The Greek e-journal of Perioperative Medicine

6-26

Authors: Papaioannou V

Acute and prolonged illness seems to result in a variety of different neuroendocrine alterations. During the acute phase of critical illness there is an actively secreting anterior pituitary gland and a peripheral resistance to anabolic hormones. In the chronic phase of critical illness there is a uniformly reduced secretion of anterior pituitary hormones, with the notable exception of cortisol. The main characteristic of these alterations is the ‘wasting’ syndrome. An acute event, such as an infection or emergency surgery in a long-stay ICU patient, is accompanied by mixed acute/chronic endocrine patterns. Wasting syndrome is manifested, among others, with hyperglycemia and insulin resistance, while the severity of this ‘diabetes of stress’ reflects the risk of death. Recently it was shown that preventing these metabolic patterns with insulin infusion improves outcome in critically ill patients. It remains to be demonstrated if other endocrine interventions will accelerate recovery, especially in long-stay patients in ICU.

41-48

Authors: Georgiadou Th, Kostoglou Ch, Kanakoudis F

Acute inflammatory response is the body’s direct response to noxious stimuli or to tissue necrosis. Ischemia-reperfusion lesion is a clinical state of acute inflammation with leucocyte-induced tissue damage. Ischemia promotes an inflammatory response which sensitizes tissues to further damage during reperfusion. Reperfusion activates inflammatory mediators from remote vascular or tissue sites or from the local vascular bed. Reperfusion remains the cornerstone for the repair of ischemic areas. Recently it is emphasized that repeated ischemic episodes of small duration with reperfusion interval periods in between make tissues more resistant to further long-termed ischemia. This is the I.P phenomenon. Many pharmacological agents (such as volatile anesthetics) are capable of inducing I.P. Other measures that can prevent or reduce ischemia-reperfusion injury, are controlled reperfusion, antioxidant, anti-complement and anti-leucocyte therapy.

60-67

Authors: Vasiliadis M , Mitragas A, Konstantinidou A, Markala D, Kaplanis K

Perioperative hypercoagulation in cancer patients is frequently a concern for the anesthesiologist. Ιt is not clarified yet whether the choice of anesthetic technique offers significant advantages for the prevention of postoperative complications. For this purpose, a prospective, randomized clinical trial was conducted. Forty-two female patients with ovarian cancer, undergoing abdominal hysterectomy, were randomized in three groups. In the first group, 19 patients received general anesthesia, in the second group 18 patients received combined anesthesia, in particular general anesthesia with epidural administration of local anesthetic and in the third group 15 patients also received combined anesthesia, but with epidural administration of opioids. The following parameters were measured: Hemoglobin, platelet count, prothrombin time, INR (International Normalised Ratio), activated partial-thomboplastin time, fibrinogen, D-Dimers, antithrombin III, protein C and resistance to activated protein C. Four blood samples were taken: 1st) preoperatively, 2nd) in the Post-Anesthetic Care Unit, 3rd) twenty-four hours and 4th) forty-eight hours postoperatively. No statistical difference was observed among the groups in all parameters. In the second postoperative day, an increase of fibrinogen (p<0.01) and of D-Dimers (p<0.001) was observed. It seems that either general anesthesia or combined anesthesia (general anesthesia with epidural local anesthetics or opioids) influence these certain coagulation parameters in the same manner in cancer patients. An increase of fibrinogen and of D-Dimers was observed in the second postoperative day in the patients of all groups.

75-77

Authors: Vassiliadis MA, Barbetakis ND, Balamoutsos NG

Several techniques have been described for percutaneous internal jugular vein catheterization. Some of them are associated with complications, such as tracheal tube cuff puncture. We describe two cases of this rare but potential devastating complication, after which our patients recovered uneventfully. Despite these unfortunate accidents, we recommend the mentioned technique, but with some consideration. We propose measures concerning angles and directions of needles, as useful aids for further use of this cannulation technique.

85-87

Authors: Papadimos TJ

Medical equipment can interfere with an electrocardiogram (ECG) and mimic a dysrhythmia [1-7]. Unnecessary interventions may occur when artifact is misdiagnosed as ventricular tachycardia (VT) [8,9]. We encountered such an ECG artifact when an orthopaedic shaver was engaged during knee arthroscopy.