Search

The aim: To find association between postpostpartum depression incidence and mode of labour analgesia. Materials and methods: This is a prospective observational study conducted at the Kyiv City Maternity Hospital №5 (from March 2020 to May 2021). Using google-form and face-to-face interviews, 321 women completed Childbirth Experience Questionnaire on the 2- 3-rd day in the postpartum period. After the first survey, only 35% of women agreed to screen for postpartum depression (PPD) by Edinburgh Postnatal Depression Scale. Univariate logistic regression method was used to assess the risk relation between PPD and factors. Results: Women who used nitrous oxide (50:50) and non-pharmacological methods of labour analgesia were associated with the decreased risk of PPD (p = 0,044), OR = 2.83 (95% CI 1,03–7,79), compared to women with patient-control epidural analgesia. On the other hand, there are factors which do not have impact on the risk of depressive symptoms, such as age (p = 0,266); parity (p = 0,713); mode of delivery (p=0,959); pain intensity (p=0,931). Conclusions: Our findings confirmed the association between nitrous oxide and the alternative methods of labour analgesia usage and decreased risk of development PPD.

Introduction. The war affects access to all ordinary civil activities, including healthcare and education, due to multiple factors: physical injury and mental health consequences in students and teachers; the educational, healthcare, and non-healthcare critical facilities destruction; the safety issues while attending the classes. All these factors could have a negative impact on medical education. It is especially crucial, since the necessities of the population in receiving health care only increase in war-affected countries. Therefore, it is essential to be able to continue providing medical education. The goal of the study was to identify if the full-scale ongoing war have an impact on final year residents-anaesthesiologists’ competence acquisition and their ability to work independently. Methods. This retrospective study started in 2021 to assess the competence acquisition and readiness for independent work in residents-anaesthesiologists after two years of residency. When Russia invasion have started in February 2022, the residency program also was changed - most live classes were replaced by online sessions, with increasing time of self-dependent work on the online platform, as well as time of practical work in the hospitals. Study was prolonged to investigate the war impact on 2022 final year residents. At first, we investigate if the war had an impact on OSCE results, comparing 2021 and 2022 years. Secondly, questionnaires were sent to all final year residents to reflect on the education quality, competence acquisition and readiness to work as an independent anaesthesiologist. Other questionnaires were sent to all teachers to assess the educational outcomes and war impact. Results. 38 residents in 2021 and 36 residents in 2022 were included in the study. All of them have passed the OSCE. The number of residents, who didn’t pass the OSCE did not differ significantly (p = 0,9). The number of residents who had 70–80% competence acquisition were a significant lower in 2022 year (p = 0,039, OR 0,36 95% CI 0,1 − 0,9), although the number of resident, who had 80–90% and more than 90% competence acquisition had a tendency to increase (p > 0,05). The number of residents, who feel absolutely confident to provide anaesthesia for ASA 1–2 patients, ASA 3–4 patients and to work independently in the ICU, did not change significantly, although tended to increase in the 2022-year residents (p > 0,05). When it comes to competence acquisition assessed by teachers: 44% accordingly stated that it was higher in 2022 residents comparing to previous years, while 63% answered that it remained the same. The readiness for independent practice teachers evaluate at the same level in residents-2022 comparing with residents-2021. Teachers and residents had similar reflection about the most effective type of learning, choosing the simulation training, live master classes and seminars in small groups, self-directed learning. Conclusion. Anaesthesiology and intensive care residents could get all necessary competences and become ready for independent work during on-going full-scale war, with increasing part of practical work in the hospital, introduction flexible hospital practice places (temporary moving to safe country regions) and sparing more time to online sessions and self-directed study. Study registration: NCT05559593, 29/09/2022, clinicaltrials.gov.

Introduction: Pain during childbirth is a complex and subjective experience that every mother experiences differently [1]. The degree of a woman's suffering in childbirth depends on the intensity of labor pain and many indirect factors [2]. Complex interrelated effects on labor pain are limited by the little number of studies available. That is why it is necessary to determine the probable factors that may affect the intensity of pain. In accordance with this, determining predictors of the intensity of pain during vaginal delivery remains an important issue for the maternity health policy.Aim: Investigate predictors of severe labor pain.Method: A prospective observational study was conducted in the period from December 2020 to May 2021 at the Kyiv City Maternity Hospital №5 (Kyiv, Ukraine). Logistic regression was used to measure the influence of risk factors on the probability of severe labor pain.Results: The examined predictors were derived from mothers` self-report of overall childbirth. 366 women took part in research, 282 of them rated their pain by ≤ 60 mm visual analog scale (VAS), while 84 patients reported their pain by ≥70 mm VAS. The study identified predictors that reduce the risk of severe labor pain, such as a woman's prenatal health (namely, a healthy prenatal woman) (OR 0.0967 [95% CI 0,0344 - 0,2719], p=0,0001), attendance of maternal school (OR 0.0978 [95% CI 0.0541 - 0.1767], pConclusion: Significant predictors of severe labor pain were identified through this study. The findings are useful in the maternal care system by focusing on early prevention of treatment labor pain. ClinicalTrials.gov: Retrospectively registered on February 23, 2022, NCT05226208

Hip fractures are a common pathology among patients older 50 years and cause disability, reduced duration and quality of life, even with adequate management and surgery. In the perioperative period, the most common complications leading to the death of patients are cardiovascular disease. about a hip fracture. The aimof our study was to determine the safest method of anesthesia in the context of acute myocardial injury during hip fracture surgery. The objectives of the study were to determine the frequency of postoperative myocardial damage in patients with hip fractures; compare the frequency of MINS with different types of anesthesia: general anesthesia (GA), spinal anesthesia (SA) and compartment psoas block with sciatic nerve block. Materials and methods.Randomized controlled trial was conducted from January 2018 to August 2019 in the medical center “Into-Sana” (Odessa, Ukraine). Patients with planned osteosynthesis of the proximal femur were randomized into 3 groups depending on the method of anesthesia: general anesthesia and postoperative systemic analgesia, spinal anesthesia and postoperative systemic analgesia, prolonged compartment psoas block with sciatic nerve block. Results.The study involved 90 patients. Acute postoperative myocardial injury was diagnosed in 17.6 % of cases. Postoperative elevation of troponins was significantly more often diagnosed in groups of patients with spinal anesthesia and general anesthesia compared to the group in which the psoas block compartment was used in combination with the sciatic nerve block. None of the patients had symptoms of myocardial ischemia and were not diagnosed with myocardial infarction. Hypotension was significantly more common in group 2 spinal anesthesia (OR 9 95 % CI 1.9-47, p=0.004) There was a direct moderate association between the intraoperative hypotension and the development of postoperative myocardial injury (r = 0.5). Conclusions.Prolonged compartment psoas block with sciatic nerve block intraoperatively is the safest method of anesthesia in the context of the development of postoperative myocardial injury. Intraoperative hypotension is associated with postoperative myocardial injury

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 p p 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.

Noninvasive ventilation (NIV) is commonly used to prevent endotracheal intubation in patients with mild to moderate acute respiratory distress syndrome (ARDS). Dexmedetomidine (DEX) provide cooperative sedation, and could be beneficial for patients with ARDS receiving NIV. Aim of this study was to compare DEX with placebo for sedation during NIV. Adults with ARDS due to community aquired pneumonia with PaO2/FiO2 ratio 150-300 mmHg were randomly allocated to receive IV dexmedetomidine (0.2 μg/kg/h titrated every 30 min to 0.7 μg/kg/h to maintain a Richmond sedation agitation score (RASS) of 0 to -2) or placebo up to 72 h, until NIV was stopped for ≥ 2 h, or until intubation. Data are presented as median and 25-75 quartiles. Nonparametric criteria were used for data analysis. DEX (n=15) and placebo (n=14) group did not differ at baseline. DEX was associated with significatly higher patient comfort (7 [6-9] vs 5 [3-7] by 10-points scale); goal level of sedation was achieved during 86 [78-92]% of total sedation time in group D, and in 63 [49-72]% of time in group P (p 0.05), bradycardia in 7/15 (47%) and 1/14 (7%) (p=0.02). DEX infusion during NIV in patients with mild to moderate ARDS could improve patients comfort and sedation quality, as well as decrease incidence of delirium and posttraumatic stress disorder.

Background Dexmedetomidine (DEX) is a centrally acting alpha-2-adrenoceptor agonist that has potential in the management of alcohol withdrawal syndrome (AWS) owing to its ability to produce arousable sedation and to inhibit the adrenergic system without respiratory depression. The objective of this randomized controlled study was to evaluate whether addition of DEX to benzodiazepine (BZD) therapy is effective and safe for AWS patients in the intensive care unit (ICU). Methods Eligible participants were randomly assigned to intervention (Group D; n = 36) or control (Group C; n = 36). In Group D, DEX infusion was started at a dose of 0.2–1.4 μg/kg/h and titrated to achieve the target sedation level (–2 to 0 on the Richmond Agitation Sedation Scale (RASS)) with symptom-triggered BZD (10 mg diazepam bolus) was used as needed. Patients in Group C received only symptom-triggered 10 mg boluses of diazepam. The primary efficacy outcomes were 24-h diazepam consumption and cumulative diazepam dose required over the course of the ICU stay; secondary outcomes included length of ICU stay, sedation and communication quality and haloperidol requirements. Results Median 24-h diazepam consumption during the study was significantly lower in Group D (20 vs. 40 mg, p