The Greek e-journal of Perioperative Medicine

2-23

Authors: Nastou M, Geleve G, Trikoupi A

Pain is a disastrous manifestation of cancer that influences the patients’ quality of life, their fami-lies, and health care providers. It is a multidimensional symptom that includes the physical, psycho-social, emotional and spiritual character of the human organism. Despite the development of new analgesic drugs and updated guidelines, the pain management remains insufficient, and some pa-tients with mild to severe pain do not received adequate pain treatment. This insufficient manage-ment can be attributed to barriers related to health professionals, to the patients, and the health care system. Common professional barriers include the bad pain evaluation, the lack of knowledge and skills, and the doctors’ reluctance to prescribe opioids. The barriers related to the patient include cognitive factors, emotional factors, and the compliance with analgesic regimens. Barriers related to the health system, like the limited access to opioids, and limited availability of pain and palliative care experts, consist additional challenges, especially in poor countries. Given the multidimensional nature of cancer pain, and the multilevelbarriers involved, the effective pain management demands multimodal interventions from interscientific groups. Educational interventions to the patients and health professionals it is possible to improve the successof pain management.

41-57

Authors: Veroniki F, Ourailoglou V, Fyntanidou B, Tsotsolis N, Kotso E, Kyparissa M, Grosomanidis V

The occurrence of intraoperative oxygenation impairment is common even in healthy individuals and will vary depending on the patient and the type of surgery. The purpose of this study was to evaluate the incidence of oxygenation impairment in patients with normal lung function and to study the safety and efficacy of three different recruitment strategies. Out of a total number of 430 patients, 150 patients developed intraoperative oxygenation impairment, which was defined as the drop of PaO2/FiO2 ratio below 300. These 150 patients were randomly assigned into four study groups according to the recruitment strategy applied. Group A (N: 38): Application of three hyperinflations of the lungs at airway pressure 40cmH2O for 10 sec, followed by an increase in PEEP from 5 to 10cmH2O. Group B (N: 38): Increase in PEEP from 5 to 10cmH2O. Group C (N: 37): Application of three hyperinflations of the lungs at airway pressure 40cmH2O for 10 sec, without any PEEP alteration and Group D (N: 37): No maneuver. Measurements were taken at the phase of oxygenation deterioration and at 5, 15, 30, 45 and 60min after applying the maneuvers and also before extubation. From a total of 430 patients 150 developed oxygenation impairment (38.4%). The median onset time of the deterioration was 30min after intubation and mechanical ventilation. In group A the PaO2/FiO2 ratio increased significantly immediately after the maneuvers and remained elevated until extubation. In group B the PaO2/FiO2 ratio presented a gradual increase to significant levels before extubation. In group C, the instant post-maneuver increase of oxygenation was not sustained until extubation. Finally in group D a gradual decrease of the PaO2/FiO2 ratio was recorded until the end of surgery. According to the results of our study, one third of patients developed intraoperative oxygenation impairment approximately half an hour after intubation. The application of three hyperinflations of the lungs at an airway pressure of 40cmH2O for 10 sec, followed by an increase in PEEP from 5 to 10cmH2O proved to be the most effective treatment of impaired oxygenation.

71-81

Authors: Siopi V, Valasiou I, Papageorgiou E , Veliki N, Tzinevi M, Rallis Th, Gogakos A.S, Paliouras D, Asteriou Ch , Anisoglou S, Barbetakis N .

The objective of postoperative pain management after thoracotomy is the prevention of postoperative complications, the reduction of the length of hospital stay, the increase of the patient’s satisfaction and finally the resumption of the daily living’s normal activities. Thoracic surgery affects postoperative respiratory function, along with a high risk of developing postoperative pulmonary complications. Pain is a subjective experience. Postoperative pain management in thoracic surgery patients should be individually applied, based on a well-organized health care system that emphasizes consistent nursing education regarding proper pain management techniques, with an effective communication between the patient and members of the existing multidisciplinary team, especially the nursing staff.

2-15

Authors: Volakli E, Sdougka M, Mantzafleri PE, Tsonidis Ch , Kontopoulos E, Tsikoulas I

The goal of of the present study is to investigate short-term and long-term functional outcome of a 8-bed, multidisciplinary pediatric intensive care unit (PICU) of a general hospital 300 PICU patients were enrolled prospectively in this observational cohort study. Functional outcome was evaluated through Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scales at admission (baseline), at PICU and hospital discharge, at 3 and 6 months, and at 1 and 2 years. Delta DPCPC and DPOPC alterations at discharge were related to major diagnostic categories and 2-year survival.Baseline PCPC and POPC scores were normal in 67% and 58.7% of study population, mild disability were recorded in 17.3% and 14.7%, moderate disability at 8% and 14%, severe disability at 4.3% and 9.3% and coma at 3.3% and 3.3%, respectively. At two years, normal PCPC and POPC scores were found in 66% and 47% of patients, mild disability in 17.3% and 30.5%, moderate disability in 9.5% and 13.6%, severe disability in 2.9% and 4.9% and coma in 4.1% and 4.1%, accordingly. Two years after discharge patients reached their PCPC baseline categories but lacked behind in POPC categories (p=0.001). Best functional outcome at discharge was recorded in respiratory and postoperative patients followed by cardiovascular, neurologic and trauma patients. Statistically significant differences were found in 2-year survival according to DPCPC [χ2 (2)=77.77, p<0.001] and DPOPC categories [χ2 (2)=44.66, p<0.001]. In conclusion, we found that two years following PICU discharge functional outcome parameters approached their preadmission values. Therefore, this chosen time period seemed to be adequate for studying long-term outcome of pediatric intensive care. Long-term PICU survivors had satisfactory PCPC (92.8%) and POPC (91.1%) categories to live an independent life. The impact of critical illness was greater on overall performance than in cognitive function.

31-37

Authors: Charitidou S, Aslanidis Th, Moutsianos G, Balaouras D, Mameletzi S.

The Fontan procedure and its modifications is the definitive therapy for a number of congenital heart diseases. Anesthesia for semi-elective Caeserian section in a pregnant woman with a history of such surgery history can be a real challenge due to probability of high perioperative morbidity and mortality. We present the anesthetic management of a young parturient with a history of a partially repaired complex cyanotic congenital heart disease and perform a literature review.

46-50

Authors: Mouloudi E, Papadopoulos S, Massa E, Giasnetsova T, Theodoridou Th, Anastasiou A, Fouzas I, Tsonidis Ch, Papanikolaou V, Gritsi - Gerogianni N

Neurologic complications after liver transplantation are quite common, with central pontine myelinolysis (CPM) being a rare but fatal complication. In this report, we describe the case of female liver transplant recipient who developed CPM after orthotopic liver transplantation (OLT).A 62-year old woman was admitted to the ICU for postoperative recovery after OLT. The procedure was described as uneventful. The patient had a history of decompensated cirrhosis, tension ascites, class I hepatic encephalopathy and chronic hyponatremia which necessitated repeated hospitalizations in the year prior to transplantation.The patient was unable to be weaned from ventilator support and did not show an improvement in mental status (GCS=5) despite the cessation of sedation. After neurologic consultation, a brain MRI was performed which showed evidence of CPM in the pons. Despite supportive therapy, the patient did not show an improvement of mental status and after a 55-day hospitalization in the ICU she died from septic complications.The etiology of CPM is multifactorial, with liver transplant recipients being at an increased risk. Supportive treatment is the standard of care, and there are not enough evidence supporting other types of treatment.