical emergency states treatment, was noted. For the fifth training sessions, there was a decrease in the practical skills execution time. The overall effectiveness and teamwork quality for cardiopulmonary resuscitation showed significant improvement.</p>","PeriodicalId":21279,"journal":{"name":"Romanian journal of anaesthesia and intensive care","volume":"24 1","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555425/pdf/rjaic-24-1-37.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35411066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}