Measurement of the cerebral saturation for assessment of safety of epidural anaesthesia during abdominal surgery.

BACKGROUND: Near Infrared Spectroscopy (NIRS) is considered a reliable assessment method of a balance between cerebral oxygen demand and supply. One of forms of anaesthesia applied during extensive abdominal surgical procedures is the epidural anaesthesia. Its application in addition to the general anaesthesia is a commonly accepted form of anaesthesia in patients undergoing abdominal surgery. The aim of this study was to verify the hypothesis that epidural blocks may have effects on cerebral saturation in patients undergoing abdominal surgery under general anaesthesia. METHODS: Cerebral saturation was monitored intrasurgically. Reduction of cerebral oxymetry by over 25% in relation to the baseline, or cerebral oxymetry value below 50% was considered clinically significant. RESULTS: One hundred and one (101) subsequent and non-randomised patients, age between 35 and 84 years (mean 64 ± 10) qualified for major abdominal surgeries were enrolled. In 14 (13.9%) patients of 101 enrolled a clinically significant reduction of cerebral saturation was observed. In 50 (49.5%) of the enrolled patients, the epidural anaesthesia was applied along the general anaesthesia. A clinically significant reduction of cerebral saturation was observed in 9 of them. No statistically significant association was found between the application of epidural anaesthesia and development of cerebral desaturation. CONCLUSION: The application of epidural anaesthesia caused no clinically significant reduction of cerebral saturation during the general anaesthesia in course of major abdominal surgical procedures.

Effect of acid-base balance on postoperative course in children with hypoplastic left heart syndrome after the modified Norwood procedure.

Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires 3-stage cardiac surgical treatment and multidirectional specialist care. The condition of newborns in the first postoperative days following the modified Norwood procedure is characterized by considerable hemodynamic instability that may result in a sudden cardiac arrest. It is believed that the most important cause of hemodynamic instability is the fluctuations in redistribution between pulmonary and systemic blood flow.The paper analyzes the postoperative course in 40 neonates with HLHS following the modified Norwood procedure performed under deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical Intensive Care Unit (CSICU) in the years 2014-2015. For all hospitalized children, the arterial blood acid-base balance (ABB) parameters (pH, pO2, pCO2, HCO3, base excess (BE), and lactic acid) were measured 2 times a day during the first 5 postoperative days. The main goal of the studies is to analysis of ABB parameters and their influence on the clinical state of newborns with HLHS. Several descriptors were concerned to describe the neonates clinical state: the date of the surgery (the day of life when the child was operated on), the duration (number of days) of mechanical ventilation employment, the time of hospitalization in intensive care unit, and the total duration of treatment in CSICU.The statistical analysis of the particular ABB parameters revealed a significant dependence (P < .001) between the values of pH, pO2, pCO2, HCO3, BE, lactic acid, and all concerned descriptors of the newborn clinical state.The article shows that monitoring the ABB parameters, proper interpretation of the results, and appropriate modification of pharmacotherapy and respiratory treatment are crucial for therapeutic results and survival rates in neonates with HLHS after the modified Norwood procedure.

The impact of environmental factors on the occurrence of congenital heart disease in the form of hypoplastic left heart syndrome.

INTRODUCTION: Congenital heart defects are the most common abnormalities in neonatal age. Congenital heart defects occur with a frequency of 3-12/1000 births. A special group is constituted by children with hypoplastic left heart syndrome because their treatment is extremely complex, requiring three-stage surgery and the involvement of various specialists. MATERIAL AND METHODS: We analysed 100 infants with congenital heart defects in the form of hypoplastic left heart syndrome (HLHS). They were compared with a control group of 100 newborns without structural heart defects. The children's parents were asked to fill out a questionnaire consisting of 10 simple questions. It had been constructed in consultation with a psychologist in order not to offend the feelings of the parents affected by the illness of their offspring. RESULTS: Congenital heart defects were present in the family medical histories of 16 HLHS children and 11 healthy children (p = 0.4). Genetic disorders were present in the family medical histories of 13 HLHS children and 15 healthy children (p = 0.73). In the HLHS group, the mothers smoked cigarettes or were exposed to tobacco smoke in 32% of cases; in the control group, this proportion amounted to 23% (p = 0.76). CONCLUSIONS: The study found no relationship between the occurrence of hypoplastic left heart syndrome in children and the parents' age, the presence of genetic disorders, or heart defects in the family medical histories.

[Origin of right pulmonary artery branch from descending aorta. Case report of the successful treatment]. / Nieprawidlowe odejscie galezi prawej tetnicy plucnej od aorty zstepujacej. Opis pomyslnego przebiegu leczenia.

This report describes an extremely rare case involving anomalous origin of part of the right pulmonary branch from the thoracic aorta in a 3 month-old boy and its successful repair.

Impact of right ventricle-pulmonary artery conduit placement on pulmonary artery development after the Norwood procedure in hypoplastic left heart syndrome.

OBJECTIVES: The right ventricle-to-pulmonary artery (RV-PA) shunt in the Norwood procedure (NP) for children with hypoplastic left heart syndrome (HLHS) provides stable haemodynamics and improves interstage survival. The aim of the study was to find the effect of RV-PA placement on pulmonary artery development after the NP. METHODS: A prospective, randomized study of 60 children with HLHS was carried out between 2008 and 2010. All children underwent the NP in the neonatal period and survivors underwent the hemi-Fontan operation (at a mean age of 4.78 ± 2.8 months). RV-PA was left side to the neo-aorta in 32 children (the first group) and right side to the neo-aorta in 28 children (the second group). Echocardiography and angiograms were used to asses the pulmonary artery size. RESULTS: There was a significant difference between right pulmonary artery (RPA) and left pulmonary artery (LPA) diameters in both groups before the NP (first: 4.94 ± 0.27 vs. 4.26 ± 0.22, P = 0.04; second: 4.97 ± 0.23 vs. 4.14 ± 0.17, P = 0.003). This difference was not significant when z-scores were taken into account. The dynamics of the pulmonary artery development was similar in both groups comparing pre-Norwood and pre-hemi-Fontan periods. A slight increase in the LPA and the RPA diameter with a significant decrease in the z-scores was noted. At the pre-hemi-Fontan stage, there was no significant difference in the diameter and the z-score between LPA and RPA in the second group, whereas in the first group, the z-score for LPA was significantly lower compared with RPA (-1.34 ± 1.6 vs. -0.86 ± 1.4, P = 0.016). CONCLUSIONS: Placement of the RV-PA conduit on the right side to the neo-aorta ensures more equal distribution of the blood to the pulmonary arteries and better development of the LPA.

[The modern approach in surgical treatment of skull base tumors in experience of neurotraumatology Department, Jagiellonian University Collegium Medicum from years 2003-2006]. / Wielospecjalistyczne metody operacyjne w leczeniu guzów podstawy czaszki na podstawie materialu Kliniki Neurotraumatologii UJCM w latach 2003-2006.

AIM: The aim of this study was to evaluate the impact of modern methods in surgical treatment of skull base tumors (multidisciplinary operating teams, new methods of dura and bone defects repair) on extension of tumor resection considering complications rate. MATERIAL AND METHODS: The retrospective study for 26 patients of Neurotraumatology Department, Jagiellonian University Collegium Medicum was carried out. All of patients were operated due to skull base tumor in period 2003 - 2006. In our series 9 patients (34.62%) was admitted with recurrence of skull base pathology. The age average for the sample was 57.38 +/- 14.84 years. RESULTS: In 16 cases (61.54%) dura was involved in pathological process. Every time if dura resection was performed, the resulting defect was repaired with Tachocomb, tissue glue, artificial meninge, fascia lata femoris, pericranium. In case of bone infiltration (especially in anterior fossa of the skull), the resection was followed by the cranioplasty (Norian, cranioplast) - prevention of brain herniation, and opened during the operation sinuses were closed with use of temporal muscle and biomaterials. 15 patients (57.69%) were operated in mixed multidisciplinary teams (cooperation with Maxillofacial Surgery and Otorhinolaryngology Department). The resection of pathological mass was evaluated as completed in 69.23% (n=18) cases. The most common histopathological finding was neoplasm from meninges: 11 (42.31%) and epithelial neoplasm 7 (26.92%). CONCLUSIONS: The modern micro- and neurosurgical techniques, new reconstructive methods of dura and bone defects (biomaterials) and multidisciplinary operating teams (craniofacial approach) diminished limitations for extended resection of tumors in very complexed area that skull base is, by complications on accepted level. Typical for skull base tumors' treatment is varied histopathological nature of mass lesions, what in relation to grading of tumors still has the strongest impact on long term results of treatment.

[Influence of anticoagulants on the appearance of chronic subdural hematoma]. / Wplyw leków przeciwzakrzepowych na wystepowanie przewleklego krwiaka podtwardówkowego.

In recent years in the Department of Neurotraumatology in Cracow it has been noticed the frequent connection between appearance of chronic subdural hematoma (CSDH) and treatment by anticoagulant medications. The aim of this study is to draw attention to the problem of insufficient control of anticoagulants consumption, especially by patients treated for cardiovascular system diseases that increases the risk of bleeding and CSDH development. The paper is based on data from questionnaires that was sent to patients with CSDH, cured in the Department of Neurotraumatology form 2004 to 2005. Analyzed was the group of 51 patients with chronic subdural hematoma; 37 individuals (72.5%) confirmed taking acetylsalicylic acid in the period of 3 months before admission to the Department, 9 (17.6%) patients answered that they were taking low-molecular weight heparin. One patient (1.9%) was taking chronically derivative of cumarin. The authors would inform that anticoagulant treatment might favour increase of chronic subdural hematoma incidence. It's especially important, because the average life expectancy has been prolonged in Poland and there are more people taking acetylsalicylic acid. This can be an epidemiological problem in future.