Bilskienė, Diana

Background and Objectives: Spinal (SA) and general anesthesia (GA) are both available for lumbar disc hernia (LDH) surgery. Patient satisfaction with anesthesia service is under-investigated and may help identify areas requiring improvement, leading to better care. Materials and Methods: A prospective, non-randomized, survey-based study was performed in patients who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (PODs) 0, 1, and 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10, and an overall satisfaction score (OSS) was calculated; a patient discomfort questionnaire was also used. Study outcomes were pain scores, satisfaction with care, and discomfort reported by SA and GA patients. Results: In total, 209 completed questionnaires in the GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics did not differ significantly between the two groups. The proportion of patients with severe pain decreased from >80% preoperatively to 6% on POD2, and pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSSs) were high: 9.71 (maximum OSS: 57% of cases) in the GA group, and 9.75 (maximum OSS: 53.7% of cases) in the SA group (p = 0.95). The ceiling effect of the patient satisfaction questionnaire had to be addressed. There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort being more prevalent in the GA group (p < 0.05). Postoperative pain was reported as a source of discomfort by >50% of patients in both the SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreased satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness, and pain. Pain on POD 0 did not influence overall patient satisfaction. An association was only found when pain persisted on POD 1 and POD 2. Conclusions: No significant differences between the two anesthesia methods were found. Patient information, anxiety management, and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed, irrespective of the anesthesia method used. Further efforts to develop optimal tools for patient satisfaction assessment are necessary.

Šiuo leidiniu siekiama praplėsti ir pagerinti praktinių metodikų informacini spektrą anesteziologijos ir reanimatologijos rezidentūros studijų sistemoje, pradedant taikyti pakopinių kompetencijų modelį. Tikimasi, kad šios praktinės metodikos padės studijuojant bei įgijant kompetencijų ir suteiks busimiesiems specialistams praktinių žinių. Rekomendacijų medžiaga paremta Lietuvos Respublikos teisės aktais, Pasaulio sveikatos organizacijos, Europos anesteziologijos ir intensyviosios terapijos bei Amerikos anesteziologų draugijos rekomendacijomis, moksliniais tyrimais ir įvairių šalių gerosios praktikos pavyzdžiais. Informacija pateikiama atsižvelgiant į kasdienius iššūkius, su kuriais susiduria kiekvienas anesteziologas. Šis leidinys skirtas tiems, kurie ieško atsakymų į praktinius klausimus, nori tobulinti savo gebėjimus ir užtikrinti pacientų priežiūros kokybę. Tikimės, kad pateikti metodai ne tik padės gydytojams rezidentams efektyviau įveikti klinikines situacijas, bet ir skatins nuolat mokytis bei tobulėti. Autoriai ir rengėjai tikisi, kad pateikta informacija padės sisteminti žinias ir tinkamiausiu būdu taikyti jas praktikoje. Šiame leidinyje pateiktos anesteziologijos metodikos yra pavyzdinės. Aprašyti veiksmai ir metodai neturėtų būti interpretuojami kaip vieninteliai galimi pasirinkimo variantai. Kiekvienas klinikinis atvejis yra individualus. Galutiniai sprendimai turi būti priimami įvertinus konkretų pacientą, jo būklę, gretutines ligas, rizikos veiksnius, numatomos procedūros pobūdį, klinikinę situaciją. Sprendimai privalo remtis galiojančiais teisiniais aktais ir įstaigos vidaus tvarkos taisyklėmis.

Safe and successful management of difficult tracheal intubations (DTIs) remains a significant challenge due to anatomical variability, patient comorbidities, and operator-dependent factors. While video laryngoscopy (VL) has improved first attempt success rates, failures still occur in 11% to 45% of cases, with ultimate failure rates between 5.2% and 7.3%. The primary aim of this prospective observational study was to evaluate efficacy of the use of a novel, handheld, image-guided robotic intubation system Spiro-VISTA (Spiro Robotics, Inc) designed to enhance precision, control and procedural success in patients with difficult airways.

Background: Perioperative vision loss (POVL) is a rare complication following non-ophthalmological surgery. Awareness of POVL and quality of evidence on prevention and management is limited. Case report: A 72-year-old male with a history of coronary artery disease, hypertension, heart failure, dyslipidemia, and obesity, ASA class III, was admitted for lumbar laminectomy with fusion at L3-5 level. Surgery was performed in a prone position under general anesthesia. The patient’s eyes were carefully taped closed. The face was placed on a foam head cushion. MAP was maintained >65mmHg. The surgery lasted 4h, blood loss – 500 ml. The patient was transferred to the postanesthesia ward, alert and stable. On postoperative day one, the patient complained of vision loss in his left eye, which had persisted since emergence from anesthesia. Fundoscopic exam showed retinal vasculopathy, sclerotic lesions, macular pallor and a cherry-red spot indicative of central retinal artery occlusion (CRAO). Cerebral CT angiography and MRI showed no specific changes. No treatment options were available due to delayed diagnosis. Further postoperative course was normal, but unilateral vision loss was permanent. A review of older medical records revealed documented transient ischemic attack in the vertebrobasilar region, significant cerebrovascular atherosclerosis and bilateral retinal angiosclerosis. Discussion: POVL incidence after spinal surgery is 0.09%, mostly attributed to ischemic optic neuropathy or CRAO. Prolonged surgery (>6h), high blood loss, eye compression, hypotension and elevated intraocular pressure are associated with POVL risk [1]. Our patient’s history of vascular diseases and prone positioning may have contributed to the development of CRAO despite uneventful surgery. Notably, initially the patient attributed impaired vision to the perception that the left eyelid was in a closed position and did not express any complaints. In the acute phase of CRAO, thrombolytic therapy and hyperbaric oxygen therapy may be attempted; however, an early recognition of this complication is crucial [2-3]. Learning points: Careful identification and information of patients at high POVL risk is necessary. Awareness of POVL risk may lead to better prevention, timely diagnosis, and treatment before the vision loss becomes irreversible.

Introduction: Multimodal analgesia is established method of postoperative pain management but physicians’ individual attitudes are very important for implementation of it [1,2]. Aim of the study was to assess opinions and practices of anaesthesiologists in Lithuanian tertiary hospital on the use of systemic non-opioid analgesics, adjuvants, and regional analgesia for the relief of postoperative pain. Methods: An anonymous questionnaire survey with bioethical approval (No. 2025-BEC2-0216) was distributed to all certified anaesthesiologists working at the Hospital of LUHS in February 2025. 18 questions included demographics and subjective opinions on the effectiveness and use of multimodal analgesia. Descriptive statistics and chi-square (χ2)were used for analysis(statistical significance if p<0.05).Results: The survey yielded 47 completed questionaires (response rate - 65%). 70,2% of respondents reported post-op-erative pain management challenges in less than 20% of patients. 85,1% recognized epidural analgesia as highly effective, 66% used it in less than 25% of eligible patients.Peripheral nerve blocks were more frequently used - 75%applying them to over 76% of eligible patients. Both paracetamol and NSAIDs were widely considered effective for reducing overall opioid requirements (p<0.001) and prescribed to 76-100% of patients. Practitioners who believed that dexamethasone did not reduce opioid requirements were likely to hold the same view regarding magnesium sulphate, and vice versa (p<0.001). Magnesium sulphate, intravenous lidocaine and ketamine were administered to less than 25% of patients.Conclusions: Most anaesthesiologists recognize the effectiveness of multimodal analgesia methods, such as epidural analgesia and peripheral nerve blocks, their use remains limited in clinical practice. While paracetamol and NSAIDs are widely prescribed to reduce opioid requirements, analgesic adjuvants are used infrequently.

Introduction: Postoperative pain is common in the first 24 hours after brain surgery and is often undertreated for the fear of masking neurosurgical pathology or depressing ventilation[1-3]. The aim of our study was to compare regional analgesia versus systemic analgesia and its effect on postoperative pain reduction in patients undergoing craniotomy for brain tumor surgery. Methods: The study included 141 adult craniotomy patients that were randomly separated into three equal groups (Table1). A group with scalp nerve blockade (B) and wound infiltration (I) received 0.25% bupivacaine combined with 1% lidocaine and 1:200,000 epinephrine. 1g of Paracetamol and 2mg/kg Ketoprofen were administered intravenously after skin closure in a group with systemic analgesia (S). Pain intensity was evaluated after 1, 3, 6, and 24h postoperatively using a visual analogue scale. The amount of rescue analgesia and the duration for its first requirement were recorded.Results: Significantly lower pain scores were observed in the group with a scalp nerve blockade compared to the group with systemic analgesia or wound infiltration after 24h, p<0.05. Regional anesthesia ensured a stable analgesic effect for all 24h(Table 2). Fewer rescue analgesics were required in group Band I compared to patients in group S, p=0.001. Data is presented in percentages in Figure 1.Conclusions: The results of our study show that most patients experience pain in the early postsurgical hours. Scalp nerve blockade significantly reduced the incidence and severity of pain after a craniotomy and the amount of rescue analgesia used in this group of patients in the first 24 hours after craniotomy.

Background and Objectives: Postoperative pain is common in the first 24 hours after brain surgery and is often undertreated for the fear of masking neurosurgical pathology or depressing ventilation. The aim of our study was to compare diierent types of analgesia and its eiect on postoperative pain reduction in patients undergoing craniotomy for brain tumor removal. Methods: The study included 141 adult craniotomy patients that were randomly separated into three equal groups. A group with scalp nerve blockade (B) and wound infiltration (I) received 0.25% bupivacaine combined with 1% lidocaine and 1:200,000 epinephrine. One gram of paracetamol and 2 mg/kg ketoprofen were administered intravenously (IV) after skin closure in a group with systemic analgesia (S). Pain intensity was evaluated after 1, 3, 6, and 24 h postoperatively using a visual analogue scale (VAS). The amount of rescue analgesia (ketorolac, paracetamol, and pethidine) and the duration for its first requirement were recorded. Results: One hundred and forty-one patients were included in the prospective, randomised, double - blind study. The main pain scores were significantly lower in the groups with regional anesthesia compared to group S after 1 hour (group B Median (ME) = 5, group I ME = 8, group S ME = 37), after 3 hours (group B ME = 8, group I ME = 5, group S ME = 16) and after 6 hours (group B ME = 8.5, group I ME = 12, group S ME = 16), p < 0.05. Significantly lower pain scores were observed in the group with a scalp nerve blockade (ME = 8) compared to the group with systemic analgesia (ME = 19.5) or wound infiltration (ME = 12.5) after 24 h, p < 0.05. Regional anesthesia ensured a stable analgesic eiect for all 24 h. Fewer rescue analgesics were required in groups B (ketorolac 68.1%, paracetamol 10.0 %) and I (ketorolac 80.9%, paracetamol 12.8%) compared to patients in group S (ketorolac 93.6%, paracetamol 40.0%), p = 0.001. The duration for the requirement of the first rescue analgesia was significantly longer in Groups B and I compared to Group S (B: 514 ± 471 min; I: 398 ± 418 min; S: 149 ± 128 min), p = 0.000. Discussion and Conclusion: The results of our study show that most patients experience pain in the early postsurgical hours. Scalp nerve blockade significantly reduced the incidence and severity of pain after a craniotomy and the amount of rescue analgesia used in this group of patients in the first 24 hours after craniotomy

Augant gydytojų specialistų įgūdžiams ir ultragarsu kontroliuojamoms procedūroms tampant rutininėmis, atėjo metas rinktis ne techniškai paprasčiausią, o į pacientą orientuotą metodiką. Centrinės venos prieiga poraktikaulinėje srityje dėl savo unikalios, gilios, nutolusios nuo są-narių lokalizacijos užtikrina geras antitrombozines, antimikrobines savybes ir yra gerai toleruojama. Anatominiais orientyrais paremta po¬raktikaulinės venos kateterizacija dėl didelio nesėkmingų procedūrų bei mechaninių komplikacijų skaičiaus modernioje anestezio¬logijoje yra nepriimtina. Ultragarsinės vizualizacijos metodų panau¬dojimas poraktikaulinėje srityje yra sudėtingas: greta esantis plautis reikalauja atidumo, o artimos kaulinės struktūros riboja ultragarsines manipuliacijas ir lemia atokesnę, išreikštos galvinės krypties punkciją. Vena, tikėtina, perforuojama atokiau pirmojo šonkaulio lateralinio krašto ir ne tik atitinka pažastinės venos apibrėžimą, tačiau taip pat sąlygoja gilesnio kateterio įvedimo poreikį. Standartinės, antropologiniais parametrais paremtos po¬raktikaulinės venos kateterizacijai skirtos kateterio įvedimo gylio skai¬čiuoklės nėra tinkamos. Dešinės rankos judesiai, esant artimai peties sąnariui kateterio fiksacijai, gali sąlygoti kateterio kilpos migraciją į poodinį sluoksnį. Išreikšta kranialinė punkcijos kryptis jungo venos santakos link, tikėtina, sąlygoja apsunkintą stygos įvedimą bei dažną kateterio kryptį į tos pačios pusės vidinę jungo veną. Nepaisant neabejotinos ultragarsinių vizualinių tyrimų naudos kateterizuojant vidinę jungo veną, porak¬tikaulinės ar pažastinės venos prieigos atveju tyrimų rezultatai yra nevie¬nareikšmiai.

Vadovėlis „Vaikų anestezija“ skirtas gydytojams rezidentams, studijuojantiems Anesteziologijos ir Intensyvios terapijos rezidentūroje, Vaikų intensyvios terapijos rezidentūroje ir Skubiosios medicinos rezidentūroje bei Išplėstinės slaugos studentams, studijuojantiems Anesteziologijos cikle. Ši knyga taip pat gali būti naudinga ir gydytojams, atliekantiems anesteziją įvairaus amžiaus vaikams. Knygos autoriai - ilgametę patirtį, dirbant su vaikais, turintys gydytojai. Tikimės, kad ši knyga bus ne tik naudinga besimokantiems, bet taip pat bus vienu iš įrankių, padėsiančių užtikrinti saugią ir kokybišką anesteziją ir sklandų poanestezinį periodą vaikams.

Background and Objectives: Recent findings suggest that neurodegeneration starts early in the course of multiple sclerosis (MS) and significantly contributes to the progression of patients’ disability. Tau is a microtubule-binding protein that is known to play a role in the pathophysiology of many neurodegenerative disorders. Newly emerging data on tau protein-induced neurodegenerative processes and its possible involvement in MS suggest that it may be involved in the pathology of early-stage MS. Therefore, this study aimed to test this hypothesis in patients with newly diagnosed MS. Materials and Methods: Cerebrospinal fluid (CSF) was collected from 19 patients with newly diagnosed MS and 19 control subjects. All MS patients underwent neurological examination, lumbar punction, and brain magnetic resonance imaging (MRI). CSF concentrations of total and phosphorylated tau (phospho-tau-181) protein were measured using commercial enzyme-linked immunosorbent assay kits. Results: The total tau concentration was significantly higher in the CSF of MS patients compared to controls (141.67 pg/mL, IQR 77.79–189.17 and 68.77 pg/mL, IQR 31.24–109.17, p = 0.025). In MS patients, the total tau protein positively correlated with total CSF protein (r = 0.471, p = 0.048). Significantly higher total tau concentration was measured in MS patients with higher lesion load in brain MRI (≥9 versus <9 lesions; 168.33 pg/mL, IQR 111.67–222.32 and 73.33 pg/mL, IQR -32.13–139.29-, p = 0.021). The CSF concentration of phospho-tau-181 protein was below the detection limit in both MS and control subjects. Conclusions: The concentration of total tau protein level is elevated, whereas phospho-tau-181 is undetectable in the CSF of patients with early-stage MS.