Aim: To compare the effectiveness of ventilation of each of three methods: mouth-to-mouth ventilation using a foil face mask with a filter pad, mouth-to-mask technique with a pocket face mask and bag valve mask ventilation using a self-inflating bag and a face mask, performed during CPR by qualified non-medical rescuers. Material and methods: Ventilation effectiveness was assessed on manikin and compared for mouth-to-mouth, mouth-to-mask and bag valve mask ventilation method. 46 qualified non-medical rescuers-lifeguards participated in the study. Tidal Volume of 0,4-0,7L was considered as effective. The length of chest compressions pauses was recorded. The ventilation methods were also evaluated subjectively by participants in the questionnaire. Results: Effectiveness 90,75% vs. 92,38% vs. 69,5%; average number of effective rescue breaths: 7,26 vs. 7,39 vs. 5,65; average length of chest compressions pause: 7,7s vs. 8,1s vs. 9,9s for MTM, MPFM and BMV respectively. MPFM method was considered as the easiest, the second in terms of the difficulty in use was MTM, and BMV was described as the most difficult to use. Conclusions: Artificial ventilation using the pocket mask, in the course of resuscitation performed by one qualified non-medical rescuer, e.g. the water lifeguard, is an effective method ensuring adequate tidal volume and is more effective than mouth-to-mouth method and bag valve mask ventilation.
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Aim: The aim of this study was to compare the effects of dexmedetomidine, midazolam, propofol, and intralipid on lidocaine-induced cardiotoxicity and neurotoxicity. Methods: Forty-eight male Sprague-Dawley rats were randomly divided into six groups (n = 8 per group): control (C), lidocaine (L), lidocaine + dexmedetomidine (LD), lidocaine + midazolam (LM), lidocaine + propofol (LP), and lidocaine + intralipid (LI). Dexmedetomidine (100 μg/kg), midazolam (4 mg/kg), propofol (40 mg/kg), and intralipid (10 mg/kg) were administered intraperitoneally as pretreatment. Lidocaine (90 mg/kg) was administered intraperitoneally to induce oxidative stress in all groups except the control. After 60 minutes of electrocardiography (ECG) recording, the rats were sacrificed, and heart and brain tissue samples were collected. Comparative measurements of total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and inflammatory parameters were conducted. Results: In heart tissue samples, TAS was significantly higher in LI and LD groups (p < 0.05). Additionally, oxidative stress was significantly higher in the LM group (p < 0.05). Despite an increase in oxidative stress in brain tissue samples across all groups, it was found that all groups exhibited antioxidant protective effects (p < 0.05). Inflammatory parameters in heart and brain tissues significantly decreased in all groups, especially in the LI group (p < 0.05). Conclusion: It was observed that pretreatment with midazolam increased oxidative stress induced by lidocaine, while dexmedetomidine and intralipid exhibited greater antioxidant effects. Dexmedetomidine and intralipid used as pretreatment were shown to be more effective in protecting against oxidative stress and inflammation. Keywords: oxidative stress, inflammation, dexmedetomidine, midazolam, propofol, intralipid
Introduction: We report on the anesthetic management using opioid-free method of a patient with Steinert syndrome (myotonic dystrophy, MD), autosomal dominant dystrophy which is characterized by consistent contracture of muscle following stimulation. A myotonic crisis can be induced by numerous factors including hypothermia, shivering, and mechanical or electrical stimulation. In patients with MD, hypersensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative management. If opioids are employed (systemic or neuraxial), then ICU care and continuous pulse oximetry must be considered given the high risk for respiratory depression and aspiration. Patients with MD present high sensitivity to the usual anesthetics such as volatile and muscle relaxants (both depolarizing and nondepolarizing). Opioids may induce muscle rigidity in this type of MD. Therefore, omitting opioids is recommended. Due to hypersensitivity to opioids and increased susceptibility to intra- and postoperative complications, it is recommended to introduce opioid-free anesthesia (OFA), for example, with use of dexmedetomidine (DEX). This is a new method of conducting general anesthesia without opioids and is based on concept of multimodal approach to pain management. Methods: A 31-year-old male patient (183 cm, 69 kg) was scheduled for laparoscopic operation of cholecystectomy. The patient received intravenously (IV): propofol in a dose of 250 mg followed by continuous infusion, rocuronium in a dose of 20 mg, and DEX in a loading dose of 0.6 μg/kg over 10 minutes followed by continuous infusion of dose of 0.2 μg/kg/hour. Results: The course of anesthesia and postoperative period were uneventful. The patient exited the operating theatre in a good medical state, with vitals within normal limits and fully regained consciousness. Conclusion: DEX is effective and safe for moderately painful procedures in patients with the elevated risk of respiratory and cardiovascular failure. This substance provides adequate analgesia level during surgeries of patients suffering from MD.
Awake fibreoptic intubation (AFI) is a standard method of airway management in a case of anticipated difficult intubation. It is usually performed using flexible fibroscopes. In this report, we describe the case of a 42 year-old female patient who suffered from congenital disease producing severe deformation of the head, face, neck and chest. In this case, the AFI procedure was performed successfully using a rigid intubation stylet: the Clarus Video System. One of the advantages of rigid stylets is that they are very easy to use, and in the hands of anaesthesiologists not very familiar with fibroscope intubation, they can be an alternative to flexible fibroscopes in AFI procedures.
