Anaesthesiology intensive therapy最新文献

{"title":"An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant.","authors":"Stephania Paredes,&nbsp;Vivian Hernandez Torres,&nbsp;Harold Chaves-Cardona,&nbsp;Mark Matus,&nbsp;Steven Porter,&nbsp;Johnathan Ross Renew","doi":"10.5114/ait.2023.125337","DOIUrl":"10.5114/ait.2023.125337","url":null,"abstract":"<p><strong>Introduction: </strong>Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study investigates neuromuscular blocking antagonists in this population when undergoing subsequent non-cardiac surgery.</p><p><strong>Material and methods: </strong>A retrospective review was performed for the period 2015-2019 across our health care enterprise. Patients with previous orthotopic heart transplant and subsequent non-cardiac surgery were identified. A total of 185 patients were found, 67 receiving neostigmine (NEO) and 118 receiving sugammadex (SGX). Information of patient characteristics, prior heart transplant, and subsequent non-cardiac surgery was collected. Our primary outcome was the incidence of bradycardia (heart rate < 60 bpm) and/or hypotension (mean blood pressure (MAP) < 65 mmHg) following neuromuscular blockade reversal. Secondary outcomes included need of intra-operative inotropic agents, arrhythmia, cardiac arrest, hospital length of stay (hLOS), ICU admission, and death within 30 postoperative days.</p><p><strong>Results: </strong>In unadjusted analysis, no significant differences were found between the two groups in change in heart rate [0 (-26, 14) vs. 1 (-19, 10), P = 0.59], change in MAP [0 (-22, 28) vs. 0 (-40, 47), P = 0.96], hLOS [2 days (1, 72) vs. 2 (0, 161), P = 0.92], or intraoperative hypotension [4 (6.0%) vs. 5 (4.2%), OR = 0.70, P = 0.60] for NEO and SGX respectively. After multivariable analysis, the results were similar for change in heart rate ( P = 0.59) and MAP ( P = 0.90).</p><p><strong>Conclusions: </strong>No significant differences in the incidence of bradycardia and hypotension were found in the NEO versus SGX groups. NEO and SGX may have similar safety profiles in patients with prior heart transplant undergoing non-cardiac surgery.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 1","pages":"46-51"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/c5/AIT-55-50189.PMC10156568.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9625538","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":"Comparing the quality of analgesia with ultrasound-guided pectoral nerve block and serratus anterior plane block II in patients undergoing modified radical mastectomy: a randomised clinical trial.","authors":"Abdelrhman Alshawadfy,&nbsp;Shimaa A Al-Touny","doi":"10.5114/ait.2023.126218","DOIUrl":"https://doi.org/10.5114/ait.2023.126218","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the recent use of serratus anterior plane (SAP) and pectoral nerve (PECS) blocks for pain management following breast surgery, there are insufficient data comparing their analgesic benefits. This study aimed to compare the quality of analgesia for PECS and SAP blocks in patients having modified radical mastectomy (MRM).</p><p><strong>Material and methods: </strong>This trial enrolled 50 adult female patients scheduled for MRM under anaesthesia. Patients were randomly allocated to two groups. After induction of anaesthesia, 25 patients received US-guided PECS II block, and 25 patients received US-guided SAP block. The primary outcome was the time to first analgesic request. Secondary outcomes included the total analgesic consumption and postoperative pain during the first 24 hours as well as the total time to perform the block, surgeon satisfaction, haemodynamic parameters, and postoperative nausea and vomiting.</p><p><strong>Results: </strong>Time to first analgesic request was significantly longer in the SAP group than in the PECS II block group (95% CI: 90.2-574.5, P = 0.009). The SAP block significantly lowered the total analgesics consumption, the 24 hours patient's need for analgesia, and the VAS scores immediately, as well as at 2, 8, 20, 22, and 24 hours postoperatively ( P < 0.005). Although it required a longer preparation time than PECS II block, the SAP block had comparable surgeons' satisfaction, haemodynamic parameters, and post-operative nausea and vomiting to PECS II block.</p><p><strong>Conclusions: </strong>Following MRM, US-guided SAP block provided a delayed time to first rescue analgesia with better acute pain control and lower total analgesic consumption compared to the PECS II block.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 1","pages":"52-59"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/ab/AIT-55-50432.PMC10156570.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9625539","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":"Malnutrition risk in elective surgery patients and effectiveness of preoperative nutritional interventions at a pre-anaesthetic clinic: a 4-year apart, single-centre, observational study.","authors":"Paweł Kutnik,&nbsp;Oksana Wichowska,&nbsp;Justyna Sysiak-Sławecka,&nbsp;Marta Szczukocka,&nbsp;Elżbieta Rypulak,&nbsp;Paweł Piwowarczyk,&nbsp;Michał Borys,&nbsp;Mirosław Czuczwar","doi":"10.5114/ait.2023.130632","DOIUrl":"https://doi.org/10.5114/ait.2023.130632","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 44% of all patients hospitalised for an elective surgical procedure have a malnutrition risk. In this study, we assessed the prevalence of malnutrition risk at a pre-anaesthetic clinic and the feasibility of introducing nutritional support. The primary objective of this study was to assess malnutrition risk prevalence in patients referred to a pre-anaesthetic clinic.</p><p><strong>Material and methods: </strong>This was a prospective observational study. The study was divided into two phases: one in 2020 and the other in 2023. Consecutive patients scheduled for an elective surgical procedure at a pre-anaesthetic clinic were asked to participate in the study by filling out the questionnaire. We divided the patients into two groups based on the GLIM criteria.</p><p><strong>Results: </strong>We included a total of 467 patients, including 214 from 2020 and 253 from 2023. In the total sample, 93 (19.9%) patients met the GLIM criteria for malnutrition risk, and 37 (7.9 %) fulfilled the ESPEN criteria for preoperative nutritional support. Out of 93 patients at malnutrition risk, 41 (44%) had BMI > 25 kg m -2 . The number of patients with indications for preoperative nutritional support in all departments remained similar across both time points. However, the number of patients receiving preoperative ONS almost doubled over the study period (36.8% in 2020 vs. 72.2% in 2023).</p><p><strong>Conclusions: </strong>Malnutrition risk was consistently high among our elective surgery patients. Not all patients with indications for preoperative nutritional support received it. As such, pre-anaesthetic clinics might be one of the major links in the nutritional programme chains of hospitals.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 3","pages":"179-185"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/1c/AIT-55-51276.PMC10496095.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41098214","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":"High-frequency oscillatory ventilation for respiratory failure after congenital heart surgery: a retrospective analysis.","authors":"Alok Kumar,&nbsp;Ankur Joshi,&nbsp;Badal Parikh,&nbsp;Nikhil Tiwari,&nbsp;Ravi H Ramamurthy","doi":"10.5114/ait.2023.126219","DOIUrl":"https://doi.org/10.5114/ait.2023.126219","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary complications such as acute respiratory distress syndrome and refractory respiratory failure have been major causes of morbidity and mortality after cardiac surgery in children. Patients are usually transitioned to either high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO) as \"salvage therapy\" when the maximal medical management and controlled mechanical ventilation (CMV) become ineffective.</p><p><strong>Material and methods: </strong>A retrospective review of paediatric patients who underwent congenital heart surgery and developed cardiorespiratory failure during their stay in a paediatric cardiac ICU, refractory to maximal CMV, was performed in the study. The outcomes assessed were respiratory variables such as SpO 2 , RR, oxygenation index (OI), P/F ratio, and ABG parameters in CMV and HFOV as predictors of survival.</p><p><strong>Results: </strong>Twenty-four children with cardiorespiratory failure were candidates for a transition to either HFOV ( n = 15) or VA ECMO ( n = 9) for refractory hypoxaemia; of these 24 patients, 13 (54.16%) survived. PaO2 showed a significant improvement in the survivors (P = 0.03). Improvement in the PaO 2 /FiO 2 (P/F ratio) after initiation of HFOV was associated with survival ( P < 0.001). pH, PaCO 2 , HCO 3 , FiO 2 , Paw, RR/Amp, SpO 2 , and OI also showed improvements in survivors but these were not statistically significant. The HFOV survivors had longer mechanical ventilation and ICU stay than non-survivors ( P = 0.13).</p><p><strong>Conclusions: </strong>HFOV was associated with improved gas exchange for paediatric patients who developed post-cardiac surgery refractory respiratory failure. HFOV can be considered as rescue therapy where ECMO has major financial implications.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 1","pages":"60-67"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/3f/AIT-55-50433.PMC10156544.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9625541","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":"Optimizing neuromuscular blockade management for improving patient safety and peri-operative outcomes: a pilot phase of a quality improvement initiative.","authors":"Selene Martinez Perez, Juan C Segura-Salguero, Marcin Wąsowicz, Carlos A Ibarra-Moreno","doi":"10.5114/ait.2023.130805","DOIUrl":"10.5114/ait.2023.130805","url":null,"abstract":"<p><strong>Introduction: </strong>Although quantitative monitoring of neuromuscular blockade (NMB) is recommended, it is not routinely used in daily practice. The optimizing NMB management to improve patient safety and perioperative outcomes (OBISPO) quality improvement (QI) initiative intends to address this issue and change clinicians' behaviors.</p><p><strong>Material and methods: </strong>A pilot phase of the prospective QI intervention was conducted. The primary objective was implement clinical practice change that emphasizes improving NMB monitoring in patients undergoing elective cardiac surgery who are eligible for fast-track extubation between February 2021 and December 2021. The secondary objective was to reduce the train-of-four ratio (TOFR) < 0.9 incidence before tracheal extubation to less than 20%. The intervention included educational sessions for teams.</p><p><strong>Results: </strong>A total of 859 patients underwent elective cardiac surgery, 40% were eligible for fast-track extubation. From our cohort of fast-track cardiac cases, 69% had reported TOFR; 47% of them had residual paralysis (TOFR < 0.9) on arrival to PACU, 22% persisted with residual paralysis after extubation, and 27% were extubated without monitoring. The survey identified cognitive biases, knowledge gaps, unfamiliarity, and lack of trust in quantitative monitoring devices. Workflow disruptions imposed by COVID and changes in NMB monitoring devices have negatively affected our initiative.</p><p><strong>Conclusions: </strong>Our study showed that changes in clinician behavior are among the most challenging issues in perioperative medicine. Continuous teaching and QI initiatives, focused on quantitative NMB monitors and adequate reversal agent use, are mandatory to improve perioperative outcomes. Therefore, new proposals are required to promote changes in current practices.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 3","pages":"196-204"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/ca/AIT-55-51315.PMC10496104.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41091570","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":"Comparative evaluation of intraoperative dexmedetomidine versus lidocaine for reducing postoperative cognitive decline in the elderly: a prospective randomized controlled trial.","authors":"Mahendran T Kurup, Soumya Sarkar, Rohit Verma, Renu Bhatia, Puneet Khanna, Souvik Maitra, Rahul Anand, Bikash R Ray, Akhil K Singh, K K Deepak","doi":"10.5114/ait.2023.134251","DOIUrl":"10.5114/ait.2023.134251","url":null,"abstract":"<p><strong>Introduction: </strong>Neuroinflammation, neuronal cytotoxicity, and apoptosis due to exposure to anaesthetic agents are often implicated in postoperative cognitive dysfunction (POCD). Lidocaine and dexmedetomidine have been shown to suppress the neuron-specific markers of inflammation, and we aimed to compare their neuroprotective efficacy in elderly patients.</p><p><strong>Material and methods: </strong>This prospective randomized control study compared the incidence of POCD in ASA I/II patients aged 60 to 80 years without any history of substance abuse or any disorder affecting cognition. Dexmedetomidine and lidocaine were administered intraoperatively, and their effects on POCD were correlated with serum levels of IL-1, IL-6, TNF-a, amyloid-β, and S100 on postoperative day 3. POCD was assessed by the Stroop test, Trail making test-B, Porteus Maze test, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) on the day before surgery and the third postoperative day, along with blood samples.</p><p><strong>Results: </strong>Demographic parameters, anaesthesia duration, exposure to anaesthetic gases, intraoperative opioid use, and blood transfusion were similar in the lidocaine ( n = 31) and dexmedetomidine ( n = 29) groups. The incidence of POCD was 29.03% in the lidocaine group and 24.1% in the dexmedetomidine group ( P = 0.77). On postoperative day 3, IL-1 levels increased by 449% with lidocaine and 202% with dexmedetomidine ( P = 0.03). TNF-a, IL-6, and S-100β levels increased similarly in both groups. There was no significant correlation between percentage changes in neuropsychological tests and biomarkers.</p><p><strong>Conclusions: </strong>There was no significant difference in the incidence of POCD, but dexmedetomidine had a better anti-inflammatory effect in terms of lesser rise of postoperative IL-1 compared to lidocaine.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 5","pages":"349-357"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10801457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139569579","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":"Predictive role of selected biomarkers in differentiating gram-positive from gram-negative sepsis in surgical patients: a retrospective study.","authors":"Nenad Nešković, Domagoj Drenjančević, Slavica Kvolik, Sonja Škiljić, Dino Budrovac, Ivana Haršanji Drenjančević","doi":"10.5114/ait.2023.134214","DOIUrl":"10.5114/ait.2023.134214","url":null,"abstract":"<p><strong>Introduction: </strong>Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients.</p><p><strong>Material and methods: </strong>A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days.</p><p><strong>Results: </strong>Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes.</p><p><strong>Conclusions: </strong>PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 5","pages":"319-325"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10801538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139569624","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":"Preoperative anxiolytic and antidepressant medications as risk factors for increased opioid use after total knee arthroplasty: a matched retrospective cohort analysis.","authors":"Alberto E Ardon,&nbsp;Abuzar B Baloach,&nbsp;Shaina Matveev,&nbsp;Matthew M Colontonio,&nbsp;Patricia M Narciso,&nbsp;Aaron Spaulding","doi":"10.5114/ait.2023.130661","DOIUrl":"https://doi.org/10.5114/ait.2023.130661","url":null,"abstract":"<p><strong>Introduction: </strong>Previous literature has suggested that the presence of anxiety or depression may be linked to increased postoperative pain. The objective of this retrospective analysis was to assess whether patients who use anxiolytics or antidepressants preoperatively were associated with worse acute pain outcomes after elective total knee arthroplasty (TKA).</p><p><strong>Material and methods: </strong>A chart review of patients who underwent TKA at our institution was conducted. The primary outcome was mean opioid use in oral morphine equivalents (OME) on the day of surgery (POD 0) through postoperative day 1 (POD1). Secondary outcomes included median pain scores during hospitalization, the need for an acute pain service (APS) consultation, and mean length of stay. Patients were matched (1 : 1) according to multiple factors including age, surgical anaesthesia type, preoperative pain scores, and placement of a single-injection adductor canal block.</p><p><strong>Results: </strong>83 patients were successfully matched in each group. During POD0-1, patients with anxiolytic or antidepressant prescriptions required a mean of 101.36 mg OME (SD = 66.89), compared to 86.78 mg (SD = 62.66) among patients without use of these medications ( P = 0.011) (estimate of average treatment effect of +22.86). Similarly, these patients were more likely to report a slightly higher median pain score than patients not taking anxiolytics or antidepressants (4.00 [SD 1.95] vs. 3.77 [SD 2.01], P = 0.031) (estimate of average treatment effect of +0.55). However, there were no differences in hospital length of stay, acute pain service consultation, visit to an Emergency Department within one week of discharge, and readmission within one week of discharge. There were also no differences in outcomes when comparing patients with a history of anxiety or depression to those without this history.</p><p><strong>Conclusions: </strong>The use of chronic anxiolytics or antidepressants was associated with increased opioid use and slightly higher pain scores in patients undergoing TKA. These associations were independent of a medical diagnosis of anxiety or depression. The mode-rate increase in perioperative opioid consumption and pain scores was not associated with an increase in APS consultations or length of stay.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 3","pages":"205-211"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/73/AIT-55-51286.PMC10496098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41105776","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":"Critical care echocardiography: barriers, competencies and solutions. A survey of over 600 participants.","authors":"Mateusz Zawadka,&nbsp;Adrian Wong,&nbsp;Anna Janiszewska,&nbsp;Filippo Sanfilippo,&nbsp;Luigi La Via,&nbsp;Piotr Sobieraj,&nbsp;Igor Abramovich,&nbsp;Paweł Andruszkiewicz,&nbsp;Ib Jammer","doi":"10.5114/ait.2023.130294","DOIUrl":"https://doi.org/10.5114/ait.2023.130294","url":null,"abstract":"<p><strong>Introduction: </strong>Critical care echocardiography (CCE) is at the core of point-of-care ultrasound (POCUS), and although a list of the necessary competencies has been created, most European countries do not have established training programmes to allow intensivists to gain such competencies. To address barriers to the implementation of CCE, we conducted an online European survey, and analysed the current barriers to this with the aim of providing novel, modern solutions to them including environmental considerations.</p><p><strong>Material and methods: </strong>A 23-item survey was distributed via email with support from the European Society of Intensive Care Medicine, national societies, and social media. Questions focused on bedside CCE prevalence, competencies, and barriers to its implementation. An additional questionnaire was sent to recognised experts in the field of CCE.</p><p><strong>Results: </strong>A total of 644 responses were recorded. Most respondents were anaesthesia and intensive care physicians [79% ( n = 468)], and younger, with 56% in their first five years after specialization ( n = 358). Most respondents [92% ( n = 594)] had access to an ultrasound machine with a cardiac probe, and 97% ( n = 623) reported being able to acquire basic CCE windows. The most common barriers identified by respondents to the implementation of CCE in practice were a lack of sufficient experience/skill [64% ( n = 343)], absence of formal qualifications [46% ( n = 246)] and lack of a mentor [45% ( n = 243)]. Twenty-eight experts responded and identified a lack of allocated time for teaching as a main barrier [60% ( n = 17)].</p><p><strong>Conclusions: </strong>We found that bedside CCE is perceived as a crucial skill for intensive care medicine, especially by younger physicians; however, there remain several obstacles to training and implementation. The most important impediments reported by respondents were inadequate training, absence of formal qualifications and difficulties in finding a suitable mentor.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 3","pages":"158-162"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2a/d7/AIT-55-51197.PMC10496096.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132370","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":"Serious complications related to regional anaesthesia: Study of Greek Courts' Decisions.","authors":"Evangelia Samara,&nbsp;Lampros Tzoumas,&nbsp;Konstantinos Tzoumas,&nbsp;Petros Tzimas,&nbsp;Georgios Papadopoulos","doi":"10.5114/ait.2023.129302","DOIUrl":"https://doi.org/10.5114/ait.2023.129302","url":null,"abstract":"<p><strong>Background: </strong>Regional anaesthesia and analgesia present many advantages. Related complications are few and have been fully described. Information on regional anaesthesia malpractice is lacking in Greece. The objectives of the analysis were to highlight areas of high litigation risk and report the financial impact of claims.</p><p><strong>Methods: </strong>Published judicial decisions of criminal, civil, administrative and disciplinary content, from 1995 to 2020, were searched in the legal information banks. The court decisions were analysed by an expert in collaboration with the lawyers of the investigation.</p><p><strong>Results: </strong>A total of 26 court decisions related to complications from regional anaesthesia were found involving 10 cases, which comprised: 8 convictions, 1 referral of the case for a new expert opinion and 1 acquittal. In 6 cases the medical negligence involved complications after epidural anaesthesia and in 2 after subarachnoid anaesthesia. In 1 case there was collective liability of the anaesthesiologist and the obstetrician for negligent homicide and in 7 cases liability of the anaesthesiologist for bodily injuries. The duration of the litigation was 5-16 years.</p><p><strong>Conclusions: </strong>Analysis of court cases made it possible to identify the causes that led to complications during regional anaesthesia. Informed consent, non-traumatic technique, careful patient selection, adherence to safety rules, and early diagnosis and treatment of complications are essential to avoid permanent injury.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"55 2","pages":"109-113"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/d6/AIT-55-51044.PMC10415607.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10046802","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}