Anna Dylczyk-Sommer - Academia.edu (original) (raw)
Papers by Anna Dylczyk-Sommer
Anaesthesiology Intensive Therapy, 2020
The most frequently mentioned risk factors for dysphagia in the intensive care unit (ICU) include... more The most frequently mentioned risk factors for dysphagia in the intensive care unit (ICU) include admission for an acute neurological disease, previous neurological conditions, neuropathy/frailty in critically ill patients, and prolonged mechanical ventilation with endotracheal tube maintenance [1, 2, 7-12]. Other factors influencing the incidence of dysphagia are age [7, 13-15], heart failure, postoperative pulmonary complications, sepsis, perioperative stroke, as well as dysphagia present prior to admission to the ICU, head and neck cancers and consequences of their treatment [8, 12, 14-17]. Less frequently mentioned risk factors for dysphagia include a high APACHE II or SOFA score, sex and comorbidities, such as arterial hypertension, kidney disease, diabetes, chronic obstructive pulmonary disease, myocardial infarction, heart failure, and nicotine addiction [1, 2, 6, 7, 13]. Among invasive procedures, trans-oesophageal echocardiography was associated with a higher incidence of dysphagia [6, 8, 12, 18]. The major risk factor for dysphagia in ICU patients, however, is endotracheal intubation; therefore, the concept of post-extubation dysphagia (PED) is increasingly used [3]. Endotracheal tube maintenance may promote dysphagia via several mechanisms. Apart from direct trauma to the larynx and its vicinity, the endotracheal tube may disturb the sensory reactions within the larynx, which, in
Anaesthesiology Intensive Therapy, 2020
Swallowing disorders-such as aphagia, odynophagia and dysphagia are increasingly observed among p... more Swallowing disorders-such as aphagia, odynophagia and dysphagia are increasingly observed among patients in intensive care units (ICU). Aphagia means inability to swallow, and odynophagia means painful swallowing. Their most common causes are inflammatory or neoplastic lesions in the oropharynx, or the consequences of oncological treatment, e.g. radiotherapy [1-3]. Dysphagia is an abnormality in the swallowing process, i.e. ingestion of food, grinding it, and transporting it from the oral cavity through the oesophagus to the stomach. The severity of the pathology may vary depending on the aetiology. It can be caused by structural anomalies in the upper gastrointestinal (GI) tract or functional disturbances of the nervous and/or muscular systems [3]. Both the diagnosis and treatment of dysphagia require the cooperation of specialists in many fields of medicine. It seems that anaesthesiologists should be included in this group [3]. Dysphagia significantly worsens the patients' quality of life. It results in increased morbidity and mortality, mainly due to a higher risk of aspiration and subsequent aspiration pneumonia, as well as to difficulties in the intake of food and/or fluids by mouth, which leads to malnutrition [1]. Diagnosis and determination of the cause of dysphagia is crucial, and in many cases it offers the opportunity to treat and/or compensate for swallowing problems and thus reduce the risk of complications. The final effect of the therapy, however, is
Anestezjologia Intensywna Terapia, Jul 11, 2007
Anestezjologia Intensywna Terapia, 2016
Background: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic b... more Background: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes. Methods: Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio. Results: No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G. Conclusions: Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.
Anestezjologia Intensywna Terapia, 2015
Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjny... more Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej? Does epidural anaesthesia reduce the incidence of postoperative oxygen desaturation episodes in patients undergoing open abdominal aortic aneurysm repair?
Minerva anestesiologica, Jan 15, 2014
Ondansetron was effectively used to prevent spinal anaesthesia--induced hypotension in the genera... more Ondansetron was effectively used to prevent spinal anaesthesia--induced hypotension in the general population and women anaesthetised for caesarean section. The aim of this study was to test the hypothesis that blocking type 3 serotonin receptors with intravenous ondansetron administration reduces hypotension and bradycardia induced by spinal anaesthesia in elderly patients. Fifty--three patients participated in the study with 26 in the ondansetron group (received 8 mg intravenous ondansetron) and 27 in the placebo group (received 0.9% NaCl solution). The heart rate and arterial blood pressure were measured every 5 minutes after spinal anaesthesia, which was performed with 2.5 to 3 mL of 0.5% hyperbaric bupivacaine solution. Decreases in both the heart rate and mean systolic, as well as diastolic, arterial pressure compared to the baseline values were noted in both groups. The minimum diastolic and mean blood pressure values obtained over a 20--minute observation period were signifi...
Anestezjologia intensywna terapia
Transportation to the recovery room after surgery can be associated with significant hypoxaemia, ... more Transportation to the recovery room after surgery can be associated with significant hypoxaemia, if a portable oxygen source and a pulse oximeter are not used. We analysed the condition of patients on admission to recovery after being transported from the operating room without additional oxygen and monitoring. One hundred and thirty-one ASA II and III patients, aged 58.2 ± 15.96 years, were enrolled to the study. SaO2 readings immediately before transportation, and on arrival in recovery, were compared. Additionally, blood-gas analysis was performed 10 min after admission to the recovery room. The duration times of transport (T1), lack of monitoring (T2) and breathing with room air (T3) were measured. The mean SaO2 before transportation was 96.9 ± 10.55%, and on arrival in the recovery room was 93.0% ± 6.35. The mean T values were: T1 - 90.0 ± 94.2 s, T2 - 152.6 ± 86.6 s, and T3 - 122.9 ± 86.8 s. Although the length of transport time was relatively short, mild hypoxaemia was observ...
Ultrasound in Medicine & Biology, 2011
magnetic tracker). After manual pre-positioning of the robotic device, acquisition of scans and g... more magnetic tracker). After manual pre-positioning of the robotic device, acquisition of scans and graphical selection of both insertion and target points, the correct needle position and angulation will be set automatically by the robot. During the intervention, the small robot system holds the needle guide in a defined position/orientation to the patient's body and needle insertion will be performed manually by the physician. The complete intervention can be monitored and documented by superimposed information of planned and real biopsy trajectory on the actual US scan. Results: The decoupling of the needle from the US probe combines the advantage of freehand scanning by still having stable needle guidance by the robot device. System accuracy and clinical relevance currently are being tested in a series of in vitro tests. Conclusion: Robotic-assisted biopsies with high accuracy are feasible using US guidance.
Regional Anesthesia and Pain Medicine, 2008
Background and Objectives: Side effects of spinal anesthesia include arterial hypotension and bra... more Background and Objectives: Side effects of spinal anesthesia include arterial hypotension and bradycardia. Both of them may be induced by sympathetic nerve blockade as well as by the Bezold-Jarisch reflex, which may be mediated by peripheral serotonin receptors (5-HT 3 type). The aim of this study was to verify the hypothesis that blockade of type 3 serotonin receptors by intravenous ondansetron administration might reduce hypotension and bradycardia induced by spinal anesthesia. Methods: Seventy-one patients participated in the study; 36 in the ondansetron group (receiving 8 mg intravenous ondansetron), and 35 in the placebo group (receiving isotonic NaCl solution). Measurements of heart rate and arterial blood pressure were taken every 5 minutes after spinal anesthesia was performed with 4 mL 0.5% hyperbaric bupivacaine solution. Results: Decreases in mean, systolic, and diastolic arterial pressure as well as in heart rate, compared with baseline values were observed in both groups. Minimal systolic and mean blood pressure values obtained over a 20-minute observation period were significantly higher in the ondansetron group. There were no significant differences in diastolic blood pressure and heart rate values between the groups. Conclusions: Ondansetron given intravenously attenuates the fall of systolic and mean blood pressure, but does not have an influence on diastolic blood pressure or heart rate.
European Journal of Anaesthesiology, 2007
European Journal of Anaesthesiology, 2005
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2005
group and incidence of VAP was 20%. In group B the pH changes were not statistically significant ... more group and incidence of VAP was 20%. In group B the pH changes were not statistically significant and incidence of VAP was 33%. The difference between incidence of VAP in both groups was not statistically significant (p ϭ 0,34). Conclusion: IEF technique can be used to obtain a temporary increase of gastric contents acidity that inhibits gastric colonization, however, this not cause a statistically significant decrease in incidence of VAP. References:
European Journal of Anaesthesiology, 2010
Local and Regional Anaesthesia Materials and Methods: 60 patients with femur fractures (ASA III) ... more Local and Regional Anaesthesia Materials and Methods: 60 patients with femur fractures (ASA III) were randomly allocated in 2 groups to receive hypobaric (2 ml isobaric 0,5% bupivacaine+4 ml twice-distilled water) for unilateral (Group 1) or isobaric (3-3,5 ml 0,5%) bupivacaine for bilateral (Group 2) spinal anesthesia. After spinal anesthesia epidural catheter was placed for postoperative analgesia. In case of first signs of sensitivity recovery epidural catheter was used for extension of anesthesia-patients received 4 ml 0,5% isobaric bupivacaine. The difference between groups in incidence of hypotension and/or bradicardia, inadequate anesthesia and needs in additional epidural anesthesia due to short duration of spinal block were compared with analysis of proportions: Fisher's test, Relative Risk (RR), Number Needed to Treat (NNT), Number Needed to Harm (NNH). Results and Discussion: Both groups had similar characteristics for sex, age, surgery, and duration of surgery. Significant different in hypotension and/ or bradycardia was observed (two-tailed Fisher's p=0,012): 1 from 30 patients in Group 1 and 9 from 30 patient in Group 2, RR = 9 (95%C.I. 1,21-66,75), OR=12,43 (95%C.I. 1,47-363,05), NNT=3,75. In uSA Group number of patients who needed in additional epidural anesthesia was significantly greater: 9/30 vs. 2/30 (p=0,042), RR=4,5 (95%C.I. 1,06-19,11), OR=6 (1,05-61,03), NNH=4,3. Using uSA considerably reduces risk of hypotension and/or bradicardia in high risk trauma patients with femur fractures but due to shorter duration of blockade often requires additional anesthesia. It can be suggested for potential long-term surgery. Epidural or subarachnoid catheterization solves this potential problem. Conclusion(s): uSA with hypobaric bupivacaine for high risk trauma patients with femur fractures reduces risk of hypotension but requires epidural or subarachnoid catheterization for additional anesthesia in case of long-term surgery.
Anaesthesia, 2009
Drugs used in anaesthesia may provoke torsadogenic changes in cardiac repolarisation. The aim of ... more Drugs used in anaesthesia may provoke torsadogenic changes in cardiac repolarisation. The aim of this study was to assess the effect of promethazine on the parameters of ventricular repolarisation: QTc interval and transmural dispersion of repolarisation. Forty patients were randomly allocated to receive promethazine (25 mg) or midazolam (2.5 mg). Changes in the ECG and arterial blood pressure were recorded. Correction of QT interval was calculated using Bazett's formula and Fridericia's correction; transmural dispersion of repolarisation was determined as T(peak)-T(end) time. Significant prolongation of QT interval, corrected with both formulae, was detected in patients receiving promethazine, while no change in the QTc value was observed in the midazolam group. There were no significant differences in T(peak)-T(end) time either between or within the groups. In conclusion, promethazine induces significant QTc prolongation but the lack of influence on transmural dispersion of repolarisation makes the risk of its torsadogenic action very low.
Anaesthesiology Intensive Therapy, 2020
In the last months of 2019, disturbing news from China began to spread around the world about the... more In the last months of 2019, disturbing news from China began to spread around the world about the increased incidence of viral infections, which turned out to be caused by a coronavirus. It was originally referred to as 2019-nCov, now as SARS-CoV-2; the disease it caused has been named COVID-19 by the World Health Organization (WHO) (11 February 2020). At present it is known that the virus has reached Europe (including Poland) and the highest number of cases has been recorded in the northern part of Italy. The knowledge regarding epidemiology is changing dynamically, so is the scope of information about the virus. This paper aims to provide upto-date information on COVID-19, which should be important for anaesthetists, intensivists and trainees in this specialty. We are aware that new findings are reported every day; therefore, it is essential to keep track of online sources of information, including websites of the Ministry of Health and the Chief Sanitary Inspector. The most important guidelines and updates on COVID-19 are being translated into
Anaesthesiology Intensive Therapy, 2020
The most frequently mentioned risk factors for dysphagia in the intensive care unit (ICU) include... more The most frequently mentioned risk factors for dysphagia in the intensive care unit (ICU) include admission for an acute neurological disease, previous neurological conditions, neuropathy/frailty in critically ill patients, and prolonged mechanical ventilation with endotracheal tube maintenance [1, 2, 7-12]. Other factors influencing the incidence of dysphagia are age [7, 13-15], heart failure, postoperative pulmonary complications, sepsis, perioperative stroke, as well as dysphagia present prior to admission to the ICU, head and neck cancers and consequences of their treatment [8, 12, 14-17]. Less frequently mentioned risk factors for dysphagia include a high APACHE II or SOFA score, sex and comorbidities, such as arterial hypertension, kidney disease, diabetes, chronic obstructive pulmonary disease, myocardial infarction, heart failure, and nicotine addiction [1, 2, 6, 7, 13]. Among invasive procedures, trans-oesophageal echocardiography was associated with a higher incidence of dysphagia [6, 8, 12, 18]. The major risk factor for dysphagia in ICU patients, however, is endotracheal intubation; therefore, the concept of post-extubation dysphagia (PED) is increasingly used [3]. Endotracheal tube maintenance may promote dysphagia via several mechanisms. Apart from direct trauma to the larynx and its vicinity, the endotracheal tube may disturb the sensory reactions within the larynx, which, in
Anaesthesiology Intensive Therapy, 2020
Swallowing disorders-such as aphagia, odynophagia and dysphagia are increasingly observed among p... more Swallowing disorders-such as aphagia, odynophagia and dysphagia are increasingly observed among patients in intensive care units (ICU). Aphagia means inability to swallow, and odynophagia means painful swallowing. Their most common causes are inflammatory or neoplastic lesions in the oropharynx, or the consequences of oncological treatment, e.g. radiotherapy [1-3]. Dysphagia is an abnormality in the swallowing process, i.e. ingestion of food, grinding it, and transporting it from the oral cavity through the oesophagus to the stomach. The severity of the pathology may vary depending on the aetiology. It can be caused by structural anomalies in the upper gastrointestinal (GI) tract or functional disturbances of the nervous and/or muscular systems [3]. Both the diagnosis and treatment of dysphagia require the cooperation of specialists in many fields of medicine. It seems that anaesthesiologists should be included in this group [3]. Dysphagia significantly worsens the patients' quality of life. It results in increased morbidity and mortality, mainly due to a higher risk of aspiration and subsequent aspiration pneumonia, as well as to difficulties in the intake of food and/or fluids by mouth, which leads to malnutrition [1]. Diagnosis and determination of the cause of dysphagia is crucial, and in many cases it offers the opportunity to treat and/or compensate for swallowing problems and thus reduce the risk of complications. The final effect of the therapy, however, is
Anestezjologia Intensywna Terapia, Jul 11, 2007
Anestezjologia Intensywna Terapia, 2016
Background: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic b... more Background: Abdominal aortic clamping during aneurysm repair may cause a decrease in splanchnic blood flow and deterioration of gut barrier integrity. Epidural blocks have beneficial effects on vital organs during abdominal surgery, but sparse data are available on the influence on gut permeability during open aortic surgery. The aim of this study was to verify the hypothesis that epidural blocks may have beneficial effects on intestine permeability changes. Methods: Seventy individuals undergoing elective open abdominal aortic aneurysm repair were randomly assigned to receive either balanced anaesthesia (continuous epidural and general anaesthesia, group E&G) or only general anaesthesia (group G). For group E&G, an epidural catheter was inserted into the epidural space before the induction of general anaesthesia. Ropivacaine was used for intraoperative and postoperative blocks. For both groups general anaesthesia was maintained with sevoflurane. For group G, analgesia was provided with remifentanil. The assessments of gut function were based on measurements of the absorption and percentages of urinary excretion of four sugars (m 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose) and the lactulose/rhamnose (L/R) ratio. Results: No intergroup differences were observed for sugar recovery or L/R ratio. Significant decreases in 3-O-methyl-D-glucose, D-xylose, and L-rhamnose recoveries were revealed in both examined groups when comparing the results obtained at 12 and 24 hours following the administration of anaesthesia. The rate of blood pressure decrease was significantly higher in group E&G. Conclusions: Aortic clamping during open abdominal aortic repair led to unfavorable changes in intestinal permeability. Epidural block did not attenuate this deterioration.
Anestezjologia Intensywna Terapia, 2015
Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjny... more Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej? Does epidural anaesthesia reduce the incidence of postoperative oxygen desaturation episodes in patients undergoing open abdominal aortic aneurysm repair?
Minerva anestesiologica, Jan 15, 2014
Ondansetron was effectively used to prevent spinal anaesthesia--induced hypotension in the genera... more Ondansetron was effectively used to prevent spinal anaesthesia--induced hypotension in the general population and women anaesthetised for caesarean section. The aim of this study was to test the hypothesis that blocking type 3 serotonin receptors with intravenous ondansetron administration reduces hypotension and bradycardia induced by spinal anaesthesia in elderly patients. Fifty--three patients participated in the study with 26 in the ondansetron group (received 8 mg intravenous ondansetron) and 27 in the placebo group (received 0.9% NaCl solution). The heart rate and arterial blood pressure were measured every 5 minutes after spinal anaesthesia, which was performed with 2.5 to 3 mL of 0.5% hyperbaric bupivacaine solution. Decreases in both the heart rate and mean systolic, as well as diastolic, arterial pressure compared to the baseline values were noted in both groups. The minimum diastolic and mean blood pressure values obtained over a 20--minute observation period were signifi...
Anestezjologia intensywna terapia
Transportation to the recovery room after surgery can be associated with significant hypoxaemia, ... more Transportation to the recovery room after surgery can be associated with significant hypoxaemia, if a portable oxygen source and a pulse oximeter are not used. We analysed the condition of patients on admission to recovery after being transported from the operating room without additional oxygen and monitoring. One hundred and thirty-one ASA II and III patients, aged 58.2 ± 15.96 years, were enrolled to the study. SaO2 readings immediately before transportation, and on arrival in recovery, were compared. Additionally, blood-gas analysis was performed 10 min after admission to the recovery room. The duration times of transport (T1), lack of monitoring (T2) and breathing with room air (T3) were measured. The mean SaO2 before transportation was 96.9 ± 10.55%, and on arrival in the recovery room was 93.0% ± 6.35. The mean T values were: T1 - 90.0 ± 94.2 s, T2 - 152.6 ± 86.6 s, and T3 - 122.9 ± 86.8 s. Although the length of transport time was relatively short, mild hypoxaemia was observ...
Ultrasound in Medicine & Biology, 2011
magnetic tracker). After manual pre-positioning of the robotic device, acquisition of scans and g... more magnetic tracker). After manual pre-positioning of the robotic device, acquisition of scans and graphical selection of both insertion and target points, the correct needle position and angulation will be set automatically by the robot. During the intervention, the small robot system holds the needle guide in a defined position/orientation to the patient's body and needle insertion will be performed manually by the physician. The complete intervention can be monitored and documented by superimposed information of planned and real biopsy trajectory on the actual US scan. Results: The decoupling of the needle from the US probe combines the advantage of freehand scanning by still having stable needle guidance by the robot device. System accuracy and clinical relevance currently are being tested in a series of in vitro tests. Conclusion: Robotic-assisted biopsies with high accuracy are feasible using US guidance.
Regional Anesthesia and Pain Medicine, 2008
Background and Objectives: Side effects of spinal anesthesia include arterial hypotension and bra... more Background and Objectives: Side effects of spinal anesthesia include arterial hypotension and bradycardia. Both of them may be induced by sympathetic nerve blockade as well as by the Bezold-Jarisch reflex, which may be mediated by peripheral serotonin receptors (5-HT 3 type). The aim of this study was to verify the hypothesis that blockade of type 3 serotonin receptors by intravenous ondansetron administration might reduce hypotension and bradycardia induced by spinal anesthesia. Methods: Seventy-one patients participated in the study; 36 in the ondansetron group (receiving 8 mg intravenous ondansetron), and 35 in the placebo group (receiving isotonic NaCl solution). Measurements of heart rate and arterial blood pressure were taken every 5 minutes after spinal anesthesia was performed with 4 mL 0.5% hyperbaric bupivacaine solution. Results: Decreases in mean, systolic, and diastolic arterial pressure as well as in heart rate, compared with baseline values were observed in both groups. Minimal systolic and mean blood pressure values obtained over a 20-minute observation period were significantly higher in the ondansetron group. There were no significant differences in diastolic blood pressure and heart rate values between the groups. Conclusions: Ondansetron given intravenously attenuates the fall of systolic and mean blood pressure, but does not have an influence on diastolic blood pressure or heart rate.
European Journal of Anaesthesiology, 2007
European Journal of Anaesthesiology, 2005
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2006
European Journal of Anaesthesiology, 2005
group and incidence of VAP was 20%. In group B the pH changes were not statistically significant ... more group and incidence of VAP was 20%. In group B the pH changes were not statistically significant and incidence of VAP was 33%. The difference between incidence of VAP in both groups was not statistically significant (p ϭ 0,34). Conclusion: IEF technique can be used to obtain a temporary increase of gastric contents acidity that inhibits gastric colonization, however, this not cause a statistically significant decrease in incidence of VAP. References:
European Journal of Anaesthesiology, 2010
Local and Regional Anaesthesia Materials and Methods: 60 patients with femur fractures (ASA III) ... more Local and Regional Anaesthesia Materials and Methods: 60 patients with femur fractures (ASA III) were randomly allocated in 2 groups to receive hypobaric (2 ml isobaric 0,5% bupivacaine+4 ml twice-distilled water) for unilateral (Group 1) or isobaric (3-3,5 ml 0,5%) bupivacaine for bilateral (Group 2) spinal anesthesia. After spinal anesthesia epidural catheter was placed for postoperative analgesia. In case of first signs of sensitivity recovery epidural catheter was used for extension of anesthesia-patients received 4 ml 0,5% isobaric bupivacaine. The difference between groups in incidence of hypotension and/or bradicardia, inadequate anesthesia and needs in additional epidural anesthesia due to short duration of spinal block were compared with analysis of proportions: Fisher's test, Relative Risk (RR), Number Needed to Treat (NNT), Number Needed to Harm (NNH). Results and Discussion: Both groups had similar characteristics for sex, age, surgery, and duration of surgery. Significant different in hypotension and/ or bradycardia was observed (two-tailed Fisher's p=0,012): 1 from 30 patients in Group 1 and 9 from 30 patient in Group 2, RR = 9 (95%C.I. 1,21-66,75), OR=12,43 (95%C.I. 1,47-363,05), NNT=3,75. In uSA Group number of patients who needed in additional epidural anesthesia was significantly greater: 9/30 vs. 2/30 (p=0,042), RR=4,5 (95%C.I. 1,06-19,11), OR=6 (1,05-61,03), NNH=4,3. Using uSA considerably reduces risk of hypotension and/or bradicardia in high risk trauma patients with femur fractures but due to shorter duration of blockade often requires additional anesthesia. It can be suggested for potential long-term surgery. Epidural or subarachnoid catheterization solves this potential problem. Conclusion(s): uSA with hypobaric bupivacaine for high risk trauma patients with femur fractures reduces risk of hypotension but requires epidural or subarachnoid catheterization for additional anesthesia in case of long-term surgery.
Anaesthesia, 2009
Drugs used in anaesthesia may provoke torsadogenic changes in cardiac repolarisation. The aim of ... more Drugs used in anaesthesia may provoke torsadogenic changes in cardiac repolarisation. The aim of this study was to assess the effect of promethazine on the parameters of ventricular repolarisation: QTc interval and transmural dispersion of repolarisation. Forty patients were randomly allocated to receive promethazine (25 mg) or midazolam (2.5 mg). Changes in the ECG and arterial blood pressure were recorded. Correction of QT interval was calculated using Bazett's formula and Fridericia's correction; transmural dispersion of repolarisation was determined as T(peak)-T(end) time. Significant prolongation of QT interval, corrected with both formulae, was detected in patients receiving promethazine, while no change in the QTc value was observed in the midazolam group. There were no significant differences in T(peak)-T(end) time either between or within the groups. In conclusion, promethazine induces significant QTc prolongation but the lack of influence on transmural dispersion of repolarisation makes the risk of its torsadogenic action very low.
Anaesthesiology Intensive Therapy, 2020
In the last months of 2019, disturbing news from China began to spread around the world about the... more In the last months of 2019, disturbing news from China began to spread around the world about the increased incidence of viral infections, which turned out to be caused by a coronavirus. It was originally referred to as 2019-nCov, now as SARS-CoV-2; the disease it caused has been named COVID-19 by the World Health Organization (WHO) (11 February 2020). At present it is known that the virus has reached Europe (including Poland) and the highest number of cases has been recorded in the northern part of Italy. The knowledge regarding epidemiology is changing dynamically, so is the scope of information about the virus. This paper aims to provide upto-date information on COVID-19, which should be important for anaesthetists, intensivists and trainees in this specialty. We are aware that new findings are reported every day; therefore, it is essential to keep track of online sources of information, including websites of the Ministry of Health and the Chief Sanitary Inspector. The most important guidelines and updates on COVID-19 are being translated into