The Greek e-journal of Perioperative Medicine

1-10

Authors: Pratsas K, Georgopoulou S, Bareka M, Ieropoulos Ch, Flossos A, Vretzakis G

In general, laparoscopic procedures of the abdominal cavity necessitate endotracheal intubation and mechanical ventilation due to the induction of pneumoperitoneum. The increased intra-abdominal pressure together with the increased carbon dioxide load to the lungs are considered as better managed under mechanical ventilation, making thus general anesthesia a necessary requirement for these operations. In the past decade, a small number of reports appeared involving regional anaesthesia for laparoscopic general surgery, including patients with coexisting pulmonary disease who were deemed high risk for general anaesthesia. More recently, a limited number of studies showed the feasibility of the application of regional anaesthesia on healthy subjects. Nowadays, the properly controlled randomized studies addressing this issue remain limited, but their results show that the strong indication of general anaesthesia for laparoscopic general needs to be re-evaluated.

28-39

Authors: Papagiannopoulou P, Kostoglou Ch

The management of cardiologic patients who are presenting for diagnostic and theurapeutic cardiac interventions has become a significant topic of interest and concern among anesthesiologists. This review will update recent reports and also will provide practical advice on delivering anesthesia in cardiac catheterization laboratory. During recent years cardiac procedures are more complex, take longer, and involve high risk patients. Many of these cases require general anesthesia rather than sedation. The anesthesiologist has to be familiar with advanced hemodynamic monitoring and also has to be aware of pitfalls and complications of the interventional procedures. In this new and changing arena, collaboration and planning between cardiologists and anesthesiologists are required for both patient safety and procedural success.

54-69

Authors: Vakalos A

Damage control surgery is defined as rapid termination of an operation after control of life threatening bleeding and contamination in severely injured and unstable patients, followed by correction of physiologic abnormalities and de-finitive management. Emphasis then shifts from the operating theater to the intensive care unit, where the patient’s physiologic deficits are corrected. These patients present many challenges for the intensive care team and emphasize the need for a multidisciplinary approach to optimize trauma patient management. This modern strategy involves a staged approach to multiply injured patients designed to avoid or correct the lethal triad of hypothermia, acidosis and coagu-lopathy before definitive management of injuries. During the first stage of damage control, hemorrhage is stopped and contamination is controlled using the simplest and most rapid means available. Temporary wound closure methods are em-ployed. The second stage is characterized by correction of physiologic abnor-malities in the ICU. Multiple issues need to be addressed simultaneously, while the overall aim is to rapidly achieve a physiological environment that allows the best possible recovery. The “lethal trial” of hypothermia, acidosis and coagulo-pathy due initial hypovolaemia require aggressive correction. From the outset ICU management must also attempt to minimize the complications of these inju-ries and the resuscitation process. In the final phase of damage control, definitive operative management is completed in a stable patient.

84-98

Authors: Petrou A

A lot of techniques have been tested for their potential to salvage myocardial tissue during an episode of acute ischaemia. Techniques that are applied before the onset of acute ischaemia, i.e. preconditioning techniques, have proved to be really protective, but scheduled ischaemia or at least high probability for the timing of it’s occurrence, is a pre-requisite for their application. This disadvantage led to experimentation on techniques that can be applied immediately after the onset of acute ischaemia or at least on the time of reperfusion. The main target of the concept of the “first golden hour after an acute cardiac ischaemic episode” is early reperfusion. Unfortunately, reperfusion injury outweighs the deleterious ef-fects of the primary ischaemic episode. Postconditioning, at its mechanical version, was invented experimentally and proved really protective. Soon, pharma-ceutical substances that had already proved their efficacy in preconditioning turned out almost equally effective in postconditioning. Volatile anaesthetics, opioids and beta blockers, so delicately managed in anesthesia practice, offer important protective advantages in animal experimental investigations and very encouraging results in limited clinical trials in humans. Detailed methods of their clinical application and the delineation of possible interactions with other substances will presumably offer new terrain of clinical application of these anaesthetics that from the time of their discovery continue to surprise us with their exceptional properties.