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Article ; Online: Malignant hyperthermia in Poland: A survey study.

Cieniewicz, Agnieszka / Trzebicki, Janusz

2023 Volume 102, Issue 10, Page(s) e33238

Abstract: Malignant hyperthermia (MH) is a life-threatening syndrome caused by sudden, uncontrolled skeletal muscle hypermetabolism in response to inhalation anesthetics and depolarizing relaxants. The estimated incidence of MH is between 1:10,000 and 1:250,000 ... ...

Abstract	Malignant hyperthermia (MH) is a life-threatening syndrome caused by sudden, uncontrolled skeletal muscle hypermetabolism in response to inhalation anesthetics and depolarizing relaxants. The estimated incidence of MH is between 1:10,000 and 1:250,000 anesthetic procedures. In Poland, due to lack of reporting, the incidence of MH is unknown. Dantrolene is imported as a life-saving drug (target import) and temporally authorized for sale. The aim of the study was to evaluate the prevalence of malignant hyperthermia in Poland and to assess the accessibility to dantrolene in Poland. A questionnaire was conducted among the chiefs of anesthesia and intensive care units in Poland. During the years 2014 to 2019, 10 episodes of MH have been reported in 238 surveyed polish anesthesia departments. The estimated prevalence is 1:350,000. Eight patients survived the MH crisis. Dantrolene is stocked in 48 (20%) anesthesiology departments. Among the surveyed hospitals, only in 38 (16%) it is possible to administer dantrolene within 5 minutes of suspecting a MH reaction. Less than half units (44%) have an algorithm for the management of MH episode in the operating theaters. The results of the study revealed, that the prevalence of MH in Poland is lower than the prevalence reported in other countries. Access to dantrolene in Poland is limited.
MeSH term(s)	Humans ; Malignant Hyperthermia/etiology ; Dantrolene ; Poland ; Surveys and Questionnaires ; Anesthetics, Inhalation
Chemical Substances	Dantrolene (F64QU97QCR) ; Anesthetics, Inhalation
Language	English
Publishing date	2023-03-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000033238
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Article ; Online: Malignant hyperthermia in Mazovia Province - are we adequately prepared?

Cieniewicz, Agnieszka / Trzebicki, Janusz

Anaesthesiology intensive therapy

2022 Volume 54, Issue 2, Page(s) 99–102

Abstract: Introduction: Malignant hyperthermia (MH) is a life-threatening syndrome caused by sudden skeletal muscle hypermetabolism in response to inhalation anaesthetics and depolarising relaxants. The estimated incidence of MH is between 1 : 10,000 and 1 : 250, ... ...

Abstract	Introduction: Malignant hyperthermia (MH) is a life-threatening syndrome caused by sudden skeletal muscle hypermetabolism in response to inhalation anaesthetics and depolarising relaxants. The estimated incidence of MH is between 1 : 10,000 and 1 : 250,000 anaesthetic procedures. In Poland the incidence of MH is unknown. Dantrolene is imported as a life-saving drug and temporally authorised for sale. The aim of the study is to assess the incidence of MH and access to dantrolene in the Mazovia Province. Methods: Anonymous questionnaires were sent to anaesthesia departments in the Mazovia Province after prior contact by phone and e-mail. The survey was approved by the local ethical review board. Results: Completed surveys were received from 60 respondents which represents 72% of anaesthesiology departments in Mazovia. In the last 5 years there have been 4 episodes of MH in the Mazovia Province. Three patients survived the MH crisis. In a centre that did not have access to dantrolene, the patient died. Dantrolene is found only in 11 (18.3%) anaesthesiology departments in Mazovia. Only 6 (10%) hospitals are able to administer dantrolene within 5 minutes of suspecting MH crisis, while 5 centres may receive it after a few days. Only 38% of units have an algorithm for dealing with MH crisis in the operating theatres. Conclusions: MH is rare, but if untreated, it can be fatal. Therefore prompt diagnosis and treatment are crucial to avoid fatal outcome. Every centre using inhalational anaesthetics and/or succinylcholine should have dantrolene. To ensure the safety of our patients, we must be better prepared.
MeSH term(s)	Anesthetics, Inhalation/adverse effects ; Dantrolene/therapeutic use ; Humans ; Malignant Hyperthermia/epidemiology ; Malignant Hyperthermia/therapy ; Operating Rooms ; Succinylcholine/therapeutic use
Chemical Substances	Anesthetics, Inhalation ; Dantrolene (F64QU97QCR) ; Succinylcholine (J2R869A8YF)
Language	English
Publishing date	2022-05-17
Publishing country	Poland
Document type	Journal Article
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2022.115348
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Article ; Online: Successful Anesthetic Management for Obese Patients with Interstitial Lung Disease Undergoing Laparoscopic Sleeve Gastrectomy: A Bridge to Improved Lung Transplant Eligibility.

Mieszczański, Piotr / Janiak, Marek / Ziemiański, Paweł / Cylke, Radosław / Lisik, Wojciech / Trzebicki, Janusz

The American journal of case reports

2024 Volume 25, Page(s) e942736

Abstract: BACKGROUND Patients with obesity with interstitial lung diseases (ILD) are encouraged to lose weight, as it improves lung function and lung transplant eligibility. As exercise tolerance in these patients is low and weight gain is a common adverse effect ... ...

Abstract	BACKGROUND Patients with obesity with interstitial lung diseases (ILD) are encouraged to lose weight, as it improves lung function and lung transplant eligibility. As exercise tolerance in these patients is low and weight gain is a common adverse effect of corticosteroids, bariatric surgery can be an effective method for the management of obesity in this patient group. However, perioperative complications in such high-risk patients remain a concern. Therefore, we aimed to demonstrate successful anesthetic management for obese patients with ILD, which may be practically utilized to reduce perioperative pulmonary complications and improve outcomes. CASE REPORT Our case report presents a 42-year-old man with ILD who underwent laparoscopic sleeve gastrectomy (LSG). Preoperative studies revealed severe restrictive disease, right ventricular overload with assessed intermediate risk of pulmonary hypertension, and heart failure, with preserved left ventricle fraction but with poor exercise tolerance. Patient had opioid-free anesthesia (OFA) and postoperative multimodal analgesia. Following a 24-h stay in the Post-Anesthesia Care Unit, the patient was transferred to the ward and ultimately discharged home 2 days thereafter. At the 1-year follow-up, the patient reduced his weight by 40 kg and reported a significant improvement in physical capacity. CONCLUSIONS Our record demonstrates that OFA can be successfully used in high-risk patients with ILD undergoing LSG. In a period of a year, the patient improved so much that he no longer required lung transplantation, which may encourage clinicians to provide bariatric surgery using the OFA technique in the population of patients with obesity and severe respiratory illness.
MeSH term(s)	Adult ; Humans ; Male ; Anesthetics ; Body Mass Index ; Gastrectomy ; Laparoscopy/methods ; Lung Diseases, Interstitial/complications ; Lung Diseases, Interstitial/surgery ; Lung Transplantation ; Obesity/complications ; Obesity/surgery ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Anesthetics
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.942736
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Article ; Online: DIC, SIC or CAC - the haemostatic profile in COVID-19 patients hospitalised in the intensive care unit: a single-centre retrospective analysis.

Pluta, Jan / Pihowicz, Andrzej / Horban, Andrzej / Trzebicki, Janusz

Anaesthesiology intensive therapy

2021 Volume 53, Issue 2, Page(s) 108–114

Abstract: Introduction: Infection with SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome requiring mechanical ventilation under the conditions of the Intensive Care Unit (ICU). The state of hypercoagulation described in COVID-19 may ... ...

Abstract	Introduction: Infection with SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome requiring mechanical ventilation under the conditions of the Intensive Care Unit (ICU). The state of hypercoagulation described in COVID-19 may deepen respiratory failure, leading to increased mortality. The aim of the presented study is to characterise the haemostatic profile based on the results of clotting system parameters and risk assessment of thromboembolic complications of patients hospitalised in the ICU. Material and methods: This retrospective study covered the first 10 adult patients hospitalised in the ICU of the Hospital for Infectious Diseases in Warsaw in the second quarter of 2020. Demographic, clinical and laboratory parameters of the coagulation system and the risk of thromboembolic complications were assessed. Well known criteria of haemostatic disorders were used to classify the observed derangements. Results: The most frequently observed deviations in the coagulation system were high concentrations of D-dimer and fibrinogen. In select cases the clotting time was prolonged. No severe thrombocytopenia was observed. All patients presented a high risk of thromboembolic complications as assesed by the Padua score. The observed clotting abnormalities did not meet the criteria for DIC (disseminated intravascular coagulation) and SIC (sepsis-induced coagulopathy) diagnosis. Conclusions: The main elements of coagulopathy that were observed in our cases differ from those usually seen in patients with recognised sepsis. The unique haemostatic profile of COVID-19 patients treated in the ICU has been described as CAC (COVID-19-associated coagulopathy).
MeSH term(s)	Adult ; Blood Coagulation Tests/methods ; COVID-19/complications ; COVID-19/therapy ; Disseminated Intravascular Coagulation/blood ; Disseminated Intravascular Coagulation/diagnosis ; Disseminated Intravascular Coagulation/etiology ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Inflammation Mediators/blood ; Intensive Care Units ; Male ; Middle Aged ; Poland ; Retrospective Studies ; Sepsis/blood ; Sepsis/diagnosis ; Sepsis/etiology
Chemical Substances	Fibrin Fibrinogen Degradation Products ; Inflammation Mediators ; fibrin fragment D
Language	English
Publishing date	2021-07-20
Publishing country	Poland
Document type	Journal Article
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2021.106691
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Article: Porównanie zmiany wartości ciśnienia śródbrzusznego podczas operacji kręgosłupa przy zastosowaniu dwóch systemów ułożenia chorego w pozycji na brzuchu – opis przypadku.

Stangiewicz, Bartosz / Kowalczyk, Rafał / Śliwka, Andrzej / Ratuski, Paweł / Trzebicki, Janusz

Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego

2022 Volume 50, Issue 296, Page(s) 134–136

Abstract: Spinal surgeries often require prone positioning of the patient. This is associated with increased intra-abdominal pressure, which may increase the risk of intra- and postoperative complications. The described case enables the comparison of two prone ... ...

Title translation	Comparison of intra-abdominal pressure, during spine surgeries, among two prone positional apparatuses in the same patient - a case report.
Abstract	Spinal surgeries often require prone positioning of the patient. This is associated with increased intra-abdominal pressure, which may increase the risk of intra- and postoperative complications. The described case enables the comparison of two prone positional apparatuses and their influence on changes in intra-abdominal pressure during spine surgeries. A case report: A 74-year-old female patient underwent two spine surgeries due to a fracture of the Th12 vertebra and traumatic kyphosis. Both were performed in the prone position. During the first procedure, stabilization of the fracture, positioning was performed by placing the patient on the Allen table, whereas during the second procedure, laminectomy, by placing the patient on gel pads. During both surgeries the patient's intra-abdominal pressure was measured. The values measured while lying on the Allen table were found to be lower (mean 13.8 mmHg ± 0.66 mmHg) than the results obtained during the procedure utilizing gel pads (mean 24 mmHg ± 1.22 mmHg). Both surgeries were completed without complications. In both cases, creatinine, urea, and potassium concentrations as well as daily diuresis were measured to assess postoperative renal function. The results of these analyses did not indicate renal damage. Conclusions: The way the patient is positioned on the abdomen has a significant impact on intra-abdominal pressure. Compared to gel pads, the Allen table allows for a reduction in abdominal pressure, which corresponds with lower values of intra-abdominal pressure. This may help reduce the risk of complications during surgeries performed in the prone position.
MeSH term(s)	Abdominal Cavity/surgery ; Aged ; Female ; Humans ; Patient Positioning/methods ; Postoperative Complications/etiology ; Prone Position ; Spine/surgery
Language	Polish
Publishing date	2022-04-14
Publishing country	Poland
Document type	Case Reports ; Journal Article
ZDB-ID	1388406-2
ISSN	1426-9686
ISSN	1426-9686
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Zs.A 4780: Show issues

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Article ; Online: COVID-19: coagulation disorders and anticoagulant treatment in patients hospitalised in ICU.

Pluta, Jan / Cieniewicz, Agnieszka / Trzebicki, Janusz

Anaesthesiology intensive therapy

2021 Volume 53, Issue 2, Page(s) 153–161

Abstract: Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience a high incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen ... ...

Abstract	Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience a high incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen levels, the abnormalities in standard coagulation tests and platelet count are minimal. Recent studies suggest contribution of fibrinolysis shutdown to this phenomenon. Endothelial injury and alteration of its antithrombotic activity can lead to micro- and macrovascular thrombosis in the lungs, occurrence of which is associated with poor clinical outcome in critically ill patients with COVID-19. Additionally, the hypercoagulability induced by activation of coagulation pathways during the immune response to SARS-CoV-2 infection contributes to impaired organ perfusion. This, alongside with hypoxemia, leads to multiorgan failure. Various diagnostic regimens, some of which include global assays of haemostasis, are currently being published and discussed. Numerous guidelines and recommendations of scientific societies and groups of specialists have been published. However, there is no single optimal algorithm for anticoagulation treatment and monitoring specific to the ICU patients with COVID-19. The authors have attempted to summarize the data related to CAC and thrombotic disease and develop an algorithm consistent with the latest clinical practice guideline recommendations.
MeSH term(s)	Algorithms ; Anticoagulants/therapeutic use ; Blood Coagulation/drug effects ; Blood Coagulation Disorders/drug therapy ; Blood Coagulation Disorders/etiology ; COVID-19/complications ; Female ; Humans ; Intensive Care Units ; Male ; Thrombosis/etiology ; Thrombosis/prevention & control ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; COVID-19 Drug Treatment
Chemical Substances	Anticoagulants
Language	English
Publishing date	2021-05-17
Publishing country	Poland
Document type	Journal Article ; Review
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2021.105783
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Article ; Online: Thrombocytopenia: the most frequent haemostatic disorder in the ICU.

Pluta, Jan / Trzebicki, Janusz

Anaesthesiology intensive therapy

2019 Volume 51, Issue 1, Page(s) 56–63

Abstract: Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are ...

Abstract	Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are the most frequent. A differential diagnosis of profound thrombocytopenia is crucial for effective treatment. A low platelet count is a strong independent predictor of morbidity and mortality because it is associated with life-threatening bleeding or thrombosis. This article aims to outline the definition and pathophysiology of thrombocytopenia and present a three-step algorithm of the clinical management of this haemostatic disorder.
MeSH term(s)	Algorithms ; Hemostatic Disorders/etiology ; Hemostatic Disorders/therapy ; Humans ; Intensive Care Units ; Thrombocytopenia/etiology ; Thrombocytopenia/therapy
Language	English
Publishing date	2019-07-06
Publishing country	Poland
Document type	Journal Article ; Review
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5603/AIT.2019.0011
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Article: Effect of Intramuscular Tramadol on the Duration of Clinically Relevant Sciatic Nerve Blockade in Patients Undergoing Calcaneal Fracture Fixation: A Randomized Controlled Trial.

Janiak, Marek / Gorniewski, Grzegorz / Kowalczyk, Rafal / Wasilewski, Piotr / Nowakowski, Piotr / Trzebicki, Janusz

Healthcare (Basel, Switzerland)

2023 Volume 11, Issue 4

Abstract: Background: Calcaneal fracture fixation can generate severe postoperative pain and analgesia can be supported by a sciatic nerve block. However, following resolution of the sensory blockade, rebound pain may ensue. The aim of this study was to assess ... ...

Abstract	Background: Calcaneal fracture fixation can generate severe postoperative pain and analgesia can be supported by a sciatic nerve block. However, following resolution of the sensory blockade, rebound pain may ensue. The aim of this study was to assess whether an incidental finding of two patients with an extension of the sciatic nerve block beyond 24 h following 100 mg of intramuscular tramadol administration could be confirmed. Methods: Thirty-seven patients scheduled for a calcaneal intramedullary fixation (Calcanail Results: The median time to first analgesic request from time of blockade in the tramadol group was 670 min compared with 578 min in the control group. The result was clinically not relevant and statistically not significant (
Language	English
Publishing date	2023-02-08
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare11040498
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Article ; Online: Comparison between multimodal and intraoperative opioid free anesthesia for laparoscopic sleeve gastrectomy: a prospective, randomized study.

Mieszczański, Piotr / Górniewski, Grzegorz / Ziemiański, Paweł / Cylke, Radosław / Lisik, Wojciech / Trzebicki, Janusz

Scientific reports

2023 Volume 13, Issue 1, Page(s) 12677

Abstract: Anesthesia for laparoscopic sleeve gastrectomy and perioperative management remains a challenge. Several clinical studies indicate that opioid-free anesthesia (OFA) may be beneficial, but there is no consensus on the most optimal anesthesia technique in ... ...

Abstract	Anesthesia for laparoscopic sleeve gastrectomy and perioperative management remains a challenge. Several clinical studies indicate that opioid-free anesthesia (OFA) may be beneficial, but there is no consensus on the most optimal anesthesia technique in clinical practice. The aim of our study was to assess the potential benefits and risks of intraoperative OFA compared to multimodal analgesia (MMA) with remifentanil infusion. In a prospective, randomized study, we analyzed 59 patients' data. Primary outcome measures were oxycodone consumption and reported pain scores (numerical rating scale, NRS) at 1, 6, 12, and 24th hours after surgery. Postoperative sedation on the Ramsay scale, nausea and vomiting on the PONV impact scale, desaturation episodes, pruritus, hemodynamic parameters, and hospital stay duration were also documented and compared. There were no significant differences in NRS scores or total 24-h oxycodone requirements. In the first postoperative hour, OFA group patients needed an average of 4.6 mg of oxycodone while the MMA group 7.72 mg (p = 0.008, p < 0.05 statistically significant). The PONV impact scale was significantly lower in the OFA group only in the first hour after the operation (p = 0.006). Patients in the OFA group required higher doses of ephedrine 23.67 versus 15.69 mg (p = 0.039) and more intravenous fluids 1160 versus 925.86 ml (p = 0.007). The mode of anesthesia did not affect the pain scores or the total dose of oxycodone in the first 24 postoperative hours. Only in the first postoperative hour were an opioid-sparing effect and reduction of PONV incidence seen in the OFA group when compared with remifentanil-based anesthesia. However, patients in the OFA group showed significantly greater hemodynamic lability necessitating higher vasopressor doses and more fluid volume.
MeSH term(s)	Humans ; Analgesics, Opioid/adverse effects ; Remifentanil/therapeutic use ; Oxycodone/therapeutic use ; Prospective Studies ; Postoperative Nausea and Vomiting/etiology ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Anesthesia ; Laparoscopy/adverse effects ; Gastrectomy/adverse effects ; Gastrectomy/methods
Chemical Substances	Analgesics, Opioid ; Remifentanil (P10582JYYK) ; Oxycodone (CD35PMG570)
Language	English
Publishing date	2023-08-04
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-39856-2
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Article ; Online: Assessment of haemostasis and impact of fibrinogen supplementation on clot properties using global haemostasis assays in patients on chronic dialysis.

Pluta, Jan / Nicińska, Barbara / Durlik, Magdalena / Trzebicki, Janusz

Anaesthesiology intensive therapy

2020 Volume 52, Issue 4, Page(s) 274–280

Abstract: Backgorund: Multifactorial haemostasis disorders are typical of patients with end-stage renal disease (ESRD) on chronic haemodialysis (HD). Thromboelastometry and impedance aggregometry allow for a comprehensive assessment of clot formation, lysis, and ... ...

Abstract	Backgorund: Multifactorial haemostasis disorders are typical of patients with end-stage renal disease (ESRD) on chronic haemodialysis (HD). Thromboelastometry and impedance aggregometry allow for a comprehensive assessment of clot formation, lysis, and platelet (PLT) function. This study aims to determine the haemostatic profile in a group of patients with ESRD on chronic, interrupted dialysis, especially in terms of PLT function and the impact of Methods: A total of 22 patients on chronic HD and 22 healthy controls (HC) were enrolled in the prospective study with a control group. Global haemostasis assays (GHA) were used to describe the haemostasis profile and to assess the effect of fibrinogen concentrate supplementation on improving clot quality. Results: Despite the lack of considerable differences in the number of PLTs, there was a significantly lower potential of PLT aggregation in the HD group (922 ±163 AUmin). A higher concentration of fibrinogen was also observed in this group which presented considerably higher maximum clot firmness (MCF) FIBTEM (22 ±5.3 mm). Clotting time (CT) EXTEM was also prolonged (72 ±23 s). No hyperfibrinolysis was reported. In vitro fibrinogen concentrate supplementation resulted in significant improvement in MCF FIBTEM (30 mm vs. 22 mm; P < 0.001). However, it also led to a deterioration in PLT aggregation as assessed by TRAPtest. Conclusions:* The haemostasis profile of ESRD patients demonstrates a limited potential of PLT aggregation, with no improvement after fibrinogen addition.
MeSH term(s)	Adult ; Dietary Supplements ; Female ; Fibrinogen/administration & dosage ; Hemostasis ; Humans ; Kidney Failure, Chronic/blood ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis
Chemical Substances	Fibrinogen (9001-32-5)
Language	English
Publishing date	2020-11-02
Publishing country	Poland
Document type	Journal Article
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2020.100568
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