PAIN, ANAESTHESIA & INTENSIVE CARE最新文献

{"title":"INTRAOPERATIVE HYPERCAPNIA, RISK FACTORS AND HOW TO RECOGNIZE THE PROBLEM IN TIME? THE INFLUENCE OF HYPERCAPNIA ON THE POSTOPERATIVE AWAKENING OF THE PATIENT","authors":"A. Morenko, S. O. Dubrov","doi":"10.25284/2519-2078.2(103).2023.284634","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284634","url":null,"abstract":"Summary: This article addresses the issue of intraoperative development of hypercapnia and its correlation with delayed patient awakening following intravenous (IV) sedation with preserved spontaneous respiration. A brief literature review was conducted on the development, pathogenesis of hypercapnia, and adequacy of patient monitoring during IV analgosedation with preserved spontaneous respiration. Through the analysis of literature on this topic, we have found that the adequacy of monitoring is insufficiently studied, and the correlation between saturation and carbon dioxide (CO2) levels in arterial blood is not always proportional in patients undergoing deep procedural sedation with preserved spontaneous respiration (PSR). Therefore, we aim to present our own clinical experience","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA & INTENSIVE CARE","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114903677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DISCUSSED PROBLEMS OF USING LOCAL ANESTHETICS FOR ULTRASOUND-DIAGNOSED EDEMA","authors":"D. Dmytriiev, Yevhenii Lisak","doi":"10.25284/2519-2078.2(103).2023.284626","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284626","url":null,"abstract":"Regional methods of anesthesia are widely used in surgical interventions on the lower limb, in particular on the foot. Patients with diabetes are distinguished by high comorbidity, the diabetic foot often includes swelling of varying degrees of severity. \u0000As part of the hypothesis, it is necessary to answer the following questions: Does peri-neural edema of the subcutaneous fatty tissue reduce the effectiveness of local anesthet-ics? If so! Then, in what way? Which factor is decisive, the dilution in the edema vo-lume, or the pH of the edema fluid itself? \u0000The degree of dilution will depend on the volume of the swelling. Indeed, in this class of patients, during ultrasound examination, we observed various patterns of edema. Which obviously correspond to different degrees of swelling. But how to objectify them? An ultrasound image is a two-dimensional image, and fluid passages (edema) chaotically fill the space between fat lobes.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA & INTENSIVE CARE","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131787039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ORGANIZATIONAL TECHNOLOGIES TO DEACREASE A RISK OF CRITICAL INCIDENTS DURING ANESTHESIA","authors":"K. Bielka, I. Kuchyn, M. Frank, G. Fomina, I. Sirenko, A. Yurovich, I. Lisnyy, G. Posternak","doi":"10.25284/2519-2078.2(103).2023.284624","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284624","url":null,"abstract":"Resume. The introduction of checklists during anesthesia could affects the critical incidents incidence during anesthesia. \u0000The purpose of the study. Studying the impact of organizational technologies the checklist «Safe Surgery» and the checklist of anesthesia equipment on the frequency of critical incidents in Ukrainian hospitals during anesthesiology. \u0000Materials and methods. The audit was conducted at the Department of Surgery, Anesthesiology and Intensive Care of Postgraduate Education of Bogomolets NMU. \u0000Results. Critical incidents occurred in 150 (12,73%) cases in the control group and 63 (5,95%)) in the intervention group (OR 0.43 [0.32-0.59], p<0.0001). \u0000Conclusions. Being a method with a consistently proven positive effect in almost any surgical environment, a checklist is a reliable way to implement modern safety standards. The checklists used by most anesthesiologists during anesthesiology helped reduce the number of errors and shortcomings during manipulations.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115527756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESPEN PRACTICAL GUIDELINE: CLINICAL NUTRITION IN CANCER","authors":"Maurizio Muscaritoli, Jann Arends, Patrick Bachmann, Vickie E. Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Elisabeth Hutterer, Elizabeth Isenring, S. Kaasa","doi":"10.25284/2519-2078.2(103).2023.284622","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284622","url":null,"abstract":"Довідкова інформація. Ці практичні настанови засновані на сучасних наукових настановах ESPEN з харчування онкологічних пацієнтів. \u0000Методи. Для спрощення використання у клінічній практиці настанови ESPEN були скорочені та переведені в блок-схеми. Практичні настанови призначені для всіх фахівців, зокрема лікарів, дієтологів, нутриціологів і медичних сестер, які працюють з онкологічними пацієнтами. \u0000Результати. В цілому представлено 43 рекомендації з короткими коментарями щодо лікування нутритивних і мета- болічних розладів у пацієнтів з онкологічними захворюваннями. Рекомендаціям, що надаються у зв’язку із захво- рюванням, передують загальні рекомендації з оцінки нутритивного статусу онкологічних хворих. \u0000Висновок. Ця практична настанова надає рекомендації медичним працівникам, які беруть участь у лікуванні онко- логічних хворих, для забезпечення оптимального харчування.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125304926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RESULTS OF PAIN TREATMENT IN MILITARY MEDICAL CLINICAL CENTERS FOR COMBATANTS AFTER GUNSHOT WOUNDS","authors":"V. Horoshko, I. Kuchyn","doi":"10.25284/2519-2078.2(103).2023.284625","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284625","url":null,"abstract":"Resume. Unfortunately, the treatment of combatants with gunshot wounds does not end with wound healing. In 66.7 %-73.1 % of these patients, pain becomes chronic and affects quality of life. Therefore, studying the results of pain treatment in combatants after gunshot wounds in military medical clinical centers can help identify weaknesses on the way to improving the results of treatment of this category of patients. \u0000Objective. To study the results of treatment of combatants' pain after gunshot wounds in military medical clinical centres. \u0000Methods. The data on the results of treatment of 769 combatants with gunshot wounds after combat operations are presented. The intensity of pain during treatment was monitored using a visual analogue scale (VAS). Also, the time interval between analgesia was recorded. The groups were compared by the Mann-Whitney test and the chi-square test, taking into account the correction for continuity. To test the distribution of quantitative indicators for normality, the Shapiro-Wilk test was used, and to analyse the dynamics of indicators, the Friedman test for related samples was used, and a posteriori comparison was performed using the Bonferroni correction. \u0000Results. On admission, the VAS pain intensity in the 2 groups was practically the same and met the criteria of moderate and severe pain, here the number of points ranged from 4 to 7, which indicates the lack of quality pain control and low effectiveness of analgesia in the preliminary stages or during medical evacuation. on the 14th day after injury, the VAS pain intensity practically corresponded to 2 points – mild pain, which indicates stable pain control and sufficiently high-quality pain treatment. However, on the 9th day of observation (p=0.009, and then <0.001), there was a difference, which is most likely due to the number of injured anatomical areas of the patient. The intervals between anesthetizations gradually increased. However, from the 10th day of observation there is a difference between the groups (p<0.001). \u0000Conclusion: The data obtained indicate that at the stage of treatment in military mobile hospitals, from which combatants are evacuated to military medical clinical centres, as well as during evacuation, more attention should be paid to the issue of pain management, because the lack of quality pain control between treatment stages is one of the factors that affects the frequency of pain chronicity.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126249104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"«MEDICAL ERROR» AND «MEDICAL NEGLIGENCE»?: LIMITS OF RESPONSIBILITY","authors":"A. Shevel, S. Dubrov, Y. Lisun","doi":"10.25284/2519-2078.2(103).2023.284632","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284632","url":null,"abstract":"In today's world, evidence-based medicine is gaining relevance, one of the principles of which is to reduce probable medical errors. The main task of the health care system in Ukraine is to improve the quality of medical care. The effectiveness and clarity of the functioning of all units (health care facilities, relevant ministries, departments, etc.) to improve the quality of health care is possible only if they are coordinated. But despite all the actions and methods aimed at improving the provision of medical care, there are cases when treatment does not give the expected result, then talk about medical errors. The definition of «medical error» is understood to mean the result of incorrect actions of a doctor in the process of diagnosing or treating a patient, which led to a threat to the life and health of the patient. In various sources, «medical error» is identified with «medical negligence» or «negligence», and whether these concepts are identical, we will try to understand","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"236 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127532192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE EFFECT OF SEDATION STRATEGY ON THE FREQUENCY OF POSTOPERATIVE ARRHYTHMIAS AFTER CARDIAC SURGERIES WITH BYPASS","authors":"Y. Plechysta, S. Dubrov","doi":"10.25284/2519-2078.2(103).2023.284631","DOIUrl":"https://doi.org/10.25284/2519-2078.2(103).2023.284631","url":null,"abstract":"Introduction: Postoperative arrhythmias are a frequent problem after surgical interventions, both noncardiac and cardiac surgeries. A 20% higher frequency of rhythm disturbances occurs in patients after cardiac surgery. Postoperative arrhythmia has many variations. Such arrhythmias include atrial fibrillation, atrial flutter, ventricular arrhythmias, and bradyarrhythmias. There are many conflicting facts about the effect of sedative drugs, which are most often used at the moment: propofol, dexmedetomidine, on reducing the frequency of postoperative arrhythmias.\u0000Purpose: To analyze whether there is a difference in the frequency of postoperative arrhythmia in patients in different groups sedated with propofol, dexmedetomidine and their combination.\u0000Materials and methods: This is a randomized controlled parallel study. The study included 356 patients over 18 years of age who underwent cardiac surgeries operative treatment. 194 patients were analyzed. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software.\u0000Results: Of the total number of patients in the propofol sedation group without prior rhythm disturbance, in whom arrhythmia was detected in the postoperative period, n=13 patients were registered. In the dexmedetomidine sedation group, postoperative arrhythmia was observed in 8 patients, which is also 50 % of the total number of patients in this group. Among 8 patients in whom postoperative arrhythmia was registered, 5 patients did not have rhythm problems before surgery. Of the total number of patients in the group of sedation with a combination of drugs without previous rhythm disturbance, postoperative arrhythmia was detected in 19 patients. When analyzing the frequency of postoperative arrhythmias, no difference in the frequency of postoperative arrhythmias has been detected in all three sedation strategies (p=0.1107).\u0000Conclusions: According to the data we obtained, no difference was found in the frequency of postoperative arrhythmias in patients after cardiac surgery in any of the sedation groups (p=0.1107).","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130215311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSESSMENT OF PATIENTS READINESS FOR WEANING FROM THE RESPIRATOR AFTER MECHANICAL LUNG VENTILATION","authors":"S. Cherniaiev, S. Dubrov","doi":"10.25284/2519-2078.1(102).2023.278324","DOIUrl":"https://doi.org/10.25284/2519-2078.1(102).2023.278324","url":null,"abstract":"Introduction. Approximately 20% of patients on mechanical lung ventilation (MLA) experience weaning difficulties. It is recommended to evaluate objective clinical criteria used to predict a patient's readiness of weaning from a respirator. Randomized trials have shown the effectiveness and safety of the spontaneous breathing test (SBT) with inspiratory pressure support as a weaning method. Currently, there are many predictors of ventilator weaning, including both clinical and sonographic criteria, such as rapid shallow breathing index (RSBI), diaphragm thickening fraction (DTf), and Diaphragmatic excursion (DE). \u0000Case description. Patient K., 87 years old, has a history of 3 acute ischemic strokes with signs of vascular dementia according to relatives. 3 weeks ago, she hit her head at home and lost consciousness. She was hospitalized in a medical institution, after drainage of subdural hematomas, she was under analgosedation. 26 hours after tracheal intubation, in the presence of clinical criteria, a SBT was performed with calculation of RSBI, DTf and DE. After evaluating the predictors of weaning from the respirator, a decision was made to extubate the patient. After weaning from the respirator, the general condition is satisfactory. \u0000Conclusions. Assessment of predictors of successful ventilator weaning is relevant in elderly patients with dementia, when assessment of mental status is difficult and the use of objective indicators helps in decision-making regarding ventilator weaning.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114192816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"POSTHUMOUS DONATION AND ORGAN TRANSPLANTATION IN UKRAINE DURING THE WAR","authors":"N. Matolinets, S. Dubrov, M. Ovechko, O. Samchuk","doi":"10.25284/2519-2078.1(102).2023.278300","DOIUrl":"https://doi.org/10.25284/2519-2078.1(102).2023.278300","url":null,"abstract":"One of the leading directions of the development of Ukrainian medicine during the last few years is organ transplantation, because it is a treatment method that remains the last hope when all other methods are already ineffective. However, despite the successes in this area, there are also problematic moments, the main of which is the lack of donor organs. And the reason for this shortage is considered to be the disapproval of relatives for the removal of organs, due to the low level of awareness of the procedure for establishing brain death. But, despite this, as well as in spite of the difficult working conditions during the war, Ukrainian transplantology is constantly developing, as evidenced by the data of the Ministry of Health and the Ukrainian Center for Transplant Coordination. A significant success in the field of transplantology is the second lung transplant recently carried out in Ukraine and the first carried out independently by Ukrainian doctors.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127551298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MANAGEMENT OF SEVERE PERIOPERATIVE BLEEDING","authors":"S. Cherniaiev, S. Dubrov","doi":"10.25284/2519-2078.1(102).2023.278327","DOIUrl":"https://doi.org/10.25284/2519-2078.1(102).2023.278327","url":null,"abstract":"Introduction. Perioperative bleeding remains a major complication during and after surgery, leading to increased morbidity and mortality. Its prevalence depends on numerous factors affecting the hemostasis system. \u0000Objective. Review of updated guidelines for the perioperative management of patients with severe bleeding \u0000Conclusions. Management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. First of all, it is important to identify a group of patients with an increased risk of perioperative bleeding. Strategies to correct preoperative anemia and stabilize macro- and microcirculation should then be employed to optimize the patient's bleeding tolerance. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and thus to reduce subsequent morbidity and mortality.","PeriodicalId":306479,"journal":{"name":"PAIN, ANAESTHESIA &amp; INTENSIVE CARE","volume":"243 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132930396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}