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Background: The aim of this study was to evaluate how anaesthesiologists manage a "cannot intubate, can ventilate" (CI) and "cannot intubate, cannot ventilate" (CICV) scenarios, and how following simulation training will affect their guideline adherence, skills and decision-making immediately after training and 6 months later., Methods: A prospective controlled study was conducted from July to December 2022. Anaesthesiologists who applied for the continuous medical education course "Difficult Airway Management" were involved in the study. Each volunteer participated in two simulation scenarios (CI, CICV) with structural debriefing after each scenario. After the first simulation round, volunteers were trained in difficult airway management according to DAS guidelines, using the same equipment as during the simulation. The participants repeated the simulation scenarios the day after the training and six months later. The primary and secondary endpoints were compared between three rounds: initial simulation (Group 1), immediately after training (Group 2), and six months after training (Group 3)., Results: A total of 24 anaesthesiologists consented to participate in the study and completed the initial survey form. During the first session, 83.3% of participants had at least one major deviation from the DAS protocol. During the first CICV scenario, 79% of participants made at least one deviation from the DAS protocol. The second time after simulation training, significantly better results were achieved: the number of anaesthesiologists, who attempted more than 3 laryngoscopies decreased (OR = 7 [1.8-26.8], p = 0.006 right after training and OR = 3.9 [1.06-14.4], p = 0.035 6 month later); the number, who skipped the supralaryngeal device attempt, call for help and failure to initiate surgical airway also decreased. Simulation training also significantly decreases the time to call for help, cricothyroidotomy initiation time, and mean desaturation time and increases the odds ratio of successful cricothyroidotomy (OR 0.02 [0.003-0.14], p < 0.0001 right after training and OR = OR 0.02 [0.003-0.16] 6 months after training)., Conclusions: Anaesthesiologists usually display major deviations from DAS guidelines while managing CI and CICV scenarios. Simulation training improves their guideline adherence, skills, and decision-making when repeating the simulation immediately after training and 6 months later., Study Registration: NCT05913492, clinicaltrials.gov, 22/06/2023., (© 2024. The Author(s).)

Background: In civilian life, from 11 to 40% of patients suffer from chronic pain after receiving injuries. There are almost no data on chronic pain in patients with gunshot wounds, isolated clinical cases have been published. The purpose of our study is to determine the factors that can potentially affect the results of treatment of such patients, namely the frequency of development of chronic pain, acute stress reactions, satisfaction with the results of treatment and the number of wound localizations., Methods: The treatment of 769 patients was analyzed. Pain intensity was diagnosed using a visual analog scale (VAS). To detect neuropathic pain, the Douleur Neuropathique 4 questions (DN4). The presence of an acute stress reaction (ASR) was diagnosed using The hospital anxiety and depression scale (HADS) and medical history, the diagnosis was established by a psychiatrist. Satisfaction with treatment results was studied using the Chaban quality of life scale (CQLS). Group comparisons were made using the Mann-Whitney test and the chi-square test, taking into account continuity correction., Results: Chronic pain was observed in 538 (70% 95% CI 66.7%-73.1%) patients with gunshot wounds: of them, 439 patients had wounds in 1, 2 anatomical parts of the body, here the frequency of pain chronicity is 69.7% (95% CI 66.0%-78.5%), and 99 patients had wounds in 3 or more anatomical parts of the body - 71.2% (95%CI 63.4%-78.5%). DN4 data suggest the presence of a neuropathic pain component in these patients. Also, all patients were diagnosed with ASR upon admission: the number of HADS points ranged from 9 to 25 points. CQLS data indicate that satisfaction with treatment outcomes was high (76 points) before hospital discharge, but subsequently decreased to a low level (64 points)., Conclusions: Patients with gunshot wounds have a high risk of chronic pain, averaging 45% higher than the general population in civilian trauma patients. A greater frequency of the neuropathic component of pain and acute stress reactions is the reason for such chronicity. A decrease in the level of satisfaction with the results of treatment, in the remote period of observation, compared to the level at the time of discharge from the hospital, is probably a consequence of the formation of chronic pain., Trial Registration: ClinicalTrials.gov: Retrospectively registered on August 1, 2022, NCT05489029., (© 2023. The Author(s).)

Background: Although anesthesiologists are one of the leaders in patient safety, anesthesia in low and low-middle income countries still need improvement in safety mesures with evidence-based practice application. The study aim was to audit the safety principles implementation in the Ukrainian anesthesiologist`s practice., Methods: The study was held in March 2021-Februrary 2022 by filling out an online questionnarie. The link to the survey was distributed through Ukrainian Anesthesiologists Association (UAA) members emails and also published on UAA webpage and facebook page. The email was sent to 1000 UAA members., Results: Summary 210 respondents took part in the study. Among the respondents, 79.1% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology, but only 40,3% declared that the principles of this Declaration had been implemented in their medical institutions. Even though most of the respondents declared that the quality of the work has improved with the application of the Helsinki Declaration, 16% stated, that there is no positive impact. Most of the medical institutions include mandatory perioperative monitoring, while 17% of hospitals have no access to pulse oximetry for all patients in the operating room and intensive care unit. Concerning using clinical protocols, the one on the treatment of massive bleeding is used in 60.3% of cases, on infection control in 60.5%. In relation to checklists, 28.2% of respondents have never heard about the WHO Safe Surgery checklist. Checklists for equipment inspection are used in only 27.8% of medical institutions. 72.8% hospitals keep records of anaesthesia complications., Conclusion: The study showed that significant positive steps are being taken to improve patient safety in Ukraine, where most hospitals comply with the minimum standarts of monitoring during anesthesia. Although there are many challenges for improvement, more hospitals need to implement WHO Safe Surgery and equipment checklists, protocols etc. These areas are a priority for further development in Ukraine., Trial Registration: Clinicaltrials.gov NCT05175976 on 04/01/2022., (© 2022. The Author(s).)

Background: Proximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia., Methods: We included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6-8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6-8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence., Results: There were no differences in the duration of ICU stay - gr.1 72 [70-75], gr.2 74 [72-76], gr.3 72 [70-75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170-184], gr.2170 [148-188], gr.3178 [144-200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0-5] mg versus 15 [10-20] and 20 [15-25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0-1] vs. 3 [2-4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7-9] vs. 6 [5-7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery - sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01-77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2-91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium., Conclusion: Perioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed., Trial Registration: Clinicaltrials.gov: NCT04648332 , first registration date 1/12/2020., (© 2021. The Author(s).)

Background: Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC)., Methods: A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017. Adult patients (18-79 years) with American Society of Anesthesiology (ASA) physical status I-II were randomly assigned to 0.5 μg/kg/h DEX infusion from induction of anaesthesia to extubation (Group D; n = 30) or normal saline infusion (Group C; n = 30). The primary efficacy outcomes were postoperative morphine consumption. Secondary efficacy outcomes included: time to first use of rescue analgesia; postoperative morphine consumption; intraoperative fentanyl consumption; time from end of surgery to extubation; lengths of intensive care unit (ICU) and general ward stay; degree of postoperative pain 3, 6, 12 and 24 h after surgery; incidence of persistent post-surgical pain., Results: DEX infusion was associated with a decrease in postoperative morphine consumption (p = 0.001), lower incidence of severe postoperative pain (odds ratio [OR] 9, 95% confidence interval [CI] 1.1-77, p = 0.04) and significantly longer time to first use of rescue analgesia (p = 0.001). Group D also had significantly lower fentanyl consumption both intraoperatively (p = 0.001) and in the time from end of surgery to extubation (p = 0.001) plus decreased incidence of persistent post-surgical pain (OR 14.5, 95% CI 1.7-122, p = 0.005). The incidence of postoperative nausea and vomiting was lower in Group D than Group C (OR 5, 95% CI 1.1-26, p = 0.005). Median pain intensity did not differ between the groups 3, 6, 12 or 24 h after surgery and there were no inter-group differences in the lengths of ICU stay or overall hospital stay between groups. The incidence of hypertension was significantly higher in Group C (OR 13.8, 95% CI 4-48, p < 0.0001); there were no inter-group differences in incidences of hypotension and bradycardia., Conclusions: Intraoperative DEX infusion is safe and effective for improving analgesia during and after elective LC. DEX appears to significantly reduce the number of patients with severe postoperative pain, postoperative morphine consumption and prolong time to first use of rescue analgesia., Trial Registration: ClinicalTrials.gov: Retrospectively registered on July 7, 2017,  NCT03211871 .