Year 2022 in review - anaesthesia.

By 2022, publishing has already returned to the standard. This means that the global SARS-CoV-2 pandemic for anaesthesiologists is all but forgotten, and the safety of anesthesia is again the dominant issue. However, in addition to the traditional search for answers to whether we should prefer regional or general anesthesia and for which procedures and what is the best prevention of PONV, there is now another associated topic - postoperative delirium and postoperative cognitive dysfunction. Although both entities are crucial to the overall perioperative course, they still need more attention. This is even though, especially in elderly patients, they have already been shown to significantly affect perioperative morbidity and mortality. Moreover, to the surprise of many, recent data show that their incidence is not so much dependent on the type of anesthesia but on the quality of its administration. This text aims to briefly summarize some key publications in the field of anesthesiology and to highlight papers that should not escape attention.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Year 2022 in review - Anesthesiology in obstetrics.

The article highlights and discusses several current topics that have been published in the field of anaesthesiology in obstetrics in the Czech Republic and abroad last year. It summarizes the influence of the COVID-19 pandemic on anesthesiological praxis in obstetrics. It also presents new developments in systemic and neuraxial obstetric analgesia, Caesarean Section anesthesia, and emergencies in the peripartum period.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox.

PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

Year 2021 in review - Anaesthesia

While 2020 was significantly affected by the SARS-CoV-2 pandemic, including publications, 2021 has already returned to "normal". Almost back to normal, because the world, medicine, and even anaesthesia, will never be what they used to be. What COVID-19 has changed is that the safety of what we do has come much more to the fore. The safety of our procedures and the safety of each anaesthetic, but not only. The aim of this text is to briefly summarise some key publications in the field of anaesthesiology, and to highlight papers that should not escape attention.

Year 2021 in review - Anaesthesiology in obstetrics

The article highlights and discusses several current topics that have been published in the field of anaesthesiology in obstetrics in the Czech Republic and abroad last year. It summarizes the influence of COVID-19 pandemia on anaesthesiological praxis in obstetrics. It also presents new developments in systemic and neuroaxial obstetric analgesia, Caesarean Section anaesthesia and emergencies in peripartum period.

Reducing detection time from 24 months to 9 months or less for rapid visual field loss in glaucoma

Purpose : Patients with rapidly progressing glaucoma must be identified quickly to receive aggressive treatment to save their vision. Progression is diagnosed with visual field tests, but current tests lack precision, with a test-retest variability of ~1.0 dB in mean sensitivity (MS) for moderate to severe glaucoma. New at-home tests with redesigned psychophysical procedures have recently made it practical to test 10 times in 5-10 days (Deiner, Damato & Ou, 2020. Implementing and Monitoring At-Home VR Oculo-kinetic Perimetry During COVID-19. Ophthal 127:1258). The additional data reduces test-retest variability by a factor of √10, to 0.3 dB. We asked how many months are needed to detect rapid progression (-2 dB/year) for a patient taking quarterly clusters of 10 tests, as compared to a conventional test quarterly or twice-yearly. Methods : Simulations in Matlab modeled progression in 10,000 cases each at rates of 0 dB or -2 dB/year, respectively. Test-retest variability for single tests was 1.0 dB. Specificity was set to 0.95 and sensitivity to 0.8. The testing procedure continued until the fitted rate parameter for progression (the slopes of the regression lines) could be segregated by a boundary, with 95% of non-progressors below, and 80% of progressors above, the boundary. Results : Detecting progression took 24 months for tests administered twice yearly, 18 mos for quarterly, but only 9 mos for 10-test clusters quarterly. Alternatively, specificity and sensitivity could be 99% and 98% respectively, for time-to-detect of 36, 27, and 12 months, respectively. Many glaucoma patients have test-retest variability < 1.0 dB. In a patient whose test-retest variability is 0.5, time-to-detect is 6 months for quarterly clusters. It is similarly reduced if the new at-home test has better test-retest variability than conventional tests. Conclusions : Even by itself, at-home testing of visual fields using conventional psychophysical methods would greatly improve treatment of glaucoma. Additionally, new testing procedures that are less fatiguing for the patient mean that 10 tests can collected at a time, shortening the time to detect progression to as little as 6 months.

Year 2020 in review – Anaesthesiology in obstetrics

The article highlights and discusses several current topics that have been published in the field of anaesthesiology in obstetrics in the Czech Republic and abroad last year. It summarizes the influence of COVID-19 pandemic on anaesthesiological praxis in obstetrics. It also presents new developments in systemic and neuroaxial obstetric analgesia, Caesarean Section anaesthesia and emergencies in peripartum period.