Patient-controlled epidural analgesia versus conventional epidural analgesia after total hip replacement - a randomized trial.

AIMS: Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR). METHODS: This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery. RESULTS: The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P<0.001).There was greater patient satisfaction (P<0.001) in the PCEA group. The mean pain intensity over 24 hours postoperatively was similar for both groups (P=0.14). There was no significant difference in rate of analgesia-related complications between the groups (hypotension, P=0.14; bradypnea, P=0.11). CONCLUSION: Compared to conventional epidural analgesia based on physician prescription, PCEA led to less total analgesic consumption and greater patient satisfaction after THR.

Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study.

BACKGROUND: Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes. METHODS: In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension. RESULTS: Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective. CONCLUSION: GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.

Health status and physical fitness of mines rescue brigadesmen.

OBJECTIVES: The aim of the study was to assess health status of regular and part-time mines rescue brigadesmen. MATERIAL AND METHODS: A group of 685 mines rescue brigadesmen was examined within the preventive testing - a basic internal, biochemistry and anthropometric examination, physical fitness testing. RESULTS: The average age of the subjects was 41.96±7.18 years, the average exposure in mining was 20±8.1 years, out of that 11.95±7.85 years as mines rescue brigadesmen. Elevated levels of total serum cholesterol (T-CH) and low-density lipoprotein cholesterol (LDL-CH) were found in over 1/2 of the subjects. Systolic hypertension (systolic blood pressure (SBP) ≥ 140 mm Hg) was confirmed in 34%, overweight (body mass index (BMI) ≥ 25) in 62.3% and obesity (BMI ≥ 30) in 20.4% of the examined mines rescue brigadesmen. The metabolic syndrome was found in 15.2% of persons. The highest physical fitness was found in mines rescue brigadesmen and the lowest in mine officers. Limit values of maximum oxygen uptake (VO2 max/kg) determined by the management of the mine rescue station were not reached by every 3rd of all mines rescue brigadesmen. Compared with the control group of the Czech and Slovak population, the rescuers are taller, have greater BMI, higher percentage of body fat in all age categories and proportionally to that they achieve a higher maximum minute oxygen uptake; however, in relative values per kg of body weight their physical fitness is practically the same as that of the controls. CONCLUSIONS: The prevalence of risk factors of cardiovascular diseases and VO2 max/kg in the group of the mines rescue brigadesmen is comparable with that in the general untrained Czech population.