Myomectomy during cesarean section

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

Proportion of immediate severe postoperative pain in laparoscopic sterilization under general anaesthesia: A cross-sectional study (postoperative pain in laparoscopic sterilization)

Background: Effective control of immediate post operative abdominal pain following laparoscopic sterilization is challenging. The objective of the study was to estimate the incidence of immediate severe postoperative pain following laparoscopic sterilization under general anaesthesia by the proportion of patients with the pain assessed on a numerical rating scale. Methods: A cross sectional study was conducted with the approval of institutional review board and ethics committee. Fifty seven participants with written informed consent underwent the study over a period of six months. Pain was assessed by a trained recovery nurse and data was collected and analyzed. The main outcome measure was immediate severe post operative pain on numerical rating scale (NRS). Results: Among the 57 participants, 14 (24.6%) had immediate severe post operative pain with median score of five in the inter quartile range of 0 to 5.75 and 43 (75.4%) participants had no severe pain. Conclusion: The incidence of immediate severe postoperative abdominal pain after laparoscopic sterilization under general anaesthesia is high. Therefore, the management of pain following laparoscopic sterilization requires individually based multimodal analgesia.

Efficacy and opioid-sparing effect of interpleural bupivacaine in patients undergoing laparoscopic cholecystectomy: Prospective observational study (Running title: Efficacy of inter-pleural bupivacaine in laparoscopy)

Introduction: Laparoscopic cholecystectomy is considered minimally invasive, but pain following laparoscopy is moderate to severe, leading to increased morbidity and length of hospital stay. Various medications, including opioids, NSAIDs, and techniques like intraperitoneal local anesthetic infiltration, are used. In this study, we investigated interpleural block with bupivacaine for pain relief following laparoscopic cholecystectomy. Methods: A total of 60 patients were included in the study. 30 patients received 20 ml of 0.5% interpleural bupivacaine (group 1), and 30 patients recieved 20 ml of 0.9% normal saline (group 2). We recorded visual analog score (VAS), vital signs, and postoperative opioid requirements. Tramadol (2 mg/kg) was rescue medication if VAS ≥ 5. Results: Significant difference between study groups was recorded among VAS scores measured at 30 minutes, 1, 2, 6, 10, and 12 hours (p value < 0.05). The difference in VAS scores at 15 minutes and 14 hours between study groups was insignificant (p value > 0.05). The number of patients who received tramadol was 9 (30%) patients in group 1 and 29 (96.7%) patients in group 2. The difference in proportion for tramadol intake at 6 hours was significant among study groups (p-value < 0.05). Conclusion: Interpleural bupivacaine 20 ml of 0.5% used as analgesia reduces post-operative opioid requirement following laparoscopic cholecystectomy. Hence interpleural block can be safely used as a regional technique for pain relief following laparoscopic cholecystectomy.

Role of ultrasound in cardiopulmonary resuscitation: Ultrasound CPR

Ultrasound has predictive value of identification and management of reversible causes of cardiac arrest on the outcome after applied CPR, in terms of ROSC (return of spontaneous circulation) and the hospital discharge and neurological findings after applied CPR measures. Ultrasound is used in all phases of resuscitation including period before cardiac arrest, during cardiopulmonary resuscitation (CPR), and in the period after that. Ultrasound use during CPR offers numerous advantages including non-invasiveness, easiness, the short time for examination and a safe possibility for a repeat test whenever it is needed. Focused Echocardiography Examination in Life support (FEEL) and Focused Echocardiographic Evaluation in Resuscitation (FEER) protocols are mostly used when we talk about heart examination in cardiopulmonary resuscitation.

Comparison of efficacy and safety of ultrasonography and fiber optic bronchoscope guided percutaneous dilatational tracheostomy: A prospective observational study running title: Efficacy and safety of USG and FOB guided tracheostomy

Introduction: We aimed to compare the procedural time, efficacy, and incidence of complications of ultrasonography and fiberoptic bronchoscope-guided percutaneous dilatational tracheostomy (PDT). Methods: The study population included the patients admitted to the department of anesthesiology and critical care. In this prospective observational study, we randomly divided 60 participants into two groups. In the ultrasound (US)-guided group, ultrasonography was used for PDT. While in the FOB guided group, we used the fiberoptic bronchoscope (FOB). We compared efficacy parameters and complications between the two groups. The mean values were compared between study groups using an independent sample t-test. Categorical outcomes were compared using the chi-square test. P-value < 0.05 was considered statistically significant. Results: Compared with the bronchoscopy group, the US group had a significantly shorter PDT operation time (11.8 ± 2.5 versus 15.43 ± 3.27 mins, P < 0.001). FOB group had fewer puncture attempts than the US group. FOB group had more central punctures than the US group (p < 0.001). Among PDT complications, bleeding happened in two patients (6.67%) in the FOB group and tracheal tube cuff puncture was observed in 8 (26.67%) patients in the US group. Conclusion: The US-guided PDT consumes less time for the procedure compared to bronchoscope-guided PDT. FOB was more effective in terms of parameters like the number of needle puncture attempts, the accuracy of the puncture site, the incidence of the posterior tracheal wall hit compared to US-guided PDT. Complications like bleeding were present in FOB.

Delirium in the intensive care unit

Delirium is not only a mental change but also a complex clinical syndrome with multiple pathophysiological changes. Delirium is an acute brain dysfunction accompanied by change or fluctuation of basal mental status, loss of attention with disorganized thinking, or altered level of consciousness. Although healthcare professionals realize the importance of recognizing delirium, it frequently goes unrecognized in the intensive care unit. Acute delirium is associated with increased mortality, morbidity, length of stay, and healthcare costs in intensive care units and hospitals. The consequences of delirium are long-term cognitive impairment, functional disability, post-discharge cognitive dysfunction, and institutionalization. Critical illness-related delirium can affect the diagnosis and treatment of primary diseases and disappears with the improvement of primary diseases. In the intensive care unit, delirium has been reported in 40% to 60% of non-ventilated patients and up to 50% to 80% of critically ill patients undergoing mechanical ventilation. Recent investigations have shown that delirium is preventable in 30-40% of cases. Available sedation and delirium monitoring instruments allow clinicians to recognize these forms of brain dysfunction. Multiple management strategies such as ABCDE, eCASH, and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.

Urgent ultrasonographic diagnostics in acute traumatic abdominal conditions: Urgent ultrasound in abdominal trauma

Clearly defined protocols and multidisciplinary approach present a milestone for patients' condition evaluation. Ultrasound is a fast, accessible, non-invasive and repeatable radiological examination and has an important place in the trauma algorithms. It detects trauma of parenchymal and hollow abdominal organs, hematoperitoneum, and helps in the assessment of volume status. Ultrasound in trauma is performed according to the Focused Assessment with Sonography for the Trauma (FAST) protocol or as a standard ultrasonographic examination of the abdomen and can be repeated to monitor morphological changes due to indications for emergency surgical treatment.

Anesthesiologists during the COVID-19 pandemic: Heroes of the front lines or collateral damage?: Anesthesiologists during the COVID-19 pandemic

Anesthesiologists are ranked among health professionals that are most often affected by burnout syndrome. A critical view is needed to interpret data published about burnout syndrome among anesthesiologists, keeping in mind differences in methodology. This also causes difficulty to estimate the prevalence of overall burnout, no matter which professional group is studied. Safe anesthesia and surgical care are not available when needed for 5 billion of the world's 7 billion people. During the COVID-19 pandemic, even the countries with the highest numbers of Anesthesia Providers faced anesthesia shortages due to significant workload increases. The highly specialized, multidisciplinary treatment of patients during the pandemic, an increased risk of coronavirus infection, staff shortages, and a lack of equipment imposes a significant physical and cognitive burden on anesthesiologists. Burnout syndrome among healthcare workers during the COVID-19 pandemic is a critical topic. Health care workers and anesthesiologists worldwide reported relevant, work-related psychological pressure, burnout, and somatic symptoms. This fact requires attention as previous studies showed that emotional distress is associated with a long-lasting effect on professionals' health. Increasing the number of anesthesiologists, harmonizing regional, international, and world standards in education and patient safety while addressing the quality of life of anesthesiologists should be our goal, set by The World Federation of Societies of Anaesthesiologists (WFSA), so that by 2030, safe anesthesia will be available to all the people in the world.

Women in anesthesiology: Gender stereotypes and prejudice: Women in anesthesiology

Introduction: Women make up an increasing portion of the physician workforce in anesthesia, but they are consistently under-represented in academic anesthesiology and leadership positions. The objective of this study is to provide a current update on the role of women in anesthesiology in Belgrade, Serbia. Methods: A cross-sectional observational study was conducted during September and October 2013 amongst anesthesiologists at ten tertiary health care institutions in Belgrade. The study population was 272 anesthesiologists. Participants' consent and ethical approval were obtained. The questionnaire captured basic sociodemographic and work-related characteristic information: age, sex, level of academic and professional postgraduate education, the managerial position of the section or department. Sociodemographic characteristics were tested in relation to sex by Pearson's chi-squared test. Results: The response rate was 76.2%. Over two-thirds (70.7%) of respondents were women. One-third of female participants (34.5%) and 23.3% of male participants had obtained additional academic achievements; 35.2% of female participants and 40.0 % of male participants had been in managerial positions. Statistically significant gender discrepancies in the additional academic education and upper-rank leadership positions were not detected. Conclusion: Female anesthesiologists in Serbia have achieved parity with men in the highest academic ranks and leadership positions. These women may play an important role in mentoring future generations of female physicians and inspiring them to achieve their professional goals.

Effects of topical administration of tranexamic acid on blood loss in total knee arthroplasty: A retrospective study (topical use of tranexamic acid in total knee arthroplasty)

Introduction: Total knee arthroplasty (TKA) is a complex surgical intervention. By 2030, TKA is expected to reach as much as 3.48 million interventions yearly. Perioperative bleeding is a major problem in TKA, with intraoperative blood loss from 300 to 2000 ml. In orthopedic surgery, tranexamic acid (TXA) has been used to prevent blood loss and enable faster recovery. Here we present the first experience of topically applied tranexamic acid for TKA in our hospital. Method: The effects of topical use of TXA on bleeding for the one-year period were retrospectively analyzed. Comparisons were made between two groups: the T-TK group in which TXA was topically applied, and the 0-TK group, in which the drug was not used. Demographic data, hemoglobin and hematocrit, transfusion of allogeneic blood products, intraoperative and postoperative blood loss, anticoagulant and antiplatelet therapy, and the occurrence of postoperative complications were analyzed. Results: The study included 104 patients, 35 in the T-TK group and 69 in the 0-TK group. It was shown that patients with significantly higher intraoperative bleeding received topical TXA. Patients in the T-TK group received fewer transfusions on the first, fourth, fifth, and sixth days. Conclusion: Analysis of the initial use of topical tranexamic acid in our hospital indicates that patients with more intraoperative bleeding were those to receive the treatment. There is a need for better-defined indications for the topical use of TXA, particularly as an alternative for patients who are at higher risk of developing thromboembolic complications.