[Anesthesiology consulting unit in perioperative medicine]. / Anestezjologiczna poradnia konsultacyjna w medycynie okolooperacyjnej.

There is a demand, caused by increase of one-day surgery, surgery of high risk patients with coexisting diseases, and growing need for patient education, for such improvement of preoperative preparation, which will enable an optimalization in patient care. That became a special task of Preanesthetic Evaluation Clinic. The aim of the paper was to analyze activity of local Preanesthetic Evaluation Clinic in years 1993-2000. Special emphasize was put on: assessment of Clinic functioning, with regard to variety of consultations, perioperative patient education, use of perioperative risk scales, processing of guidelines of laboratory tests in particular groups of patients, assessment of perioperative fear factors. Analyze of consultations was conducted using custom design computer program, operated in the "Clinic since" 1997. Discussing own experiences, a necessity of patient education was emphasized as a significant factor lowering perioperative fear. There was also a presentation of perioperative risk assessment methods as well as guidelines of laboratory tests improving clinical effectiveness. Information for patients, prepared in the Clinic "What should you know about anesthesia" was described. As conclusions perspectives of further development of the Clinic were shown. Growing significance of an anesthetic nurse in perioperative patient preparation was foreseen. A demand for improving electronic patient records as well as use of new technologies was proven.

[Perioperative sedation and analgesia for complications from arthroscopy and arthrotomy of the knee joint]. / Sedacja i analgezja okolooperacyjna do zabiegów artroskopii i artrotomii stawu kolanowego.

Estimation of the quality of the epidural anaesthesia of the patients sedated with Alprazolam and Midazolam in premedication before arthroscopy or arthrotomy of the knee was the goal of our study. Forty six (34 men and 12 women) ASA physical status 1-2 patients were divided into groups depending on the drugs orally applied in premedication (Alprazolam 0.5 mg, n = 29 or Midazolam 15 mg, n = 17) and of the kind of analgesia. The patients subjected to arthroscopy were treated with a single-shot epidural analgesia (n = 38), while those subjected to arthrotomy--with a continuous epidural analgesia (n = 8). 2% Lignocain with addition of Epinephrine and Fentanyl was used in the perioperative analgesia, while 0.25% Bupivacain with addition of Morphine was used in the postoperative period when continuous epidural analgesia was applied. The ISAS, VAS and Ramsey scales were used and the data were analysed with the Kormogolov test. The perioperative sedation in arthroscopy and arthrotomy of the knee is good without any significant differences associated with a kind of the drugs applied. The single-shot epidural anaesthesia is inadequate only during a prolonged arthroscopy of the knee. The postoperative continuous epidural analgesia, expressed in the VAS scale, was inadequate. A level of general satisfaction of the patients of the sedation and analgesia, expressed in the points of the ISAS scale, was satisfactorily good.

[Patient satisfaction with anesthesia as a measure of quality of anesthesia care]. / Satysfakcja pacjenta znieczulanego pomiarem jakosci opieki anestezjologicznej.

Patient satisfaction with anaesthesia is very important as a expectancy satisfaction in perioperative care. It is simultaneously patient opinion about the anaesthetic care prior to and during anaesthesia, and shortly after the operation. The aim of the research was to evaluate the patient satisfaction and to determine the factors connected with satisfaction in the perioperative period Out of a total of 250 patients, 155 women (62%) and 95 men (48%) underwent general and local anaesthesia due to the operations. They answer 55 questions on the third day after the operation. At the same time anaesthesiologists and nurses evaluate the quality of theirselves anaesthesia. In the opinion of anaesthetic team the quality of anaesthesia was very good--51.6%, good--46.8% and adequate only 2.6%. Positive opinion about the quality of anaesthesia expressed 87% of patients, negative only 0.5% and 12.5% have no opinion. The very good atmosphere was in Preanaesthetic Evaluation Clinic and during the admission to the operating room. The factors decreased patient satisfaction immediately after the operation were breathing difficulties, vomiting, nausea, feeling coldness and pain. The main factors evaluating the quality of anaesthetic care and patient satisfaction are specific information, proper premedication and feeling safety in the operating room. On the other hand the discomfort and insufficient analgesia decreased patient satisfaction with anaesthesia.

[Clinical evaluation of hemofiltration in perioperative medicine]. / Ocena kliniczna hemofiltracji w medycynie okolooperacyjnej.

Haemofiltration (HF) in perioperative period is used in order to improve the function of circulatory system by means of: elimination of cytokines in patients with increased inflammatory cascade activation; improvement of gas exchange conditions by decreasing the amount of lungs extravascular fluid; reduction of high levels of metabolism products; compensation of electrolyte disequilibrium and decreasing of right ventricle afterload as well as right and left ventricles preload. The aim of the study was clinical evaluation of usefulness of continuous vein-to-vein haemofiltration (CVVH) technique used in multiprofile adults intensive care. The analysis included 20 patients aged 24-73 (mean age 48.5), treated with HF in 1998-1999. HF was introduced in the following clinical conditions: multiorgan trauma with ARDS, acute pancreatitis with multiple organ dysfunction syndrome (MODS), peritonitis, status after laparotomy and chronic circulatory failure in patients qualified to heart transplantation. In six patients (30%), significant improvement of general state and stabilisation of haemodynamic and ventilation parameters were obtained. In fourteen patients (70%), despite CVVH, no improvement of circulatory and respiratory systems state was obtained. HF is very useful technique employed in perioperative medicine. It enables improvement of gas exchange conditions by decreasing the amount of lungs extravascular fluid in patients with ARDS in the course of MODS. HF simplyfies preparation the patient with chronic circulatory failure for diagnostic and therapeutic cardiosurgical procedures. In the course of sepsis and septic shock, HF creates better prospects to nutritional therapy and replaces haemodialysis or is its continuation.

[The yeast-like fungi infections in medical intensive care patients in years 1996 - 2000]. / Zakazenia wywolane przez grzyby drozdzopodobne u pacjentów intensywnej terapii w latach 1996 - 2000.

The aim of this study was to analyse, taking into consideration the infection risk factors, the incidence of fungal infections occurrence in Medical Intensive Care Units. Yeast-like fungi strains isolated from various clinical materials underwent mycological examination. Mycological diagnosis was performed in compliance with compulsory laboratory methods. The detailed observation concerned patients who were admitted to the intensive care unit by urgent reasons or because of basic disease aggravation, trauma, surgical operations and those with diabetes mellitus. The main etiological fungal infections factor were C. albicans strains. The increased incidence of C. glabrata and C. parapsilosis participation in yeast-like fungi infection pathogenesis was observed. The results presented in this study confirm, that intensive care units patients, for the reason of fungal infections, make the increased risk group.

Certain parameters of pulmonary circulation dynamics and gas exchange in the lungs and morphotic changes in lung tissue in dogs during cardiac arrest and immediately after resuscitation.

The experiments were carried out in 33 dogs 60 min. to 12 hours after cardiac arrest was induced for 3-5 min by ventricular fibrillation. In 11 dogs closed chest cardiac massage was performed 30 min. and in 222 dogs defibrillation was used to restore heart function. The pulmonary and peripheral circulation was assessed on the basis of changes in arterial and venous blood pressure, cardiac output, vascular resistance, pulmonary shunting and capnographic determinations. The values of VA, VA/Vmin, V/Q, VDph, VD/VT, DuO2 and DuCO2, Pa-E'CO2, PaO2 were determined. Measurements of acid base balance, lactate and pyruvate levels and certain elements of blood clotting and fibrinolysis systems were performed. Moreover, lung biopsy was examined by light and electron microscopes. Functional determinations confirmed the presence of disturbances of lung perfusion and alveolar ventilation as well as disturbances in oxygen exchange at cellular level. The author suggests the term Resuscitation Lung Syndrome for these disturbances.

Correlation between acid-base status, concentrations of lactate and of pyruvate in blood and cerebrospinal fluid in patients treated in an intensive care unit.

Results of examinations of 41 patients treated in an intensive care unit are reported. The patients were divided into three groups and examined on the first and twelfth days of treatment. In the first group were 15 patients who had received circulatory resuscitation, the second group was 13 patients with lesions of the central nervous system of traumatic or vascular origin and the third group was 13 patients with acute respiratory insufficiency of toxic or infective origin. The cerebrospinal fluid of patients in the second group showed the lowest pH (mean pH 7.28) and bicarbonate concentration (19.05 mequiv./1); this group also had the lowest PO2 values. Moderate respiratory alkalosis was observed in the arterial blood of patients with lesions of the central nervous system. Concentrations of lactate in the cerebrospinal fluid were increased in all three groups of patients although blood lactate concentrations were normal. The lactate/pyruvate concentration ratio was highest in the resuscitated patients.