Osiągnięcia naukowe

Gynecological operations are surgical procedures involving the pelvic organs of a woman. They are divided into: laparoscopic, laparotomy and from vaginal access. The first two types are performed under general anesthesia with opioids (Opioid Based Anasthesia, OBA). However, due to many side effects of opioids, non-opioid anesthesia (Opioid Free Anasthesia, OFA) has become more widely used. The following review focuses on the comparison of postoperative pain, analgesic consumption, recovery quality, nausea and vomiting (PONV), hypotension and bradycardia between these two therapeutic approaches. The aim of this study is to perform comparative analysis of the effectiveness and side effects in gynecological surgeries using the OFA or OBA procedure. Review was performed with MEDLINE, EMBASE, AMED databeses and the Cochrane Library, between September 2023 and December 2023. Randomised controlled trials (RCTs) comparing efficacy and side effects between OFA and OBA were included. The review comprised 498 patients from 6 RCTs. Common interventions included laparoscopic procedures. Evidence shows a reduction in side effects in OFA. PONV frequency was reduced in OFA (RR = 0.52; 95% CI: 0.29–0.93; p = 0.004; l2 = 67.5%). The score on the recovery quality questionnaire was also significantly higher (mean difference +28.36 points/200). The difference in pain, frequency of hypotension and bradycardia slightly favors OFA, but these changes were not statistically significant. OFA procedure is not only an effective alternative to OBA in gynecological surgery, but also improves the outcomes after it. Although, further research in this field is required.

Pectus excavatum (PE) is the most common congenital deformity of the anterior chest wall, with an estimated incidence of 1 in 400–1000 births. It typically manifests in the neonatal period but can also appear during adolescence. Clinical symptoms may arise from compression of the lungs and heart. The standard treatment for PE is surgical intervention. The modified Ravitch procedure is an invasive correction method used to treat pectus excavatum. This procedure is associated with significant postoperative pain, often exceeding 5 on the numerical rating scale (NRS), which can be difficult to manage with conventional methods such as patient-controlled analgesia (PCA) or continuous thoracic epidural analgesia (cTE). A new alternative adjunct therapy for managing acute pain after thoracic surgery is peripheral nerves cryoablation – a procedure involving temporary blockade of nerve conduction in the intercostal nerves using a narrow range of low temperatures, optimally performed before the surgical procedure. This results in long-lasting analgesia that allows for a reduction of opioid requirements or even complete discontinuation. This paper presents two cases of pediatric patients who, due to invasive thoracic surgical procedures, underwent intercostal percutaneous cryoablation (IPC) before the surgery. Performing preemptive percutaneous intercostal nerve cryoablation reduced opioid intake and allowed for shorter hospital stay, as well as significantly increased comfort of our patients. The description of these two cases aims to highlight the preemptive cryoablation as a potential, potent, alternative analgesia method adjunct to pharmacotherapy of pain in patients undergoing extensive thoracic surgical procedures.

Cardiogenic shock is a life-threatening condition characterized by a significant morbidity and mortality. It occurs as a result of a decrease in cardiac output caused by severe dysfunction of the heart. Despite conventional treatment approaches, there are extreme cases that remain refractory to therapy, necessitating alternative interventions such as extracorporeal support techniques to assist the failing heart. These techniques not only help maintain proper tissue oxygenation and perfusion but also relieve the left ventricle and increase cardiac output. This article presents a case study of a patient experiencing severe cardiogenic shock due to acute coronary syndrome after thoracic trauma with pneumothorax. The authors highlight the value of simultaneous utilization of two treatment modalities: veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the Impella CP microaxial pump. By sharing this case, the authors underscore the importance of comprehensive and innovative approaches in managing critical cases of cardiogenic shock. 22 Introduction Cardiogenic shock is a severe form of myocardial insufficiency, where the decrease of cardiac output (CO) is below 2.2 l/min/m2, leading to generalized tissue hypoperfusion. It results in metabolic acidosis and eventually multiple organ failure. Unlike other types of shock caused by peripheral vascular dysfunction or insufficient circulating blood volume, cardiogenic shock arises from the dysfunction of the heart as a pump. Thus, diagnosis of this type of shock involves observing the decrease in cardiac output, peripheral hypoperfusion, systolic blood pressure below 80 mmHg without pharmacological and mechanical support, and normovolemic status indicated by pulmonary capillary wedge pressure above 15 mmHg [1,2]. Early identification and treatment of the underlying cause are crucial in managing cardiogenic shock. Cardiac echocardiography plays a vital role in assessing heart contractility, valve function, and overall myocar-dium condition. Additionally, coronary angiography is obligatory when myocardial infarction is suspected as the cause of the shock, as it allows to evaluate vascular perfusion and guides potential interventions such as angioplasty or even coronary artery bypass grafting [3,4].

Opioids are a class of drugs that operate on opioid receptors and are typically used to treat moderate and severe pain. In the USA, 1.5% of pregnant women self-reported misusing these drugs in 2019. Studies have shown that more than 2% of neonates after opioid-exposed pregnancies had neonatal opioid withdrawal syndrome (NOWS), which was severe in more than half of cases. Symptoms of this condition include irritability, trouble sleeping, seizures, altered neurodevelopment, respiratory and gastrointestinal issues. There are currently no recognized diagnostic methods or accepted standards of care for NOWS. The study aims to present data on the prediction markers of NOWS severity and novel treatment options. Topics of effectiveness and the mechanism of action were discussed. The most recent scientific reports have been considered. MicroRNAs (miRNAs) are small non-coding RNA molecules that regulate RNA translation within cells. They can also be released into the circulatory system, where they are likely involved in cell-to-cell communication. Studies show that their profile is different after opioid use. Some miRNAs can help predict the severity of symptoms, the necessity for pharmaceutical treatment, and the length of hospitalization with high accuracy (up to 90%). Resting-state functional magnetic resonance imaging (rs-fMRI) has been shown to also have a prediction role in the severity of NOWS by identifying brain structure and connectivity. Strong opioid agonists like morphine and methadone are commonly used as therapy in NOWS, but they have side effects and can be overdosed. This problem can be overcome with buprenorphine, which is a partial opioid agonist and has a lower risk of overdose. Additionally, according to clinical trials, using ondansetron (5-HT3 antagonist) reduces the need for opioid therapy by almost 15%. Moreover, non-pharmacological methods of care like whole-body massage exhibit encouraging outcomes. The work has a review character. A review of the scientific literature was conducted using the PubMed NCBI database and additional resources related to the work's subject.

Sevoflurane is an anesthetic gas commonly used in modern medicine. It is distinguished by a quick onset of action, a low minimal alveolar concentration (MAC) rate, little irritation of the airways, and a pleasant scent for patients. Despite its many benefits, studies demonstrate its neurotoxicity and neuroinflammation. These issues are especially observed in sedated patients over 50 years of age and recently also in young patients. Sevoflurane via inflammatory mechanism cause an increase in blood-brain barrier permeability and overproduction of amyloid plaques, including Tau protein, which may be a precursor to Alzheimer's disease. Additionally, research has demonstrated that neuronal apoptosis caused by sevoflurane exposure in developing brains, especially in the hippocampus, is mediated by receptor-interacting protein kinase 1 and 3 (RIPK1 and RIPK3). The disturbed iron metabolism and overexpressed Ca 2+-calpain pathway may also be involved in this process. Due to the increased understanding of the mechanisms of sevoflurane-induced neurotoxicity, various innovative methods of eliminating it were described. One of the examples is dexmedetomidine, known for its neuroprotective effects, which impacts cell apoptosis and mitophagy via the miR-330-3p/unc-51 like autophagy activating kinase 1 (ULK1) axis. Moreover, echinatin increases the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and reduces the neurotoxicity that sevoflurane causes to hippocampus neurons, according to in vitro and in vivo studies. Additionally, the RIPK1 inhibitor necrostatin-1 (Nec-1) and bumet-anide, which leads to inhibiting gamma-aminobutyric acid (GABAA) receptor, can block other pathways in which sevoflurane are casuing side effects. The quality and lifespan of patients who receive this gas for anesthesia may be improved with further research in this field. The study aims to present data on the mechanisms of this neurotoxicity and novel treatment options. The most recent scientific reports have been considered. The PubMed NCBI database and additional sources relevant to the topic of the work were used to perform a review of the scientific literature.