The Greek e-journal of Perioperative Medicine

1

Authors: Papagiannopoulou P, Mouloudi E

Editorial

16-29

Authors: Fyntanidou B, Amaniti A, Fortounis Κ, Papadopoulos A, Chatsiou E, Ourailoglou V, Kotzampassi K, Grosomanidis V

Anaphylaxis is a severe, potential life threatening allergic reaction, which is characterized by rapid onset and varied clinical manifestations involving in most of the cases the respiratory and cardiovascular systems and sometimes skin and mucosa. Twentysix patients (16♀ & 10♂) with a mean age of 59.7± 8.6yrs were included in this study. All patients were managed by Emergency Medical Services (EMS) of Thessaloniki. Triggers were medications in 25 patients and in 1 case food. Regarding medications, antibiotics were responsible for the vast majority of the cases (23 out of 25). On EMS arrival, 21 patients suffered hypotension, 2 intense bronchospasm, 1 pulmonary edema and 2 were in cardiac arrest (CA). Moreover, 15 patients had generalized urticarial and 4 complained for abdominal pain. In 4 out of the 21 patients with hypotension, pulse was palpable only in the carotid artery and in the rest pulse was detectable in the radial artery but faint. One patient (the one with the pulmonary edema) had severe bradycardia (<30b/min). Of the 26 patients, 23 had a good level of consciousness (GCS: 15) and only 1 patient was in coma (GCS: 3). Initially, all patients received 0.5mg adrenaline IM. Thereafter, a peripheral IV line was established and fluids (LR), hydrocortisone and antihistamines were administered. Moreover, all of them received O2 by mask at 10L/min. A second dose of 0.5mg adrenaline was administered in 8 patients, and 1 patient received an additional third dose. Adrenaline administration resulted in clinical improvement in a mean time of 6.1±4.2min. After clinical improvement, all patients were transferred into a hospital in good clinical condition. Cardiopulmonary resuscitation (CPR) according to the current European Resuscitation Council (ERC) guidelines was performed in the 2 CA victims and resuscitation efforts were terminated after 30min. In both CA victims, initial CA rhythm was asystole and did not change until the end of CPR. Early prehospital treatment of a severe allergic reaction by adrenaline administration can be lifesaving.

36-44

Authors: Varvarousi G, Stamatakis E, Pavlidis M, Valsamidis D

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis characterized by progressive ossification of the spinal column with resultant stiffness. Patients, with AS, have a suppressed immune function due to proinflammatory cytokines and chemokines which are responsible for the inflammation of the joint. In AS stress, inflammation responses to surgery and postoperative pain may further suppress immunity function and promote cancer progression. A 77-year-old woman, ASA III status and with AS for almost 20 years, was planned to receive anaesthesia for total abdominal hysterectomy, pelvic and paraaortic lymph node dissection. Sufficient operating conditions, with adequate depth of anaesthesia, analgesia and neuromuscular blocking, attenuated surgical stress and reduced intraoperative and postoperative inflammatory mediators. We report the anaesthetic management of a patient with AS undergoing gynaecological cancer surgery. Titration of drugs and adequate monitoring reduced the consumption of drugs and allowed recovery to be shortened with no side effects.