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Introduction: Over the last two decades transcatheter aortic valve replacement (TAVR) has been approved for clinical use. The anaesthetic choice for this procedure is evolving. General anaesthesia was the predominant anaesthetic technique. Growing experience and advances in technology and economic considerations have led to an increasing interest in performing TAVR under monitored sedation., Aim: The assessment of monitored sedation, called cooperative sedation, involves pharmacologically mediated suppression of consciousness and preservation of verbal contact in response to stimulation as a safe method of anaesthesia for TAVR., Material and Methods: Sixty out of 63 TAVR patients with femoral access received monitored sedation. Dexmedetomidine was administered in most of such cases (46 patients). A questionnaire was also carried out by staff involved in performing TAVR procedures, with more than 5 years of experience in it, concerning the method of anaesthesia and perioperative care., Results: Conversion to general anaesthesia was required in 10% of patients (6 cases), only one as a patient-related complication (hypercarbia). The questionnaire carried out showed that anaesthesia and postoperative care after TAVR are underestimated., Conclusions: The preliminary results regarding anaesthetic management in TAVR procedures demonstrate that monitored sedation is safe, provided that contraindications are observed., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Objectives: This study explores the association between self-reported exposure to traffic-related air pollution and respiratory health symptoms, as well as lung functions and skin prick tests in adolescents living in the vicinity of main roads., Material and Methods: The data in the study were acquired using a cross-sectional study conducted between 2004-2005 in Chorzów (Silesia, Poland) among adolescents (N = 936) aged 13-15 years, attending junior high schools. Adverse respiratory health symptoms and exposure to traffic-related air pollution were determined on the basis of a questionnaire. Moreover, all children underwent spirometry and skin prick tests. Multivariable logistic regression with multiple imputation for missing data was used to assess the prevalence of adverse respiratory symptoms in relation to self-reported exposure to traffic-related air pollution, adjusted for socioeconomic and environmental factors., Results: Among respiratory tract diseases, asthma and allergic rhinitis associations were statistically significant (OR = 2.16, 95% CI: 1.12-4.15 and OR = 1.69, 95% CI: 1.08-2.64, respectively). Likewise, among respiratory disorders, statistically significant associations were found in the case of wheezes and dyspnea attack (OR = 1.58, 95% CI: 1.10-2.26 and OR = 2.39, 95% CI: 1.56-3.66, respectively), with respect to the vicinity of the main road. Living in the area with high traffic intensity was statistically significantly associated with a higher prevalence of asthma and wheezes (OR = 2.31, 95% CI: 1.22-4.39 and 1.48, 95% CI: 1.09-2.01, respectively). The results obtained did not confirm the relationship between the adopted way of exposure to traffic-related air pollution and lung function indices or skin prick tests., Conclusions: Results of the study suggest that children living in the area with intense traffic are more likely to develop respiratory disorders. Moreover, the vicinity of a main road as well as traffic intensity could be suitable in assessing the relationship between road transport and potential health problems among exposed inhabitants. Int J Occup Med Environ Health. 2019;32(4):553-67., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

The concept of early recovery after surgery (ERAS) consists of bundle interventions during the pre-, intra- and postoperative periods and team work. The ERAS, which is a multimodal strategy, enables one to limit the neurohumoral response to the surgery, maintain homeostasis, reduce the risk of complications, shorten the hospital stay, accelerate the return to everyday functioning, improve the patient's satisfaction, achieve a satisfactory quality of life and finally reduce the treatment costs and eliminate any redundant and ineffective practices. Almost every patient can be classified for the ERAS strategy except for patients undergoing urgent and emergency surgery. The necessity to give up ERAS can result from poor organisation and management. Moreover, the procedure itself can be the cause of the lack of adherence to the planned standard. It is necessary to use protocols and checklists. While fulfilling this doctrine, the anaesthesiologist becomes a perioperative specialist., Competing Interests: The authors report no conflict of interest.

Objective: The aim of the study was to estimate changes in the prevalence of respiratory diseases and disorders between 2003/2004 and 2011/2012 in 13-16 years old children living in Bytom, one of the biggest cities in the Silesia agglomeration and provide the evidence for local policy makers., Methods: Data from two cross-sectional surveys, based on the Polish version of the International Study of Allergy and Asthma in Childhood (ISAAC) questionnaire, conducted in 2003/2004 and 2011/2012 was used. Response rate in the first and the second survey was 68% and 35%, respectively. The number of analyzed observations was 4,041 and 707 from the first and the second survey. The selection bias was controlled with the propensity score matching and potential determinants of analyzed respiratory diseases and disorders were controlled in the multivariable logistic regression model., Results: We found statistically significant increase in asthma ever diagnosed by medical doctor (4.5% vs. 9.6%; p < 0.01), seizures of dyspnea (8.2% vs. 27.7%; p < 0.01), and chest wheeze (9.6% vs. 19.2%; p < 0.01)., Conclusion: Our study revealed significant increase in the prevalence of respiratory diseases and disorders after 8 years in adolescents living in the Upper Silesian Industrial Zone. This is a relevant finding which provides the evidence for decision makers in the scope of local public health policies.

Introduction: Significant impairment of left ventricular function causes low cardiac output syndrome in the immediate postoperative period in 3-14% of patients undergoing surgery, increasing the mortality 15-fold., Aim: To assess the use of levosimendan in patients undergoing cardiac surgery in 2016., Material and Methods: The analysis included 14 patients: 3 (21.4%) women and 11 (78.6%) men aged 65.4 ±11.8 years. The mean value of left ventricular ejection fraction amounted to 20 ±6.25%. In 11 patients, levosimendan infusion was started immediately after the induction of anesthesia. Three patients received the agent during the early postoperative period due to low cardiac output syndrome refractory to conventional therapy. The dosage was modified within the range of 0.05-0.2 μg/kg/min. On the day of the surgery, all patients received continuous infusion of adrenaline and levonor., Results: The cardiac index amounted to 2.8 ±0.71 l/m 2 after several hours of infusion and 2.9 ±0.1 l/m 2 the next morning. The first examination showed that the mean systemic vascular resistance was 1010 dyn/s -5 and the second: 940 ±100 dyn/s -5 ; mixed venous blood saturation amounted to 66 ±7.5% and 65.5 ±8%, respectively. Respectively, the mean concentration of lactates was 2.0 ±0.96 mmol/l and 1.8 ±0.24 mmol/l. Mechanical lung ventilation lasting more than 48 hours was required in 50% of the patients. Two patients with chronic kidney disease required bedside renal replacement therapy before the procedure. Two (14.3%) patients died. Nine (64.3%) patients were discharged home, and three were transferred to cardiac wards., Conclusions: Levosimendan therapy proved safe in the study group. The nature of the study and the small sample size preclude the formulation of detailed conclusions.

Objectives: Published reports suggest that some adverse health impact may be related to noise exposure, and motor vehicle traffic is considered to be the main source of environmental hazard of noise. The aim of this study has been to assess an association between occurrence of sleep and attention disorders with exposure to the noise generated by motor vehicle traffic in the case of a large group of children living in an urban environment., Material and Methods: The data was obtained using a cross sectional study design in Bytom (Silesia, Poland) from 2003-2007 for a selected group of 7-14 year olds (N = 5136). The geographic information system was used for assessing the exposure to noise generated by the motor vehicle traffic. The association between occurrences of sleep disturbances or attention disorders and exposure to the traffic noise was examined by means of multivariable logistic regression., Results: Sleep disturbances and attention disorders were found to be statistically significantly associated with exposure to the traffic noise. The multivariable logistic regression results suggest that sleep disturbances and attention disorders were more likely to occur in the case of children living in the area with higher traffic density, the odds ratio (OR) = 1.44 (95% confidence interval (CI): 1.05-1.97) and 1.38 (95% CI: 1.03-1.86), respectively., Conclusions: The results of the study have confirmed that the exposure to the traffic noise could be a significant risk factor for sleep disturbances and attention disorders among children. Int J Occup Med Environ Health 2017;30(3):511-520., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Objective: A number of studies show an association between traffic-related air pollution and adverse respiratory health effects in children. However, most evidence relates to the regions with low or moderate levels of ambient air pollution. The study was undertaken to assess the impact of traffic-related air pollution on respiratory health status in children living in the area of high levels of industrial and municipal ambient air pollution., Materials and Methods: Analyses involved data obtained from cross-sectional study on respiratory health in children (N = 5733), conducted between 2003-2004 in Bytom, one of the largest cities of Silesian Metropolis (Poland). Exposure to traffic-related air pollution was assessed by means of geographic information system and expressed as several measures of potential exposure to traffic-related air pollution, involving residential distance to major road and traffic density in the residential area. Logistic regression was used to examine association between reported respiratory health and traffic measures., Results: Statistically significant association was found between doctor-diagnosed asthma and residential proximity to traffic. Results of multivariate logistic regression (logOR; 95%CI) confirmed the effect of living in an area of a city with high-traffic-density on childhood asthma: 1.60 (1.07-2.39). Similar effects were found in case of allergic rhinitis and rhinitis symptoms, but the observed associations were not statistically significant., Conclusion: The study findings suggest that even in an area with poor regional ambient air quality, adverse respiratory health outcomes are more frequent in children living in a proximity to the high vehicle traffic flow.