The Greek e-journal of Perioperative Medicine

1-2

Authors: Papagiannopoulou P, Mouloudi E.

[None]

18-35

Authors: Serchan P, Tsaousi G, Antonitsis P, Fyntanidou B, Papanikolaou D,Kyparissa M, Alexiou Ι, Grosomanidis V

Several prevention and treatment strategies have been applied in order to prevent hypoxemia after open heart surgery with comparable good results. The aim of this study is to compare the effectiveness of two different alveolar recruitment maneuvers [RM] for the management of oxygenation impairment in cardiac surgical patients. A total number of sixty patients were included in this study. All patients underwent cardiac surgical procedures with extracorporeal circulation and developed oxygenation impairment after withdrawal of extracirculation support and sternal closure. Patients were randomly assigned into two Groups A and B according to the applied RM. In Group A three hyperinflations of the lungs were applied at an airway pressure of 40cmH2O for 10 sec, whereas in Group B Pressure Control Ventilation was applied for 2min with the inspiratory pressure set at 40cmH2O. After application of any of the two RM, PEEP was increased from 5 to 10 cmH2O in all patients. Anesthesia induction and maintenance and mechanical ventilation settings were similar in both study Groups. Measured parameters were associated with oxygenation, pulmonary mechanics and hemodynamics and were recorded at the following phases: Phase 1[I]: Arrival at the operating theatre, Phase 2[II]: After anesthesia induction, Phase 3[III]: Sternal closure, Phase 4[IV]: After RM application. The PaO2/FiO2 ratio in Group A was: [I] 413.9 ± 85.5 [II] 340.7 ± 74.7 [III] 176.8 ± 55.2 and [IV] 410.4 ± 63.1 mmHg and in Group B as follows: [I] 388.9 ± 53.1 [II] 343.8 ± 65.6 [III] 208.4 ± 53.8 and [IV] 295.1 ± 52.3. Both general anesthesia induction and initiation of mechanical ventilation have negatively affected patients’ oxygenation. After withdrawal of extracirculation support and sternal closure, oxygenation impairment was more severe in a statistically significant manner in Group A. RM application in Group A has proved to be more effective in the enhancement of impaired oxygenation compared to Group B. Parameters associated with pulmonary mechanics and hemodynamics did not differ statistically significant between the study groups. According to our study the RM applied in Group A has proved to be more efficient compared to the corresponding applied RM in Group B.

48-60

Authors: Tsimpinos E, Stamatakis E, Pavlidis M, Hadzilia S, Valsamidis D

The number of pregnant women with morbid obesity (BMI 40–49.9 kg/m2) has significantly increased worldwide. Management of these patients presents a challenge for obstetric anesthesiologist. We report our management of cesarean delivery in a parturient with a BMI 47.3 kg/m2. We present this case to emphasize usefulness of Tuohy needle as an introducer for performing spinal anesthesia with a long 27G pencil point needle. Literature review is discussed.

67-73

Authors: Serchan P, Papanikolaou D, Toliopoulou K, Papagiannopoulou P,Kostoglou Ch, Zachariadou Ch

Acute uvular edema is a rare complication that can be presented in the postoperative period, usually after general anesthesia. If severe enough, it can even result in a compromised airway. In this case report, we present a case of postoperative acute uvular edema occurred in an orthopedic patient, after spinal anesthesia and infraclavicular brachial plexus nerve block combined with intravenous sedation.