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Article ; Online: Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

Bareka, Metaxia / Hantes, Michael / Arnaoutoglou, Eleni / Vretzakis, George

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA

2018 Volume 26, Issue 2, Page(s) 478–484

Abstract: Purpose: The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ... ...

Abstract	Purpose: The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Methods: Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. Results: The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p < 0.005). Similarly, VAS scores during tourniquet inflation and autograft harvesting were significantly higher (p < 0.005) in the PLPS group and this is also reflected in the intraoperative fentanyl consumption and conversion to general anaesthesia. Finally, patients in this group also reported higher post-operative VAS scores and consumed more morphine. Conclusions: Peripheral nerve blockade of FOS nerve block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. Level of evidence: I.
MeSH term(s)	Adolescent ; Adult ; Analgesia ; Anterior Cruciate Ligament Reconstruction ; Arthroscopy ; Electric Stimulation ; Female ; Femoral Nerve ; Humans ; Intraoperative Period ; Lumbosacral Plexus ; Male ; Nerve Block/methods ; Obturator Nerve ; Pain Measurement ; Pain, Postoperative/therapy ; Sciatic Nerve ; Ultrasonography, Interventional ; Young Adult
Language	English
Publishing date	2018-02
Publishing country	Germany
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	1159064-6
ISSN	1433-7347 ; 0942-2056
ISSN (online)	1433-7347
ISSN	0942-2056
DOI	10.1007/s00167-017-4525-7
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Article: Corrigendum to "Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery".

Bouzia, Aik / Tassoudis, Vassilios / Karanikolas, Menelaos / Vretzakis, George / Petsiti, Argyro / Tsilimingas, Nikolaos / Arnaoutoglou, Elena

Anesthesiology research and practice

2018 Volume 2018, Page(s) 5981895

Abstract: This corrects the article DOI: 10.1155/2017/2753962.]. ...

Abstract	[This corrects the article DOI: 10.1155/2017/2753962.].
Language	English
Publishing date	2018-10-17
Publishing country	United States
Document type	Journal Article ; Published Erratum
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2018/5981895
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Article ; Online: Spinal versus general anesthesia for transabdominal preperitoneal (TAPP) repair of inguinal hernia: Interim analysis of a controlled randomized trial.

Sarakatsianou, Chamaidi / Georgopoulou, Stavroula / Baloyiannis, Ioannis / Chatzimichail, Maria / Vretzakis, George / Zacharoulis, Dimitris / Tzovaras, George

American journal of surgery

2017 Volume 214, Issue 2, Page(s) 239–245

Abstract: Background: General anesthesia has been used as standard for laparoscopic hernia repair by the transabdominal preperitoneal (TAPP) approach. Regional anesthesia has been occasionally applied in high risk patients where general anesthesia is ... ...

Abstract	Background: General anesthesia has been used as standard for laparoscopic hernia repair by the transabdominal preperitoneal (TAPP) approach. Regional anesthesia has been occasionally applied in high risk patients where general anesthesia is contraindicated. This randomized clinical trial compares spinal anesthesia with general anesthesia for TAPP inguinal hernia repair in non-high risk patients. Methods: Seventy adult American Society of Anesthesiologists I, II and III patients undergoing elective TAPP inguinal hernia repair were randomized to either general or spinal anesthesia. Results: Postoperative morphine consumption was significantly less immediately postoperatively (p < 0.001) in the spinal anesthesia group. Postoperative pain was also significantly decreased within the first 8 h postoperatively (p < 0.05) in the spinal anesthesia group. Conclusions: Spinal anesthesia offers some advantages in patient analgesia during the early postoperative period after TAPP inguinal hernia repair and can be proposed as an effective alternative method of anesthesia for TAPP repair.
MeSH term(s)	Anesthesia, General ; Anesthesia, Spinal ; Female ; Hernia, Inguinal/surgery ; Herniorrhaphy ; Humans ; Male ; Middle Aged ; Pain, Postoperative/prevention & control
Language	English
Publishing date	2017-08
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2017.01.032
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Article: Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery.

Bouzia, Aik / Tassoudis, Vassilios / Karanikolas, Menelaos / Vretzakis, George / Petsiti, Argyro / Tsilimingas, Nikolaos / Arnaoutoglou, Elena

Anesthesiology research and practice

2017 Volume 2017, Page(s) 2753962

Abstract: Introduction. ...

Abstract	Introduction.
Language	English
Publishing date	2017-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2017/2753962
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Article: Do Difficult Airway Techniques Predispose Obese Patients to Bronchospasm?

Ieropoulos, Polyhronis / Tassoudis, Vassilios / Ntafoulis, Nick / Mimitou, Ioanna / Vretzakis, George / Tzovaras, George / Zacharoulis, Dimitrios / Karanikolas, Menelaos

Turkish journal of anaesthesiology and reanimation

2018 Volume 46, Issue 4, Page(s) 292–296

Abstract: Objective: The existing evidence separately correlates morbid obesity with difficult intubation and bronchospasm. However, there is a lack of data on whether anaesthesia provider manipulations during difficult intubation contribute to an increased ratio ...

Abstract	Objective: The existing evidence separately correlates morbid obesity with difficult intubation and bronchospasm. However, there is a lack of data on whether anaesthesia provider manipulations during difficult intubation contribute to an increased ratio of bronchospasm in these patients. Methods: This is a retrospective analysis of data prospectively taken from 50 morbidly obese patients involved in a previously published study. A possible difficult intubation was preoperatively investigated by recording the following specific physical examination indices: Mallampati and Cormack-Lehane (CL) classifications, cervical spine mobility (CSM), thyromental distance (Td) and patients' ability to open their mouth (mouth opening). Bronchospasm was clinically detected by auscultation and confirmed by measuring peak airway pressures during mechanical ventilation. The Kruskal-Wallis H test was used for data analysis, followed by the Mann-Whitney U test as applicable. Results: Different physical examination prognostic indices, including Mallampati and CL scales (p<0.001; the CSM excluded -p=0.790), showed that they are related to difficult intubation. Bronchospasm not attributable to difficult intubation was observed in six obese patients. Conclusion: Patients with morbid obesity constitute an increased relative risk group as far as difficult intubation is concerned, particularly if preoperative findings support a relationship between the two variables examined. In our study, difficult intubation and the concomitant use of special equipment and manipulations did not contribute to an increased rate of bronchospasm in obese patients, but in view of the lack of data, a large number of more sophisticated studies are required to elucidate such an assumption.
Language	English
Publishing date	2018-06-25
Publishing country	Turkey
Document type	Journal Article
ISSN	2667-677X
ISSN	2667-677X
DOI	10.5152/TJAR.2018.02328
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Article: Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance?

Vretzakis, George / Simeoforidou, Marina / Stamoulis, Konstantinos / Bareka, Metaxia

Anesthesiology research and practice

2013 Volume 2013, Page(s) 413985

Abstract: Supraventricular arrhythmias are common rhythm disturbances following pulmonary surgery. The overall incidence varies between 3.2% and 30% in the literature, while atrial fibrillation is the most common form. These arrhythmias usually have an uneventful ... ...

Abstract	Supraventricular arrhythmias are common rhythm disturbances following pulmonary surgery. The overall incidence varies between 3.2% and 30% in the literature, while atrial fibrillation is the most common form. These arrhythmias usually have an uneventful clinical course and revert to normal sinus rhythm, usually before patent's discharge from hospital. Their importance lies in the immediate hemodynamic consequences, the potential for systemic embolization and the consequent long-term need for prophylactic drug administration, and the increased cost of hospitalization. Their incidence is probably related to the magnitude of the performed operative procedure, occurring more frequently after pneumonectomy than after lobectomy. Investigators believe that surgical factors (irritation of the atria per se or on the ground of chronic inflammation of aged atria), direct injury to the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute independently or in association with each other to the development of these arrhythmias. This review discusses currently available information about the potential mechanisms and risk factors for these rhythm disturbances. The discussion is in particular focused on the role of postoperative pain and its relation to the autonomic imbalance, in an attempt to avoid or minimize discomfort with proper analgesia utilization.
Language	English
Publishing date	2013-10-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2013/413985
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Article ; Online: Regional anesthesia for laparoscopic surgery: a narrative review.

Vretzakis, George / Bareka, Metaxia / Aretha, Diamanto / Karanikolas, Menelaos

Journal of anesthesia

2013 Volume 28, Issue 3, Page(s) 429–446

Abstract: Laparoscopic surgery has advanced remarkably in recent years, resulting in reduced morbidity and shorter hospital stay compared with open surgery. Despite challenges from the expanding array of laparoscopic procedures performed with the use of ... ...

Abstract	Laparoscopic surgery has advanced remarkably in recent years, resulting in reduced morbidity and shorter hospital stay compared with open surgery. Despite challenges from the expanding array of laparoscopic procedures performed with the use of pneumoperitoneum on increasingly sick patients, anesthesia has remained largely unchanged. At present, most laparoscopic operations are usually performed under general anesthesia, except for patients deemed "too sick" for general anesthesia. Recently, however, several large, retrospective studies questioned the widely held belief that general anesthesia is the best anesthetic method for laparoscopic surgery and suggested that regional anesthesia could also be a reasonable choice in certain settings. This narrative review is an attempt to critically summarize current evidence on regional anesthesia for laparoscopic surgery. Because most available data come from large, retrospective studies, large, rigorous, prospective clinical trials comparing regional vs. general anesthesia are needed to evaluate the true value of regional anesthesia in laparoscopic surgery.
MeSH term(s)	Analgesia/adverse effects ; Analgesia/methods ; Anesthesia, Conduction/adverse effects ; Anesthesia, Conduction/methods ; Clinical Trials as Topic ; Humans ; Laparoscopy/methods ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2013-11-07
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	1107821-2
ISSN	1438-8359 ; 0913-8668
ISSN (online)	1438-8359
ISSN	0913-8668
DOI	10.1007/s00540-013-1736-z
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Article: Bronchospasm in obese patients undergoing elective laparoscopic surgery under general anesthesia.

Tassoudis, Vassilios / Ieropoulos, Hronis / Karanikolas, Menelaos / Vretzakis, George / Bouzia, Aik / Mantoudis, Elias / Petsiti, Argyro

SpringerPlus

2016 Volume 5, Page(s) 435

Abstract: Background: Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied.: Methods: This was a prospective observational study ... ...

Abstract	Background: Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied. Methods: This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation. Blood gases were measured at predetermined time intervals intraoperatively. Categorical variables were analyzed using Fisher's exact test, while numerical variables within and between groups were compared using repeated measures general linear model. Results: The incidence of bronchospasm was significantly higher in obese compared to non obese patients (P = 0.027). Peak airway pressures and blood gases differed significantly when comparing non obese patients versus obese patients without bronchospasm versus obese patients with bronchospasm. Hypoventilation resulting in gradual increase of arterial PaCO2 was noted in all groups during surgery. Conclusion: The incidence of bronchospasm is higher in obese patients compared to non obese patients undergoing elective laparoscopic surgery. Airway pressures and blood gas values in obese patients are somewhere between values in non obese patients and values in patients with bronchospasm, thereby implying that obesity is associated with a state where bronchial smooth muscles are not fully relaxed. Consideration of increased airway reactivity in obese patients undergoing laparoscopic surgery is important for improved patient care and uneventful anesthetic course.
Language	English
Publishing date	2016-04-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2661116-8
ISSN	2193-1801
ISSN	2193-1801
DOI	10.1186/s40064-016-2054-3
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Article ; Online: Management of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery.

Vretzakis, George / Kleitsaki, Athina / Aretha, Diamanto / Karanikolas, Menelaos

The heart surgery forum

2011 Volume 14, Issue 1, Page(s) E28–39

Abstract: Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, ... ...

Abstract	Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.
MeSH term(s)	Adult ; Blood Transfusion/methods ; Cardiac Surgical Procedures/adverse effects ; Humans ; Water-Electrolyte Imbalance/etiology ; Water-Electrolyte Imbalance/prevention & control
Language	English
Publishing date	2011-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2069188-9
ISSN	1522-6662 ; 1098-3511
ISSN (online)	1522-6662
ISSN	1098-3511
DOI	10.1532/HSF98.2010111
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Article: Depth of Anesthesia as a Risk Factor for Perioperative Morbidity.

Petsiti, Argyro / Tassoudis, Vassilios / Vretzakis, George / Zacharoulis, Dimitrios / Tepetes, Konstantinos / Ganeli, Georgia / Karanikolas, Menelaos

Anesthesiology research and practice

2015 Volume 2015, Page(s) 829151

Abstract: Introduction. The prognostic value of age, physical status, and duration of surgery on perioperative course has been extensively studied. However, the impact of deep hypnotic time (time when Bispectral Index values are less than 40) has not been well ... ...

Abstract	Introduction. The prognostic value of age, physical status, and duration of surgery on perioperative course has been extensively studied. However, the impact of deep hypnotic time (time when Bispectral Index values are less than 40) has not been well evaluated. Methods. We designed an observational study to clarify the relative influence of deep hypnotic time (DHT) on outcome. Eligible participants were mentally stable patients over 18 years old scheduled for elective major abdominal surgery. In total, 248 patients enrolled. Data were analyzed using Fisher's exact test and multiple logistic regression. Results. Five variables (DHT, hypotension, age, comorbidity, and duration of surgery) showed statistically significant association with complications, when examined independently. However, when all variables were examined together in a multiple logistic regression model, age and comorbidity were no longer associated with outcome. DHT, hypotension, and duration of surgery were significant predictors of "complications," and "hypotension" was a significant predictor of prolonged hospital stay (P < 0.001). Conclusion. Deep hypnotic time emerged as a new factor associated with outcome, and its impact compared to other factors such as age, surgery duration, hypotension, and comorbidity is redefined. Monitoring and managing depth of anesthesia during surgery are important and should be part of careful operation planning.
Keywords	covid19
Language	English
Publishing date	2015-06-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2015/829151
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