Dissertations / Theses on the topic 'ANESTETICA'

UVOD. Bilijarna kalkuloza je najčešće oboljenje hepatobilijarnog sistema, a holecistektomija predstavlja jedan od najčešće izvođenih operativnih zahvata. Laparoskopska holecistektomija je danas zlatni standard lečenja holelitijaze. Laparoskopska holecistektomija je pokazala poboljšanje u klinički značajnim ishodima kao što su skraćenje operativnog vremena, kraća hospitalizacija, smanjenje jačine i trajanja postoperativnog bola i brži povratak dnevnim i radnim aktivnostima. Postoperativna bol i vreme potpunog oporavka ostaju dva glavna problema posle nekomplikovane laparoskopske holecistektomije koje bi trebalo poboljšati. Bol koji je povezan sa laparoskopskom holecistektomijom je kompleksan i multifaktorijalan. On nastaje oštećenjem tkiva, disekcijom i uklanjanjem žučne kesice iz svoje lože, stimulacijom periportalnih nerava, iritacijom dijafragme, mehaničkim i hemijskim interakcijama gasa i pneumoperitoneuma, incizijama portova. Istraživanja su označila parijetalni i visceralni bol kao dva glavna mehanizma nastanka bola kod laparoskopske holecistektomije. Bol se ne može meriti nego proceniti jer je subjektivni osećaj. Pokazalo se potrebnim da se na čvršćim naučnim osnovama da odgovor na pitanje da li je moguće blokirati parijetalni i visceralni bol posle laparoskopske holecistektomije u akutnoj fazi. CILJEVI. Cilj studije je da uporedi standardnu analgeziju (ne-opioidnu) (grupa O) sa davanjem parijetalne blokade (grupa P), ili davanjem visceralne blokade (grupa V), ili sa obe date blokade (grupa P+V). Primarni ishodi studije su bolesnikov procenjeni bol pre operacije i posle operacije na 1, 2, 4, 6, 12, 24, 48 sati i 7. dana. Sekundarni ishodi studije su bolesnikova procenjena mučnina na 1,2,4,6,12 sati i bolesnikova procenjena mobilnost 1. 2. i 7. dan. HIPOTEZA. Blokada postoperativnog visceralnog bola i blokada postoperativnog parijetalnog bola posle laparoskopske holecistektomije putem intraperitonealne lokalne infiltracije anestetikom i putem lokalne infiltracije anestetikom pristupnih laparoskopskih portova može značajno smanjiti rani postoperativni bol. MATERIJAL I METODE. Ova prospektivna, randomizirana jednostruko slepa studija je započela septembra 2014. godine i trajala je do januara 2016. godine. Istraživanje je sprovedeno na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju i Urgentnom centru Kliničkog centra Vojvodine u Novom Sadu kod bolesnika operisanih metodom laparoskopske holecistektomije. Rad je podeljen u nekoliko celina. 1. Procena veličine uzorka; 2. Procena podobnosti za studiju; 3. Anketiranje i uključivanje u studiju; 4. Razvrstavanje u grupe i operativni rad; 5. Period postoperativnog praćenja; 6. Statistička obrada i pisanje rada.1. Procena veličine uzorka. Studija je realizovana podelom bolesnika u 4 grupe. Neophodni broj bolesnika je izračunat uzimajući podatke iz pilot istraživanja slične studije iz 2012. godine. Veličina uzorka je računata za primarni ishod studije  (bolesnikov procenjen bol sa NAS) na pretpostavci da treba biti 20% smanjenja bola u prvom postoperativnom satu, uz verovatnoću Tip 1 greške α=0.05 i Tipa 2 greške β=0.10 da postigne adekvatnu statističku snagu oko 80% i da otkrije 20% razlike u srednjoj vrednosti procenjenog bola jedan sat nakon laparoskopske  holecistektomije. Procenjeni broj ispitanika po grupama prema zadatim kriterijumima je bio (P+V=65; P=68; V=68; O=65). Studija je započela uključivanjem prvog bolesnika u studiju a završena ispunjenim periodom praćenja sve dok poslednji bolesnik nije doneo upitnike o bolu, mučnini i kretanju. 2. Procena podobnosti za studiju. U periodu studije ukupan broj holecistektomiranih bolesnika je bio 1024 (440 klasično i 584 laparoskopski). Samo pogodni bolesnici su anketirani (584) i pročitali su informacioni list o istraživanju. Uključivanje ili procena podobnosti bolesnika za studiju sprovedena je na osnovu uključnih i isključnih kriterijuma. U studiju nije uključeno ukupno 226 bolesnika. Od tog broja 82 bolesnika je odbilo učestvovati u studiji a 144 bolesnika nije ispunilo uključne postavljene kriterijume. Svojim potpisom potvrdilo je učešće u studiji 358 bolesnika. 3. Anketiranje i uključivanje u studiju. Nakon prijema bolesnika u bolnicu ispitivači su uzimali anamnezu i bolesnicima je ponuđen informacioni list i informisani pristanak. Nakon čitanja informacije, potpisivanja informisanog pristanka i zadovoljavanja  uključnih i isključnih kriterijuma 358 bolesnika je uključeno u studiju. Obavljena je preoperativna priprema i ispitivači su popunili deo podataka u individualnom listu. 4. Razvrstavanje u grupe i operativni rad. Neposredno preoperativno od strane nezavisne osobe neuključene u studiju napravljena je randomizacija izabranih (n=358) u studijske grupe tablicama slučajnog izbora, tako da bolesnici nisu znali kojoj grupi pripadaju, dok su operater i osoblje to znali na početku operacije (jednostruko slepa studija). Nakon randomizacije i operacije bolesnici pripadaju jednoj od sledeće 4 grupe: Kontrolna grupa O=89, u kojoj su bolesnici sa urađenom laparoskopskom  holecistektomijom bez visceralne blokade anestetikom i bez parijetalne blokade anestetikom. Eksperimentalna grupa P=88, u kojoj su bolesnici sa urađenom laparoskopskom holecistektomijom bez visceralne blokade anestetikom i sa parijetalnom blokadom anestetikom. Eksperimentalna grupa V=92, u kojoj su bolesnici sa urađenom laparoskopskom holecistektomijom sa visceralnom blokadom anestetikom i bez parijetalne blokade anestetikom. Eksperimentalna grupa P+V=89, u kojoj će biti bolesnici sa urađenom laparoskopskom holecistektomijom sa visceralnom blokadom anestetikom i sa parijetalnom blokadom anestetikom. Primenjivan je uobičajni, standardni protokol anestezije za laparoskopske operacije kod svih ispitanika. Svim bolesnicima plasirana je orogastrična sonda koja se nakon operacije odstranjivala. Kod  bolesnika kod kojih je primenjivan lokalni anestetik neposredno pre početka operacije pravio se rastvor lokalnog anestetika (Marcaine® 0,25%). Bolesnici su otpušteni sa bolničkog lečenja prvog postoperativnog dana, pod uslovom da nisu imali komplikacija. 5. Postoperativno praćenje i ispunjavanje upitnika. Po dolasku na odeljenje  bolesnicima je odmah uključivana ista analgezija. Tokom ispunjavanja informisanog pristanka, bolesnici su dobili upitnik na kojoj će sami procenjivati nivo bola, mučnine i kretanja tokom ležanja u bolnici i vremena praćenja od 7 dana kući. Bolesnici su dolazili na unapred zakazane postoperativne kontrole 7 do 10 dana posle operacije i donosili ispunjene upitnike. Otpušteno je i za praćenje ostalo n=302 laparoskopski operisanih bolesnika a isključeno iz studije n=20 bolesnika. 6. Statistička obrada i pisanje rada. Ukupno je analizirano 274 listića operisanih bolesnika: u Grupi P+V =67; u Grupi P =70; u Grupi V =70 i u Grupi O =67. Od osnovnih deskriptivnih statističkih parametara za kvalitativnu i kvantitativnu procenu dobijenih rezultata su korišćeni apsolutni brojevi, relativni brojevi, mediana, mod, aritmetička sredina i standardna devijacija (SD). Obrada podataka se vršila  osnovnim i naprednim statističkim metodama i programima. Rezultati su prikazani tabelarno i grafički. REZULTATI. Demografski podaci. Ukupno je bilo 188 žena i 86 muškaraca, u odnosu 2,2 : 1. Prosečna starost cele grupe je bila 52,1 ± 15,72 godine. Ukupno je bilo 179 zaposlenih i 95 nezaposlenih. Ukupno je bilo 45 ispitanika sa osnovnim obrazovanjem, 153 ispitanika sa srednjim obrazovanjem i 76 ispitanika sa visokim obrazovanjem. Ukupno je bilo 186 nepušača i 88 pušača. Prosečna vrednost BMI cele grupe je bila 27,24 ± 4,21 kg/m2. Prosečna vrednost ASA u celoj grupi je bila 2,03 (mediana=2, mod=2). Ne postoji statistički značajna razlika između posmatranih grupa u odnosu na posmatrane parametre. Laboratorijski podaci. Postoji statistički značajna razlika u vrednosti leukocita između posmatranih grupa (p=0,039), u vrednosti uree između posmatranih grupa (p=0,040). Ne postoji statistički značajna razlika u vrednosti eritrocita, trombocita, hemoglobina, ŠUK-a, kreatinina i bilirubina posmatranih grupa. Operativni i postoperativni podaci. Ne postoji statistički značajna razlika u količini upotrebljenog Fentanila između posmatranih grupa. Postoji statistički značajna razlika u dužini trajanja operacije između posmatranih grupa (p=0,003), u trajanju postavljenog abdominalnog drena između posmatranih grupa (p=0,024), u trajanju hospitalizacije između posmatranih grupa (p=0,027), u broju dana do povratka uobičajenim aktivnostima između posmatranih grupa (p=0,000), u broju uzetih tableta između posmatranih grupa (p=0,000). Prosečna ocena zadovoljstva bolesnika posle operacije u celoj grupi je bila 8,80 (mediana=9; mod=10). Najbolju ocenu zadovoljstva bolesnika posle operacije je imala grupa P+V. Procena bola, mučnine i kretanja. Postoji statistički značajna razlika između posmatranih grupa u proceni jačine bola pre operacije (p=0,003). Postoji statistički značajna razlika između posmatranih grupa u proceni jačine bola 1h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 2h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 4h posle operacije (najbolju procenu bola je imala grupa P); u proceni jačine bola 6h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 12h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 24h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 48h posle operacije (najbolju procenu bola je imala grupa P) i u proceni jačine bola 7 dana posle operacije (najbolju procenu bola je imala grupa P). Procenjena bol se pojačava otprilike 2,5 sata posle operacije sa vrhom 3 sata posle operacije, a smanjuje se na istu vrednost kao 2. sata posle operacije, otprilike 5. sata posle operacije. U vremenskim intervalima 1, 2. i 7. postoperativni dan postoji značajno poboljšanje u postoperativnoj mobilnosti bolesnika. U vremenskim intervalima 1, 2, 4, 6 i 12 sati postoji značajno poboljšanje u procenjenoj vrednosti mučnine bolesnika. Korelacije. Statistički značajna pozitivna korelacija ocene bola posle 1. sata, posle 2. sata, posle 6. sata, posle 12. sata je utvrđena sa brojem uzetih tableta (p=0,000), kao i procene mučnine (p=0,000). Statistički značajna pozitivna korelacija procene bola posle 4. sata je utvrđena sa brojem uzetih tableta (p=0,006), kao i aktivnosti (p=0,014). Statistički značajna korelacija procene bola posle 24. sata je utvrđena sa brojem uzetih tableta (p=0,000; pozitivna) i trajanjem operacije (p=0,028; negativna). Statistički značajna pozitivna korelacija procene bola posle 48. sata i posle 7 dana je utvrđena sa brojem uzetih tableta (p=0,000). ZAKLJUČCI: Primena lokalnog anestetika datog na bilo koji način značajno smanjuje bol posle laparoskopske holecistektomije. Primena lokalnog anestetika datog i  portalno i visceralno (P+V) značajno smanjuje bol u odnosu na samo portalnu (P) ili visceralnu (V) primenu u vremenskim intervalima 2, 6, 12 sat posle laparoskopske holecistektomije. Portalna (P) primena sa ili bez visceralne (V) primene lokalnog anestetika značajno smanjuje bol u vremenskim intervalima 1, 4, 24, 48 sati i 7 dana posle laparoskopske holecistektomije. Najbolje kretanje je bilo u grupi P+V posle laparoskopske holecistektomije. Najbolje smanjenje procenjene mučnine je bilo u grupi P posle laparoskopske holecistektomije. Najraniji povratak uobičajenim aktivnostima zabeležen je u grupi P+V. Najbolja ocena zadovoljstva bolesnika hirurškim lečenjem bila je u grupi P+V. Postoperativna bol ima najznačajniju pozitivnu korelaciju sa procenjenom mučninom i brojem tableta uzetih od momenta otpusta do prve kontrole bolesnika.
INTRODUCTION: Biliary calculosis is the most frequent disease of the hepatobiliary system, and cholecystectomy is one of the most frequently performed surgical procedures. Today laparoscopic cholecystectomy represents the golden standard in treating cholelithiasis. Laparoscopic cholecystectomy showed improvement in the clinically significant outcomes, such as: reducing the duration of the surgery, shorter hospital stay, reducing the intensity and duration of postoperative pain and faster return to normal daily and working activities. Postoperative pain and the time of full recovery remain the two major problems after a non-complicated laparoscopic cholecystectomy and they should be improved. The pain related to laparoscopic cholecystectomy is complex and multi-factorial in origin. The pain occurs due to damaged tissues, dissection and removal of gallbladder from its cavity, stimulation of periportal nerves, irritation of the diaphragm, mechanical and chemical interaction of gases and pneumoperitoneum and port incisions. Researches have denoted parietal and visceral pains as two major mechanisms in occurrence of pain in laparoscopic cholecystectomy. Pain cannot be measured, but estimated, as it is a subjective feeling. It was considered necessary to find the answer, based on solid scientific evidence, if it was possible to block parietal and visceral pain after laparoscopic cholecystectomy in its acute phase. OBJECTIVES: The aim of this study is to compare standard, non-opioid, analgesia (group O) with applying parietal blockade (group P), or visceral blockade (group V), or compare with both applied blockades (group P+V). The primary outcomes of the study are the patient´s estimated pain before surgery and 1, 2, 4, 6, 12, 24, 48 hours and 7th day after the surgery. The secondary outcomes of this study are the patient´s estimated nausea level during 1, 2, 4, 6, 12 hours, along with the patient´s estimated mobility 1st, 2nd and 7th day, postoperatively. HYPOTHESIS. Blockade of postoperative visceral pain and blockade of postoperative parietal pain following laparoscopic cholecystectomy, applying intraperitoneal local infiltration with anesthetic and also by local infiltration with anesthetic through accessible laparoscopic ports, can significantly reduce early postoperative pain. MATERIAL AND METHODS: This prospectively randomized single-blinded study started in September 2014 and lasted up to January 2016. The research was carried out at the Clinic for Abdominal, Endocrine and Transplantation Surgery and Emergency Center, Clinical Center of Vojvodina in Novi Sad and it involved patients who underwent laparoscopic cholecystectomy. This study has been divided into several units. 1. Assessment of sample size; 2. Assessment of eligibility for the study; 3. Survey and inclusion in the study; 4. Group formation and operational work; 5. Period of postoperative follow-up; 6. Statistical processing and writing the paper.1. Assessment of sample size. The study was realized by dividing the patients into 4 groups. The number of patients necessary was determined based on the data taken as pilot study from a similar study from 2012. Sample size was calculated for the primary outcome of the study (patient´s estimated pain with NAS) based on the assumption that a pain reduction of 20% should occur during the first postoperative hour, with the probability of Type 1 error α=0.05 and Type 2 error β=0.10 to reach the adequate statistical power of about 80%, and to reveal 20% difference in the average value of the estimated pain one hour after the laparoscopic cholecystectomy. The assessed number of respondents in groups according to the set criteria was (P+V =65;P =68;V =68; O =65). The study started when the first patient was included and it ended with the complete follow-up period when the last patient handed in the survey about pain, nausea and mobility. 2. Assessment of eligibility for the study. During the study the number of patients undergoing surgery applying the method of cholecystectomy was 1024 (440 classical and 584 laparoscopic). Only the suitable patients were surveyed (584) and given to read the information leaflet about the study. Inclusion and assessment of patients´ eligibility was performed on the basis of inclusion and exclusion criteria. A total of 226 patients was not included in the study. Out of that number 82 patients refused to participate in the study and 144 did not fulfill the inclusive criteria set. By signing 358 patients confirmed their participation in the study. 3. Survey and inclusion in the study. After admitting the patients to hospital the surveyors took their anamnesis and the patients were offered an information leaflet and informed consent. Following the reading of the information leaflet, signing the informed consent and satisfying the criteria for inclusion and exclusion, 358 patients were included in the study. Preoperative preparations were performed and the surveyors filled in some of the data on the individual list. 4. Group formation and operational work. Prior to the surgery an independent person not included in the study carried out the randomisation of the patients chosen (n=358) into study groups by random selection tables. The patients did not know which group they belonged to, while it became known to the surgeon and the operation stuff at the beginning of the surgery (singleblinded study). After randomization and surgery the patients belonged to one of the following groups: Control group O=89 of patients with performed laparoscopic cholecystectomy without visceral blockade by anesthetic and without parietal blockade by anesthetic. Experimental group P=88 of patients with performed laparoscopic cholecystectomy without visceral blockade by anesthetic but with parietal blockade by anesthetic. Experimental group V=92 of patients with performed laparoscopic cholecystectomy with visceral blockade by anesthetic but without parietal blockade by anesthetic. Experimental group P+V=89 of patients with performed laparoscopic cholecystectomy with visceral blockade by anesthetic and with parietal blockade by anesthetic. The standard protocol of anesthesia for laparoscopic cholecystectomy was applied to all patients. An orogastric tube used during the surgery, was removed after it. In patients with applied local anesthetic immediately before surgery a solution of local anesthetic was made (Marcaine® 0,25%). The patients were discharged from hospital the first postoperative day, provided that no complications occurred. 5. Postoperative follow-up and completing the questionnaire. When admitted to the ward the patients were given the same kind of analgesia. While completing the informed consent the patients were given a questionnaire for estimating their pain level, nausea and mobility during their stay in hospital and during the 7-day follow-up period at home. The patients were required to come for 7 and 10-day postoperative check-ups by appointment and then they handed in the questionnaires. n=302 patients with performed laparoscopic cholecystectomy were released and designated for follow-up, and n=20 patients were excluded from the study. 6. Statistical processing and writing the paper. In total 274 operated patients´ slips were analysed, by groups as follows: in Group P+V =67; in Group P =70; in Group V =70 and in Group O =67. From the basic descriptive statistical parametres for qualitative and quantitative assessment of results obtained, absolute numbers, relative numbers, the median, mode, arithmetic mean and standard deviation (SD) were used. Data processing was carried out using basic and advanced statistical methods and programmes. The results are presented in tabular and graphical manner. RESULTS. Demographic data. In total there were 188 women and 86 men, in proportion 2,2 : 1. The average age of the whole group was 52,1 ± 15,72 years. In total there were 179 employed and 95 unemployed persons. In total there were 45 surveyed patients with primary education, 153 surveyed patients with secondary education and 76 surveyed patients with higher education. In total there were 186 nonsmokers and 88 smokers. The mean BMI value of the whole group was 27,24 ± 4,21 kg/m2. The mean value of ASA of the whole group was 2,03 (the median=2, mode=2). There is no significant difference among the groups observed considering the observed parametres. Laboratory data. There is a statistically significant difference in the value of leukocytes among the observed groups (p=0,039), and in the value of urea among the observed groups (p=0,040). There is no statistically significant difference in the value of the erythrocyte, platelets, hemoglobin, blood glucose, creatinine and bilirubin of the  observed groups. Operative and postoperative data. There is no statistically significant difference in the amount of Fentanyl® applied among the observed groups. There is statistically significant difference in the length of the surgery among the observed groups (p=0,003), in the duration of the positioning of abdominal drainage among the observed groups (p=0,024), in the duration of hospital stay among the observed groups (p=0,027), in the number of days until getting back to regular activities among the observed groups  (p=0,000), in the number of taken pills among the observed groups (p=0,000). The patients´ average satisfaction grade after surgery in the whole group was 8,80 (the median=9; mode=10). Group P+V had the best patient‘s satisfaction grade after the surgery. Assessment of pain, nausea and mobility. There is statistically significant difference in the estimation of pain intensity before surgery among the observed groups (p=0,003). There is statistically significant difference in the estimation of pain intensity 1 hour after surgery among the observed groups (P+V having the best estimated pain); in the estimation of pain intensity 2 hours after  surgery (P+V having the best estimated pain); in the estimation of pain intensity 4 hours after surgery (P having the best estimated pain); in the estimation of pain intensity 6 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 12 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 24 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 48 hours after surgery (P having the best estimated pain) also in the estimation of pain intensity 7 days after surgery (P having the best estimated pain). The estimated pain intensifies at about 2,5 hours after surgery and peaks 3 hours after surgery, and decreases to the same level as it was during 2nd hour after surgery approximately during 5th hour after surgery. There is considerable improvement in mobility of patients in the time interval 1st, 2nd and 7th postoperative days. There is considerable improvement in estimated nausea level of patients in the time interval 1, 2, 4, 6 and 12 hours. Correlations. Statistically significant positive correlation in estimated pain after 1st hour, after 2nd hour, after 6th hour and after 12th hour was determined by the number of tablets taken (p=0,000), just like the estimated nausea level (p=0,000). Statistically significant positive correlation in estimated pain after 4th hour was determined by the number of tablets taken (p=0,006), just like the activities (p=0,014). Statistically significant positive correlation in estimated pain after 24th hour was determined by the number of tablets taken (p=0,000; positive), and by the duration of the surgery (p=0,028; negative). Statistically significant positive correlation in estimated pain after 48th hour and after 7 days was determined by the number of tablets taken (p=0,000). CONCLUSIONS: The application of local anesthetic, regardless of how it was applied, considerably reduces pain after laparoscopic cholecystectomy. The application of local anesthetic by port or viscerally (P+V) considerably reduces pain compared to only by port (P) or only visceral (V) application in the time intervals of 2, 6, and 12 hours after laparoscopic cholecystectomy. The application of local anesthetic by port (P), with or without visceral (V), considerably reduces pain in the time intervals of 1, 4, 24, and 48 hours and 7 days after laparoscopic cholecystectomy. The best mobility was shown by group P+V after laparoscopic cholecystectomy. Estimated nausea was most reduced in group P after laparoscopic cholecystectomy. Group P+V presented the earliest return to regular activities. The best patients´ satisfaction grade with surgical treatment was shown by group P+V. Postoperative pain is most considerably positively correlated with the estimated nausea and pills taken, from the moment of patient´s release from hospital to the first check-up. 

Background: Lipid emulsion infusion reverses cardiovascular compromise due to local anesthetic overdose in laboratory and clinical settings. The author compared the efficacy of resuscitation from bupivacaine-induced asystole using lipid emulsion infusion versus epinephrine, vasopressin, combination of epinephrine and vasopressin, and saline control in a prospective randomized animal study. Methods: Bupivacaine was infused in male Spregue-Dawley rats anesthetized with isoflurane, producing asystole in all subjects. Rats were ventilated with 100% oxygen, given chest compression, and randomized to receive 30% lipid emulsion, vasopressin, epinephrine alone or combined with vasopressin, and saline. Treatment boluses were repeated at 2.5 and 5 minutes for a native rate-pressure product less than 20% baseline. Electrocardiogram and arterial blood pressure were monitored continuously and at 10 min arterial blood gas, central venous oxygen saturation and blood lactate were measured. Results: Lipid infusion resulted in higher rate-pressure product, pH and central venous oxygen saturation than in vasopressors groups and in control group at 10 min. Metrics indicated better tissue perfusion in lipid group than in the others group. Epinephrine treatment caused persistent ventricular ectopy in all subjects. Vasopressin and epinephrine were associated with developing of pulmonary edema. Conclusion: Lipid emulsion in this rat model provide superior hemodynamic and metabolic recovery from bupivacaine-induced cardiac arrest than do vasopressors. Vasopressin and epinephrine were associated with adverse outcomes. Systolic pressure was not an useful metric in the vasopressors group. Further studies are required to optimize the clinical management of systemic local anesthetic toxicity.
E’ stato precedentemente dimostrato il recupero di attività cardiaca spontanea dopo l’infusione di una emulsione lipidica (30% soy oil emulsion) in seguito ad arresto cardiaco bupivacaina-indotto sia in vivo sia in modelli sperimentali di cuore isolato. Numerosi case reports sono stati pubblicati sull’utilizzo clinico dell’emulsione lipidica nella rianimazione di pazienti in arresto cardiaco in seguito ad overdose di anestetico locale. Le linee guida 2005 dell’American Heart Association (AHA/ACLS resucitation protocol) prevedono l’utilizzo di una dose di 40 U di vasopressina, al posto della prima o seconda dose di epinefrina, come farmaco di prima linea nel trattamento dell’arresto cardiaco. Abbiamo studiato l’efficacia dell’emulsione lipidica versus i farmaci suggeriti dai protocolli ACLS in un modello sperimentale di arresto cardiaco bupivacaina-indotto in ratti. Sono stati analizzati parametri emodinamici, metabolici ed elettrocardiografici. L’emulsione lipidica è risultata superiore, in termini di sopravvivenza, parametri emodinamici e metabolici, all’adrenalina, alla vasopressina e alla loro associazione nel trattamento dell’arresto cardiaco indotto da un’overdose di bupivacaina. Ulteriori studi sono necessari per confermare queste osservazioni e soprattutto per determinare eventuali implicazioni sul piano clinico.

Common general anesthetics administered to young rats at the peak of brain development cause widespread apoptotic neurodegeneration in their immature brain. Behavioral studies have shown that this leads to learning and memory deficiencies later in life.The subiculum,a part of the hippocampus proper and Papez’s circuit,is involved in cognitive development and is vulnerable to anesthesia-induced developmental neurodegeneration. This degeneration is manifested by acute substantial neuroapoptotic damage and permanent neuronal loss in later stages of synaptogenesis. Since synapse formation is a critical component of brain development, we examined the effects of highly neurotoxic anesthesia combination (isoflurane, nitrous oxide, and midazolam) on ultrastructural development of synapses in the rat subiculum. We found that this anesthesia, when administered at the peak of synaptogenesis, causes long-lasting injury to the subicular neuropil. This is manifested as neuropil scarcity and disarray, morphological changes indicative of mitochondria degeneration, a decrease in the number of neuronal profiles with multiple synaptic boutons and significant decreases in synapse volumetric densities. We believe that observed morphological disturbances of developing synapses may, at least in part, contribute to the learning and memory deficits that occur later in life after exposure of the immature brain to general anesthesia
Numerosi studi hanno dimostrato che l’esposizione di varie specie animali ad anestesia generale durante il periodo di massimo sviluppo del cervello causa la morte per apoptosi di un gran numero di neuroni, che si traduce in deficit di memoria e di apprendimento in questi stessi animali durante la vita adulta. Il subicolo, che fa parte dell’ippocampo e del circuito di Papez, e’ fondamentale per un corretto sviluppo cognitivo ed e’ tra le aree del cervello piu’ vulnerabili al danno indotto da anestesia. Dal momento che la sinaptogenesi e’ una componente fondamentale dello sviluppo del cervello, abbiamo studiato gli effetti di una comune combinazione di anestetici (isofluorano, protossido d’azoto e midazolam) sullo sviluppo ultrastrutturale delle sinapsi del subicolo di ratto. Abbiamo dimostrato che, quando somministrata al picco della sinaptogenesi, questa anestesia causa un danno permanente al neuropilo subicolare. Tale danno e’ caratterizzato da una scarsita’ di profili cellulari, da degenerazione mitocondriale, da una riduzione del numero di bottoni sinaptici multipli e dalla diminuzione delle densita’ sinaptiche volumetriche. Ipotizziamo che tali alterazioni morfologiche contribuiscano almeno in parte a spiegare i deficit di memoria e di apprendimento che si osservano durante la vita adulta in topi esposti ad una anestesia generale al picco della sinaptogenesi

Plyšinių jungčių (PJ) reguliacija yra svarbi esant normalioms ir patologinėms sąlygoms. Šiame darbe pirmą kartą parodome, kad trumpagrandžiai alkoholiai (pentanolis–heptanolis) stimuliuoja PJ laidumą, o ilgagrandžiai (oktanolis–dekanolis) – blokuoja. Heksanolis didina Cx36 PJ funkcinį efektyvumą ir mažina jautrumą įtampai slopindamas blokuojantį endogeninės arachidono rūgšties (AR) poveikį. Endogeninės arachido rūgšties įtaką Cx36 PJ laidumui tyrėme, panaudodami jaučio serumo albuminą (JSA), fosfolipazių slopiklį metilarachidonilfluorofosfonatą ir aktyviklį tapsigarginą. Cx36 reguliacija HeLa kultūroje buvo tokia pati pelės kasos Langerhanso salelių β ląstelėse natyviai gaminančiose Cx36. Taip pat parodėme, kad [Mg2+]i reguliuoja Cx36 ir Cx47 PJ elektrinį laidumą, keisdamas funkcinių kanalų skaičių ir jų atsidarymo tikimybę, tačiau neveikia vienetinio kanalo laidumo. Nustatėme, kad TM2 ir TM4 domenai su juose esančiais cisteinais yra svarbūs trumpagrandžių alkoholių ir izoflurano prisijungimui bei kanalų valdymui jungties įtampa, tuo tarpu TM2 domenas ir CL kilpa gali būti potencialiais struktūriniais elementais, formuojant ilgagrandžių alkoholių prisijungimo kišenę(es).
Regulation of gap junctions (GJs) is important in normal and pathological conditions. In this study we show for the first time that short carbon chain n-alkanols (SCCAs; pentanol–heptanol) stimulate intercellular communication while long carbon chain n-alkanols (LCCAs; octanol–decanol) block it. SCCAs increase junctional conductance of Cx36 GJ channels by interfering with endogenous arachidonic acid (AA) dependent inhibition, increasing the open probability and a fraction of functional channels. We also evaluated the role of endogenous AA using other activators of Cx36 GJs coupling – bovine serum albumin (BSA) and inhibitor of phospholipase A2 isoforms methyl arachidonyl fluorophosphonate (MAFP). The observed regulation of Cx36 by SCCAs and AA in HeLa cells was the same as in β cells from mouse pancreas, natively producing Cx36. Furthermore we demonstrate that junctional conductance of Cx36 and Cx47 is regulated by [Mg2+]i in a concentration-dependent way in HeLa cells. [Mg2+]i affects the channel open probability and the number of functional channels, however, it has no impact on single channel conductance. We found that cysteines in the TM2 and TM4 domains are involved in binding of SCCAs and isoflurane and in regulation of gating properties of Cx36. Also, TM2 domain and CL loop could be potential structural elements forming binding cavity/ies for LCCAs.

Patienter i den perioperativa vården är ofta med om blodförluster. Anestesisjuksköterskor ansvarar för att övervaka, hantera och dokumentera patienters perioperativa vård. Patienters förlorade blodvolymer är viktiga att uppskatta korrekt, för att patienter ska få rätt behandling. Anestesisjuksköterskor ansvarar för bedömning och visuell uppskattning av blodvolymen på kompresser, sugbehållare och operationsdukar som används perioperativt. Studiens syfte är att kartlägga anestesisjuksköterskors förmåga att göra visuell uppskattning av patienters blodförluster perioperativt. En kvantitativ studie genomfördes med ett stickprov av 30 anestesisjuksköterskor. De analysmetoder som användes var: Wilcoxon’s rangsummetest, Mann-Whitney U test, Kruskal-Wallis test och Spearman’s korrelationstest. Deltagarna fick uppskatta blodvolymen på tre olika material vid två efterföljande stationer och fylla i en pappersenkät. Resultatet visar på att en stor majoritet underskattar blodvolymen vid de två efterföljande stationerna. Inget signifikant samband fanns mellan deltagarnas typer av uppskattningar (underskattning, korrekt skattning och överskattning) relaterat till kön, yrkeserfarenhet och självskattad förmåga. I studien påvisas det att anestesisjuksköterskors förmågor att visuellt uppskatta blödningar inte förbättras med längre yrkeserfarenhet. Det framkommer i studien att visuella uppskattningar av blodvolymer ofta blir underskattade och att effektiva och objektiva verktyg eller metoder att uppskatta blödningar perioperativt är något som saknas för anestesisjuksköterskor. Blödningar som inte uppskattas korrekt leder till att patienter i den perioperativa vården blir lidande.

Sve veća potreba za izvođenjem kolonoskopije u dijagnostičke ili terapijske svrhe nameće potrebu za usavršavanjem ove endoskopske procedure. Izvođenje kolonoskopije u opštoj, intravenskoj anesteziji, moglo bi u značajnoj meri olakšati njeno izvođenje, poboljšati podnošenje ove procedure od strane ispitanika i omogućiti otkrivanje većeg broja pacijenata sa potencijalno malignim bolestima debelog creva. Cilj ispitivanja je bio utvrditi da li primena opšte intravenske anestezije tokom kolonoskopije povećava broj totalnih kolonoskopija i skraćuje vreme intubacije cekuma, povećava broj viđenih patoloških procesa i smanjuje osećaj bola i učestalost neželjenih reakcija. Primena opšte intravenske anestezije značajno je povećala broj totalnih kolonoskopija u 94.3% ispitanika u odnosu na 78.7% totalnih kolonoskopija kontrolne grupe i skratila vreme intubacije cekuma, značajno je povećala broj viđenih patoloških promena u 46.7% ispitanika u odnosu na broj viđenih patoloških promena u 28.8% ispitanika kontrolne grupe i značajno je smanjila intenzitet bola i učestalost neželjenih reakcija. U kontrolnoj grupi ispitanika skalom bola nakon kolonoskopije ustanovljen je značajno veći intenzitet bola u poređenju sa ispitanicima ekperimentalne grupe. Na Likertovoj skali zadovoljstva ustanovljena je značajno bolja kontrola bola i lični stav lekara u ekperimentalnoj grupi, dok su poseta ustanovi i procedura, razumevanje procedure, tehnička veština lekara, lični stav medicinskih sestara i drugog tehničkog osoblja značajno bolje ocenjeni u kontrolnoj grupi. Od svih ispitivanih faktora na zadovoljstvo obe grupe pacijenata značajno su uticali: način izvođenja procedure, bol, uočene patološke promene i intubacija cekuma. U kontrolnoj grupi ispitanika između skale zadovoljstva i skale bola ustanovljena je značajna negativna korelacija. U kontrolnoj grupi se 80,1% pacijenata izjasnilo da bi ponovnu kolonoskopiju uradili u opštoj intravenskoj anesteziji u poređenju sa svim pacijentima eksperimentalne grupe koji ne bi menjali način izvođenja ponovne procedure. Primena opšte intravenske anestezije tokom kolonoskopije povećava broj totalnih kolonoskopija i uočenih patoloških promena, smanjuje učestalost i intenzitet neželjenih reakcija povećavajući zadovoljstvo pacijenata, što bi prevashodno moglo imati značaja u skriningu karcinoma debelog creva. Potrebno je proširiti ispitivanje primene opšte intravenske anestezije u drugim endoskopskim procedurama kako bi bila uvedena u svakodnevnoj kliničkoj praksi.
An increasing need to perform colonoscopy for diagnostic or therapeutic purposes imposed the need for mastering this endoscopic procedure. Performing colonoscopy in general intravenous anesthesia could greatly ease the procedure, make it more comfortable for patients and it could enable detecting a higher number of patients with occult malignant diseases of the colon. The aim of this paper was to determine if the implementation of general intravenous anesthesia during colonoscopy increases the number of total colonoscopies and shortens the time of cecum intubation, increases the number of familiar pathological processes and decreases the sensation of pain as well as the frequency of side reactions. The implementation of general intravenous anesthesia has significantly increased the number of total colonoscopies in 94.3% of examined patients in relation to 78.7% of total colonoscopies of the control group and shortened the time of cecum intubation. It has significantly increased the number of familiar pathological changes in 46.7% of the patients in relation to the number of familiar pathological changes in 28.8% patients of the control group and significantly decreased pain intensity and the frequency of side reactions. A statistically greater pain intensity after colonoscopy was determined by the pain scale in the control group in comparison to the examinees of the experimental group. Likert satisfaction scale has shown that the experiment group assessed pain control and doctors’ opinion as significantly better, while the institution visits and the procedure, understanding the procedure, doctors’ technical skills, nurses’ and technical personnel’s personal opinions were assessed as significantly better in the control group. Out of all the examined factors on the satisfaction of both groups, the following ones had a significant inluence: the way the procedure was done, the level of pain, detected pathological changes and cecum intubation. A significanlty negative correlation was determined between the scale of satisfaction and the scale of pain in the control group. 80.1% of the control group patients stated that they would undergo a general anesthesia colonoscopy again in comparison to all the patients of the experimental group who would not change the way the procedure was previously done. The implementation of general intravenous anesthesia in the course of colonoscopy increases the number of total colonoscopies and detected pathological changes, decreases the frequency and intensity of side-effects therefore it enhances patients' sastisfaction, which could play a major role in colon cancer screening. It is necessary to extend the implementation of general intravenous anesthesia in other endoscopic procedures in order to introduce it in everyday clinical practice.

Magistro darbas buvo parengtas Lietuvos sveikatos mokslų universitete, Veterinarijos akademijoje 2012 – 2013 metais. Magistro darbas susideda iš turinio, įvado , literatūros apžvalgos , rezultatų ir jų aptarimo, išvadų bei padėkos .Visą darbą sudaro 41 puslapiai , 10 lentelių ir 6 diagramos. Tikslas: Įvertinti Lietuvos sveikatos mokslų universiteto Veterinarijos akademijos dr. L.Kriaučeliūno smulkiųjų gyvūnų klinikoje chirurginėje praktikoje naudojamų bendrosios nejautros metodų efektyvumą ir gyvybinių funkcijų stebėsenos svarbą. Darbo uždaviniai:1. Išnagrinėti bendrosios nejautros būdų taikymą smulkiųjų gyvūnų klinikoje.2. Įvertinti stebėjimo (monitoravimo) rodiklius.3. Stebėti ir įvertinti pasitaikančias komplikacijas, taikomus būdus joms pašalinti bei jų prevenciją.
This master work was prepared in Lithuanian University of Health Sciences, Veterinary Academy in 2012 – 2013 years. This master work compiles from a content, introduction, review of literature, results, consideration, conclusion, and thanks. The master work consists of 41 pages and includes 10 tables and 6 pictures. The aim: Rate of small animal surgical techniques used in general anesthesia effectiveness and the importance of monitoring vital functions. The tasks: 1. Examine general anesthesia techniques by the small animal clinic.2. Monitoring indicators.3. Monitoring of common complications, their prevention and ways to remove them. After study shows that the development is an important vital functions the animal's age, breed, health status, complexity of procedures performed and the medicinal use for its intended purpose.

Il lavoro offre una ricostruzione storica del dibattito sui confini della disciplina "estetica" svolto in Germania tra il 1985 e il 2005 | Focused on the productions of German Philosophers, the Research presents the most important issuues discussed about the boundaries of waht we called "Aesthetic" in Academic Field.

Background: Surgical procedures are invariably accompanied by the use of inhalational and intravenous anesthetics. Both groups have strong influence on cardiovascular system by the interaction with myocardial oxygen supply/demand ratio and cardiomyocyte functions at the level of cell membranes, ion channels and regulatory enzymes. Aims: 1. To examine the effects of different isoflurane concentrations on the left ventricular (LV) dimensions and systolic function in the rat. 2. To examine the effects of isoflurane-induced myocardial preconditioning (APC) on the cardiac tolerance to ischemia- reperfusion (I-R) injury. 3. To compare the influence of anesthesia, based on ketamine- dexmedetomidine (KET-DEX), on the release of biochemical markers of myocardial injury and the early postoperative course with the anesthesia, based on sevoflurane-sufentanil (SEVO), in the patients undergoing coronary artery bypass grafting (CABG). Methods: 1. We carried out transthoracic echocardiographic examination in the rats immobilized by 1.5-3% concentration of isoflurane. 2. After inducing APC by isoflurane (0.5 and 1 MAC), we evaluated ventricular arrhythmias during regional ischemia (45 min), induced by the occlusion of the left anterior descending artery, and subsequent reperfusion (60 min), using the model of...

Local anesthetics are the most commonly used drugs in dentistry. This thesis provides an up-to-date summary of pharmacology and of the clinical applications of local anesthetics in stomatology. The individual chapters deal with high-risk patients, local as well as systemic adverse effects and the application of local anesthetics on children. Finally, the thesis outlines new trends in the development of local anesthesia.

The aim of this study was to assess the effects of the four most used anaesthetics in European aquaculture MS 222, clove oil, 2-phenoxyethanol and Propiscin on barbel (Barbus barbus). The effects of anaesthetics were assessed based on haematological profile, biomarker of oxidative stress and antioxidant enzymes. This study contributed to the expansion of knowledge on the safety of tested anaesthetics and selected safe anaesthetics for barbel. Barbels were exposed to a 10-minute anaesthesia with MS 222 (in recommended concentration 100 mg×l-1), clove oil (in recommended concentration 33 mg×l-1), 2-phenoxyethanol (in recommended concentration 0.4 ml×l-1) and Propiscin (in recommended concentration 1 ml×l-1). The effects of anaesthetics were evaluated immediately after 10 min. anaesthesia and 24 hours after anaesthesia. Anaesthesia with MS 222, clove oil, 2-phenoxyethanol and Propiscin had no significant effect on haematological indices, level of oxidative stress (TBARS) and activity of glutathione reductase in barbel tissues. The activity of catalase was significantly increased in the muscle 24 h after anaesthesia of all anaesthetics compared to the control. Superoxide dismutase activity was changes in all experimental groups (immediately after 10 min. anaesthesia and 24 hours after anaesthesia). The tested anaesthetics not altered hematopoietic tissue and had not effect on the level of lipid peroxidation in barbel´s tissues. The results of this study suggest that the antioxidant systems of barbel are altered by Propiscin anaesthesia, but they are slightly affected by MS 222, clove oil, and 2-phenoxyethanol anaesthesia. On the basis of the results of this thesis, for anaesthesia of barbel we can recommend clove oil and 2-phenoxyethanol as an alternative MS 222.

Nomenclature: Sensitivity to anesthetic clove oil different species of adult fish Sensitivity of breeding fishes of various species (Siberian sturgeon, Brook trout, Black carp- young breeding fishes) for anesthetic clove oil was probed by the tests performed at temperature in the period of stripping (apart from Brook trout and Black carp). The tests were carried out with 17 fish species- with cyprinids (Ide- golden form, Common dace, European Chub, Sneep, Barbel, Grass carp, Black carp, bighead carp), salmonids (Brown trout, Rainbow trout, Brook trout), thymallinae (Grayling), pikes (Northern pike), perches (Pike-perch), sturgeons (Siberian sturgeon, Beluga) and airbreathing catfishes (North African catfish). Using concentration of 0,03ml.l-1 (Brown trout, Rainbow trout, Brook trout, Grayling, Pike, Pike perch, Ide, Dace, Chub, Barbel and Sneep), 0,04ml.l-1 (Grass carp, Black carp, Bighead carp), 0,05ml.l-1 (North African catfish) and 0,07ml.l-1 (Siberian sturgeon, Beluga) the IIb. Phase has been achieved, which is sufficient for manipulation with fishes during stripping. The anesthesia subsided after time period of 10-17 minutes (12 species) at the majority of fishes and at others after interval of 20-26 minutes (5 species). The results confirmed concentrations recommended for salmodis and Grayling (0,025-0,03ml.l-1), sturgeons (0,07ml.l-1), and North African catfish (0,05ml.l-1). At the majority of cyprinids (apart from Grass carp, Black carp and Bighead carp), the concentration used was lower than recommended (0,04-0,05ml.l-1)

Using of recirculation systems for rearing of fish is common practice in Western Europe countries. Benefits of this systems are utilized in recovering programs of endangered species of fish. In this work we had paid attention on suitability of RAS for rearing Nase, Vimba bream and Barbel. In the first part two six-month experiments were conducted. The five-month-old nase and vimba bream had been trained on pellet feed and acclimated to four different temperatures. The WT fluctuated in parallel with ambient outside conditions at an average of approximately 4 °C for the inflow system and approximately 15, 18 and 21°C in closed, recirculation systems. The total length and weight were measured at two-week intervals and SGRw, FCR and survival were monitored. We observed a positive effect of higher water temperatures on their growth rate of each species. Both groups (WT 21°C) had the most rapid growth and highest SGRw. Growth rate and SGRw were lowest for each species in group with the ambient temperature conditions. Lower temperature at the level of 18°C gave good results in comparison to rearing in cold water. Individual weight was 3.25 and 4.13 times higher for nase and vimba bream, respectively. The temperature 15°C was chosen with regard to the functioning of the biofilter and in this experiment, it proved to be a minimal temperature suitable for rearing of river fish species in RAS. The economic costs to maintain this temperature is low, but the effect of production considered this level of WT as very less effective in several aspects. To conclude this part, we found intensive winter rearing of nase and vimba bream is an effective way to prepare fish for spring restocking. In the second part we have tested suitability of Vimba bream as a trainer fish for adaptation of pikeperch for commercial pellet diet. One of the basic problems in pikeperch culture in RAS is adapting early life stages to pelleted feed (PF). Our work compares four different ways of adapting 6-week-old pikeperch fingerlings to feeding on a commercial diet. The methods were designated, A - use of trainer fish and direct application of PF; B - use of trainer fish and gradual addition of PF with natural food (NF, chironomid larvae); C - direct application of PF only; D - gradual addition of PF with NF. The growth trial experiment (including adaptation to PF) lasted 14 days by which time all experimental groups were accepting PF. Pikeperch fingerlings in group A grew significantly faster and PF was more readily accepted compared to other groups. Other characteristics observed (total weight increment, FCR) also support the use of trainer fish and direct application of PF for pikeperch in their adaptation to intensive culture. The aim of the final study were to compare the effect of anaesthetics MS 222, clove oil, 2- phenoxyethanol and Propiscin on haematological and blood biochemical profiles in vimba bream. The haematological and blood biochemical profiles of vimba bream anaesthetized with MS 222 (100 mg/l), clove oil (33 mg/l), 2- phenoxyethanol (0.4 ml/l), Propiscin (1.0 ml/l) and non-anaesthetized control group were tested. Each tested group was divided into two subgroups. The first subgroup was sampled immediately after 10-min anaesthesia. Second subgroup was sampled 24 h after 10-min anaesthesia. The 10-min of exposure to the anaesthetics had no effect on the haematological profile of vimba bream. The effect of anaesthetics on biochemical indices of blood plasma was demonstrated. The exposure of the anaesthetics 2-phenoxyethanol and Propiscin influenced levels of glucose, ammonia and the activity of aspartate aminotransferase compared with the control group. The level of triacylglycerols and the activity of lactate dehydrogenase was affected to exposure of MS 222. Based on the results only clove oil had no effect on the haematological and blood biochemical profiles. Other anaesthetics tested more or less affect value of blood biochemical profiles.

Title of work: Method for Assesment of the Effect of Selected Anesthetics on H-reflex in Laboratory Rat Objective: To create an applicable method for recording of the H-reflex of freely moveable unanesthetized rats. Methods: Three adult rats were each implanted in the right leg with stimulating electrodes in a flexible cuff on the tibial nerve and a pair of recording electrodes in the triceps surae muscle. After recovering it was evaluated if the electrodes are appropriate for stimulation of peripheral nerve and for recording of ongoing EMG and evoked EMG (H-reflex, M- response). Results: It is possible to use stimulating electrodes in a flexible cuff and a pair of recording electrodes for recording ongoing EMG and evoked EMG (H-reflex, M-response) in freely moveable rats. The experiment did not determine which kind of metal is the most appropriate for conductor for recording high quality EMG. Keywords: H-reflex, Electromyography, Implanted electrodes, Rat, Electrophysiology