Degloving lower leg injury - the importance of additional treatment: negative pressure and hyperbaric oxygen therapy.

Degloving injury poses a severe therapeutic challenge concerning both trauma and plastic surgery. The injury involves separation of skin and subcutaneous tissue from fascia and muscles. Treatment is often long-lasting and brings unsatisfying results due to the extent of damage, risk of infection and massive blood loss. In this article, we present the management and therapeutic outcomes of a patient admitted due to the degloving injury of the lower extremity caused by workplace accident. We described the complexity of treatment including surgical intervention as well as additional treatment, which combined brought good esthetic outcome.

Dexmedetomidine for attenuating haemodynamic response to intubation stimuli in morbidly obese patients anaesthetised using low-opioid technique: comparison with fentanyl-based general anaesthesia.

BACKGROUND: Anaesthesiologists are facing the problem of an increasing population of morbidly obese patients. In order to minimize the risk of opioid-induced postoperative respiratory failure, the intraoperative administration of opioids should be reduced or replaced with other drugs. The purpose of this study was to compare haemodynamic response elicited by intubation in morbidly obese patients between two variants of anaesthesia induction: fentanylbased or low-opioid using dexmedetomidine. METHODS: Forty-two morbidly obese patients scheduled for bariatric surgery were randomly assigned to two groups: low-opioid using dexmedetomidine (DEX) or fentanyl-based (FNT) anaesthesia. Patients were premedicated with 100 µg of fentanyl i.v. In the DEX group, a 10 minute infusion of a loading dose of 200 µg of dexmedetomidine was started. In the FNT group, 2 mg of intravenous midazolam was given. Thereafter, propofol was used in both groups. In the FNT group, patients received a dose of fentanyl up to 5 µg kg⁻¹ of ideal body weight. Following administration of rocuronium, laryngoscopy and tracheal intubation were performed. Haemodynamic parameters, including systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure, as well as heart rate (HR), were recorded before and after intubation. Patients who were not intubated at first attempt were excluded from the study. RESULTS: Data from 33 patients were analysed. There were no statistically significant differences between the DEX and FNT groups regarding demographic data. Haemodynamic response to intubation was defined as mean change (d) in values of analysed parameters that occurred during intubation. The following differences were observed: dSBP FNT +11.6 mm Hg vs. DEX +0.4 mm Hg (P = 0.15); dDBP FNT +3.7 mm Hg vs. DEX +3.5 mm Hg (P = 0.98); dMAP FNT +8.6 mm Hg vs. DEX +1.4 mm Hg (P = 0.36); dHR FNT +2 beats min-1 vs. DEX -1 beat min⁻¹ (P = 0.30). None of these comparisons yielded significant differences. CONCLUSIONS: The study revealed no advantage of fentanyl over low opioid dexmedetomidine-based induction of general anaesthesia in attenuating cardiovascular response to intubation in morbidly obese patients.

Assessment of Ventilation Distribution during Laparoscopic Bariatric Surgery: An Electrical Impedance Tomography Study.

Introduction. The aim of the study was to assess changes of regional ventilation distribution at the level of the 3rd intercostal space in the lungs of morbidly obese patients as a result of general anaesthesia and laparoscopic surgery as well as the relation of these changes to lung mechanics. We also wanted to determine if positive end-expiratory pressure of 10 cm H2O prevents the expected atelectasis in the morbidly obese patients during general anaesthesia. Materials and Methods. 49 patients completed the examination and were randomized to 2 groups: ventilated without positive end-expiratory pressure (PEEP 0) and with PEEP of 10 cm H2O (PEEP 10) preceded by a recruitment maneuver with peak inspiratory pressure of 40 cm H2O. Impedance Ratio (IR) was utilized to examine ventilation distribution changes as a result of anaesthesia, pneumoperitoneum, and change of body position. We also analyzed intraoperative respiratory mechanics and pulse oximetry values. Results. In both groups general anaesthesia caused a ventilation shift towards the nondependent lungs which was not further intensified after pneumoperitoneum. Reverse Trendelenburg position promoted homogeneous ventilation distribution. Respiratory system compliance was reduced after insufflation and improved after exsufflation of pneumoperitoneum. There were no statistically significant differences in ventilation distribution between the examined groups. Respiratory system compliance, plateau pressure, and pulse oximetry values were higher in PEEP 10. Conclusions. Changes of ventilation distribution in the obese do occur at cranial lung regions. During pneumoperitoneum alterations of ventilation distribution may not follow the direction of the changes of lung mechanics. In the obese patients PEEP level of 10 cm H2O preceded by a recruitment maneuver improves respiratory compliance and oxygenation but does not eliminate atelectasis induced by general anaesthesia.

Bacterial infections in Intensive Care Unit patients analyzed on the example of the Lodz Medical University Hospital No 1 in the period 2002-2015.

INTRODUCTION: In the present study, nosocomial infections, increased resistance to carbapenem among clinical isolates of Pseudomonas aeruginosa and Acinetobacter spp. are analyzed on the example of the intensive care unit (ICU) at the Lodz Medical University Hospital No I in a long period of time (2002-2015). METHODS: In the period from 2002 to 2015, 19870 bacteriological cultures were made from 4289 patients hospitalized at the ICU. Material for the study were swab from the surgical wound, blood, urine and bronchoalveolar lavage (BAL). The identification of the species and drug resistance were performed using VAITEC (BioMerieux@) by 2004, next PHENIX (Becton Dickinson) by 2012 and VITEC 2 - compact (BioMerieux?) until now. The blood was incubated in the BACTEC 9050. RESULTS: Gram negative bacilli, predominantly Klebsiella pneumoniae and Pseudomonas aeruginosa, as well as staphylococci Staphylococcus aureus are a major cause of lower respiratory tract infections in ICU. The profile of bloodstream infections has changed over the period considered. Staphylococci was the main cause of bloodstream infections in the period 2002-2005, but since 2005 Klebsiella pneumoniae has dominated. Gram negative bacilli, mainly Escherichia coli and Klebsiella pneumoniae, were the most common pathogens to cause urinary tract infections. In the years 2014-2015, a significant increase in infections caused by Enterobacteriaceae strains ESBL(+) (extended-spectrum beta- lactamases) was observed. CONCLUSIONS: Klebsiella pneumoniae is a major cause of nosocomial infections in intensive care unit patients at the Lodz Medical University Hospital No 1. Increasing prevalence of antimicrobial resistance to P-lactam antibiotics (including carbapenems) among Pseudomonas aeruginosa and Acinetobacter spp. has been observed. Therefore, it is necessary to limit the use of carbapenems for the hospital treatment.

Results of the severe sepsis registry in intensive care units in Poland from 2003-2009.

BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs. METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously. RESULTS: During the 7-year period (2003-2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period. CONCLUSIONS: Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome.

Assessment of regional ventilation in acute respiratory distress syndrome by electrical impedance tomography.

Mechanical ventilation in acute respiratory distress syndrome (ARDS) incurs a risk of ventilator-associated lung injury (VALI) from inhomogeneous conditions and different properties of dependent and non-dependent lung regions at risk of atelectasis and overdistension, respectively. Electrical impedance tomography (EIT) offers regional ventilation assessment to optimise treatment with mechanical ventilation. This article provides an overview of scientific literature on the application of impedance tomography in acute respiratory distress syndrome. It also presents the results of EIT studies in different clinical situations that may be of use in implementing impedance tomography for treating ARDS.

Intraoperative monitoring of cerebral NIRS oximetry leads to better postoperative cognitive performance: a pilot study.

OBJECTIVES: The aim of this study is the assessment of the regional cerebral oximetry - NIRS (near infrared spectroscopy) as an intraoperative monitoring system to protect the patient against the incidents of brain desaturations. We hypothesize that patients monitored with NIRS present a smaller range of postoperative cognitive dysfunctions (POCD) in comparison with those without NIRS monitoring during lumbar spine surgery in a prone position. SETTINGS: This study was performed at the Clinical Department of Neurosurgery and Oncology of the Central Nervous System, Medical University of Lodz, Poland. PARTICIPANTS: The study completed 43 adult patients qualified for the surgical treatment of lumbar spondylosis. Before the procedures they were randomized into two subgroups: one monitored intraoperatively by means of NIRS cerebral oximetry (INVOS 5100), which numbered 13 patients ­ 30.2% (13 NIRS devices were made available to the authors) and the other without NIRS intraoperative monitoring, totaling 30 people ­ 69.8%. The patients who presented a history of psychiatric, neurological and cardiovascular disorders which impair cognitive processes were disqualified from the study. PRIMARY AND SECONDARY OUTCOME MEASURES: A comprehensive battery of neuropsychological tests was preoperatively performed on all patients. The subjects were then divided into two groups: with and without NIRS monitoring. Both groups were statistically homogeneous. Computerized anesthesia records were used to obtain intraoperative data: mean arterial pressure, heart rate, pulsoximetry and cerebral regional oxygenation. The depth of anesthesia monitor was not used. Besides, all the patients passed the same battery of neurocognitive tests 7 days and 1 month postoperatively. The Mann-Whitney test was performed to compare POCD and therefore assess the usefulness of NIRS as a monitoring mechanism during anesthesia in the prone position. RESULTS: There was a significant (p < 0.05) difference in the presence of cognitive deficiencies between the subgroup monitored with NIRS and the subgroup without NIRS. It included: Digit Span Test overall score and forward repetition score 7 days after operation, N- back Test results after 30 days in version 0 "back" - time, N-back Test version 1 "back" results in the number of correct answers and the number of errors. CONCLUSIONS: NIRS cerebral oximetry may be useful in reducing postoperative cognitive complications in patients operated on in the prone positioning. TRIAL REGISTRATION: RNN/556/08/KB ­ approval of the ethics committee at Medical University of Lodz, Poland.

The doripenem serum concentrations in intensive care patients suffering from acute kidney injury, sepsis, and multi organ dysfunction syndrome undergoing continuous renal replacement therapy slow low-efficiency dialysis.

Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300-400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT) slow low-efficiency dialysis (SLED) on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis. Ten patients were enrolled in this observational study. Twelve blood samples were collected during the first administration of doripenem in a 1-hour continuous infusion while CRRT SLED was provided. Fluid chromatography was used for measurement of the concentration of doripenem in serum. In all collected samples, concentration of doripenem was above the minimum inhibition concentration of this antibiotic. Based on these results, we can draw the conclusion that doripenem concentration is above the minimum inhibition concentration throughout all of CRRT. The dosing pattern proposed by the manufacturer can be used in patients receiving CRRT SLED without necessary modifications.

[Fungal infections in patients of an intensive care unit analyzed on the example of the Lodz Medical University Hospital No 1 in the period of 2002-2012]. / Analiza zakazen grzybiczych u chorych leczonych na Oddziale Intensywnej Terapii Uniwersyteckiego Szpitala Klinicznego nr 1 w Lodzi w latach 2002-2012.

INTRODUCTION: The objective of this study was to analyze the fungal infections in patients of an intensive care unit (ICU) in a long period (2002-2012) on the example of the Lodz Medical University Hospital No 1. This analysis was focused on the study of the effect of antimicrobial therapy on the level of these infections. METHODS: A total of 291 strains of fungi were isolated from blood, tips of central intravenous catheters, lower respiratory tract, urine, wounds, pressure sores, and cerebrospinal fluid of 3177 patients. An automatic system Bactec 9050, Yeast ID Phoenix BD panels and E-tests (BioMerieux) were used for the fungi analysis. RESULTS: The studies were mainly concentrated on the Candida infections, distinguishing cases caused by C. albicans and C. non-albicans pathogens. Changes in the number of these infections in consecutive years have been associated with epidemiological and therapeutic activities in the ICU. Particularly, relationships between the number of infections and the use ofceftazidime were discussed. A statistically significant positive correlation of the count of Candida infections and the ceftazidime consumption was found in the period to 2006. In the later years, the correlation was destroyed as a result of other important therapeutic factors (eg, immunosuppressive drugs). CONCLUSIONS: It has been found that the number of Candida infections in the ICU depends on the consumption of antimicrobial drugs. This conclusion is based on quantitative example of ceftazidime. Only close cooperation between the ICU and microbiologists is able to provide a reduction in nosocomial fungal infections.

Neuromuscular block reversal with sugammadex in a morbidly obese patient with myasthenia gravis.

BACKGRAOUND: Myasthenia gravis is a rare immunological illness that impairs neuromuscular transmission. Myasthenic patients are usually hypersensitive to non-depolarising muscle relaxants, and reversal with neostigmine is rarely effective. We report the successful reversal of rocuroniuminduced neuromuscular block in a morbidly obese myasthenic patient. CASE REPORT: A 38-year-old morbidly obese (body weight 160 kg, BMI 48.8 kg m⁻²) woman was scheduled for elective laparoscopic gastric banding. She was anaesthetised with propofol-based TIVA; intubation was facilitated by 24 mg of rocuronium. After spontaneous recovery of T1, she received 200 mg of sugammadex, which completely restored the NMT ratio (TOF=100%) within 2 min and 48 sec., and she was extubated. No postoperative complications were observed. CONCLUSION: Sugammadex can be successfully used in myasthenic patients, allowing for the safe use of muscle relaxants in these patients.

[The analysis of patients with body traumas treated in the Military Medical Academy's Second Clinical Hospital of the Medical University of Lodz]. / Analiza pacjentów z obrazeniami ciala, leczonych w Uniwersyteckim Szpitalu Klinicznym nr 2 (USK 2) im. Wojskowej Akademii Medycznej Uniwersytetu Medycznego w Lodzi.

According to recent WHO reports, body traumas are ranked third with respect of frequency of occurrence right after cardiovascular diseases and tumours, and are considered one of the major medical problems. Trauma is a kind of energy (mechanical, thermal or chemical) affecting the human body. After crossing the threshold of tissue endurance, an injury or damage occurs. A common problem of all the centres that treat traumas is a reliable and comparable assessment of injury severity. Constant improvement of the trauma scores, contributes to increased objectivity of the assessment of injury severity and makes trauma research easier. To a large extent, commonness of the scores enables the exchange of experiences with respect to treating patients after trauma. An ideal scale should be reliable, easy to use, and most of all commonly used, thus enabling the employment of a common "traumatologic" language. In the following research, the test group was comprised of 137 adult patients including 113 men (82%) and 24 women (18%). Most patients were aged from 20 to 60 years, that is, in the productive age. Appropriate trauma treatment results in the reduction of the costs of hospitalisation time of those patients and their recovery. An accident or worse still death of a young person is not only a personal tragedy for the family. It is also a big economic loss for the society which results from "lost years of life" and thus "lost years of work". Quick and appropriate treatment, done in a proper centre with appropriately trained staff and highest quality equipment will allow not only to reduce the victim's suffering and return to their daily life, but also minimise the social costs connected with disability pensions, benefits and compensations. Most injuries happened at work--61% were probably due to haste but most of all not complying with occupational health and safety regulations, which all employees should know and comply with. It involves doctors writing a sick note for the injured which undoubtedly involves much bigger losses for the employer and social costs in a form of increased premiums for healthcare plans. The most common mechanism of the injuries was self-injury (66.7%). In the study population, even 87% of the victims suffered from isolated body injuries. As is apparent from the analysed data, one should provide money for short-term health care, i.e. up to 2 days. The average treatment time for the study population was 4 days, with the maximum of 23 days. Most patients (60%) were brought by emergency medical services.

[Patient satisfaction with anaesthesia and pre-anaesthetic information]. / Badanie satysfakcji chorych i ich opinii na temat jakosci swiadczen anestezjologicznych w swietle objawów niepozadanych znieczulenia.

BACKGROUND: Patient satisfaction with perioperative care plays an important role in the assessment of quality of care. Written evaluation forms are commonly used all over the world for this purpose. The aim of this study was to assess the quality of perioperative care, with special attention being directed to anaesthesia-associated side effects. METHODS: Forty-two adult patients, of both sexes, scheduled for abdominal surgery, were asked to complete a questionnaire consisting of 11 questions on anaesthesia, side effects and the general quality of perioperative care. The results were analysed using the X2 test, and p < 0.05 was considered significant. The Pearson correlation coefficient was used for comparison. RESULTS: There was a strong correlation between the quality of the pre-anaesthesia visit, including the information obtained on possible complications and alternative methods of anaesthesia, and the assessment of quality of the anaesthesia service. Post-anaesthesia care facilities were also found to be of major importance for patients. CONCLUSIONS: Adequate, detailed and easily understandable information plays a crucial role in patients satisfaction with anaesthesia. Special attention should be paid to the most common side effects and complications. Residents should be trained in communication in the early stages of their training.

The role of the immuno-inflammatory response in patients after cardiac arrest.

INTRODUCTION: The aim of the research was to assess whether concentrations of inflammatory markers in blood of patients after cardiac arrest (CA) are related to their clinical state and survival. MATERIAL AND METHODS: Forty-six patients, aged 63 ±12 years, 21 of them after out-of-hospital CA and 25 after in-hospital CA, were enrolled in the study. Twenty-five patients survived and were discharged from hospital (CA-S); 21 died during hospitalization (CA-D). The clinical state of the patients was evaluated by the Glasgow Coma Scale (GCS) and the Acute Physiology and Chronic Health Evaluation II (APACHE II). On the day immediately after CA (day 1) and on the following day (day 2) the plasma concentration of high specific C-reactive protein (hs-CRP), tumour necrosis factor (TNF)-α, interleukin-10 and interleukin-6 (Ile-6) were measured. RESULTS: In CA-D patients, compared with CA-S, a significantly higher concentration of hs-CRP (on day 1, 19 ±5 vs. 15 ±4; on day 2, 21 ±3 vs. 16 ±5 mg/l, p < 0.001) and Ile-6 (on day 1, 24.9 ±19.8 vs. 9.2 ±11.3; on day 2, 24.2 ±19.7 vs. 6.9 ±6.8 IU/ml, p < 0.001) was found. The level of TNF-α was greater in CA-D on day 1 (0.42 ±0.75 vs. 0.18 ±0.21 IU/ml, p < 0.04). Concentrations of hs-CRP and Ile-6 were correlated with the scores of GCS and APACHE II. Using logistic regression analysis and ROC curves the prognostic value of hs-CRP and Ile-6 for survival was proven. CONCLUSIONS: Post-cardiac arrest immuno-inflammatory response, reflected mainly in elevated plasma concentration of hs-CRP and Ile-6, is not only correlated with patients' clinical state but also with prediction of survival.

[Inflammatory cytokines and long-term prognosis after cardiac arrest]. / Rokownicza wartosc stezenia cytokin u chorych po naglym zatrzymaniu krazenia.

BACKGROUND: The long-term survival rate after sudden cardiac arrest remains low despite progress in resuscitation, possibly due to acute ischemia of vital organs and subsequent general inflammatory reaction. We investigated a possible relationship between inflammatory cytokine concentrations and cardiac arrest (CA) survival. METHODS: Fifty one adult acute coronary syndrome patients, 35 males and 16 females, aged 62 +/- 12 years, who survived out-of-hospital CA (45%) and in-hospital CA (55%) were enrolled in the study. Twenty four of the patients died (D-CA); the other 27 survived and were discharged from the hospital (S-CA). Clinical conditions were rated by the Simplified Acute Physiology Score II (SAPS II) and Multiple Organ Dysfunction Score (MODS). Blood samples were obtained immediately after cardiac arrest. Serum concentrations of IL-6, IL-10 and TNF-alpha were analysed and rated against survival rates. RESULTS: Higher mean concentrations of all cytokines were found in the D-CA group, when compared to the S-CA group. The mean concentration of IL-6 was 225 +/- 178 IU mL(-1) in the D-CA patients and 88 +/- 120 IU mL(-1) in the S-CA group (p = 0.006), and correlated inversely with survival (p = 0.018). The higher concentrations of IL-10 and TNF-alpha in non-survivors were not significant and bore no relation to survival rates. We also found significantly higher SAPS II and MODS scores, which correlated with both IL-6 levels and survival rates. CONCLUSIONS: The relationship between the concentration of inflammatory cytokines and survival has been reported by others and should be regarded as a marker of generalized inflammatory response. A concentration of IL-6 is of high prognostic value.

[A comparison of the optical AirTraq and the standard Macintosh laryngoscope for endotracheal intubation in obese patients]. / Porównanie zastosowania laryngoskopu optycznego AirTraq i laryngoskopu klasycznego z lopatka Macintosha do intubacji dotchawiczej u chorych z otyloscia.

BACKGROUND: Endotracheal intubation in morbidly obese patients is usually difficult and may lead to traumatic complications. METHODS: We compared the median time needed for endotracheal intubation, between a newly introduced device, the AirTraq optical laryngoscope, and a standard device, the Macintosh blade. The study group comprised adult patients scheduled for elective abdominal surgery, with a BMI >39. RESULTS: Sixty-eight patients were enrolled in the study. The time to successful insertion of an endotracheal tube was 29 and 49 sec in the AirTraq and the Macintosh groups, respectively. In the AirTraq group, additional manoeuvres were required to improve the laryngeal view in 7 cases. In the Macintosh group, an elastic guidewire was used to facilitate endotracheal intubation. No traumatic complications were observed in either group. CONCLUSION: The optical AirTraq laryngoscope proved to be more useful than the Macintosh blade for faster and easier intubation in morbidly obese patients.

[Influence of antibiotic-therapy on the selection of multi-drug resistant pathogens]. / Wplyw terapii antybiotykowej na selekcje wielolekoopornych szczepów bakteryjnych.

In this paper, relations between the number of nosocomial infections caused by multi-drug resistant pathogens and antibiotic-therapy were investigated. It was found that the number of MRSA infections is directly proportional to the amount of CAZ (ceftazidime) used in the therapy. It was also stated that CAZ, Amc (amoxicillin-clavulan acid) and IPM (imipenem) are strong inductors of ESBL. A good correlation between the number of infections caused by ESBL(+) strains and the total consumption of these antibiotics was found. A growing number of infections generated by Ps. aeruginosa and Acinetobacter spp. strains resistant to carbapenems as a result of IPM therapy is also an anxiety-provoking fact. In this case, the changes in the number of isolated IPM-R streins occur only after approx. half an year from the changes in the IPM consumption.

[Reversal from non-depolarising neuromuscular blockade in the postoperative period]. / Ocena przewodnictwa nerwowo-miesniowego po operacjach wykonywanych w znieczuleniu ogólnym z zastosowaniem niedepolaryzujacych srodków zwiotczajacych.

BACKGROUND: Postoperative residual curarisation (PORC) is a serious and underestimated problem and may occur even after relaxation with medium-acting non-depolarising agents. METHODS: One hundred adult patients, scheduled for elective surgical procedures, were enrolled in the study. Atracurium or cis-atracurium was used for relaxation. Neostigmine was administered for reversal at the end of surgery, at the discretion of the attending anaesthesiologist. Neuromuscular transmission was not monitored in the operating room. In the recovery room, the presence of residual block was assessed by a blinded investigator using accelerometry (TOF-Guard, Organon, Holland) immediately after arrival (T-A) and after 45 min (T-B). Those who received neostigmine were allocated to group I (49 patients), and those who did not were allocated to group II (51 patients). RESULTS: The mean duration of anaesthesia was 92 min in group I and 103 min in group II. The respective doses of atracurium were 78.2 and 72.0 mg; and of cis-atracurium--17.6 mg and 18.0 mg. Immediately after arrival, a TOF below 0.7 was detected in 26% of patients, and below 0.9 in 48% of patients. After forty-five minutes the TOF was still below 0.7 in one patient and below 0.9 in seven. The number of patients with residual block (TOF<0.9) did not differ statistically between those who received neostigmine and those who did not (3.92% and 10.2%, respectively). CONCLUSION: The clinical assessment of neuromuscular blockade reversal did not allow for detection of PORC. Neostigmine was not fully effective in reversal.