Karbonskienė, Aurika

Introduction The occurrence of subcutaneous emphysema and pneumomediastinum due to transient esophageal microperforation is rare and scarcely reported. Although usually benign, these conditions can present with rapid, life-threatening deterioration.(1,2,3,4) Case Presentation A 57-year-old male with a malignant thoracic esophageal tumor underwent diagnostic thoracoscopy under general anesthesia. The tumor was unresectable due to invasion into surrounding tissues. After extubation, the patient required high-flow oxygen, crepitus appeared around left clavicle, rapidly spreading to the neck and face within 20 minutes, leading to respiratory distress and hypotension. The patient was transferred to the ICU, reintubated and started on norepinephrine. Chest X-ray revealed pneumothorax, bronchoscopy showed no airway defect. In two hours, CT demonstrated extensive subcutaneous emphysema and mediastinal air but no tracheal injury, physical reevaluation noted spread until scrotum. By the next morning, both emphysema and hemodynamic instability improved. X-ray confirmed pleural air resolution, patient was extubated and two days later discharged with complete recovery. Discussion Determining the source of subcutaneous emphysema is crucial, as its treatment typically leads to resolution. Close monitoring is needed to assess whether intervention is required.(2,3) In this case, prior CT imaging revealed necrotic paratracheal lymph nodes near the tumor, suggesting a transient esophageal microperforation that sealed spontaneously, consistent with a similar report.(5) Conclusions We report a rare case of postoperative, extensive subcutaneous emphysema with pneumomediastinum, shock and respiratory insufficiency, spontaneously resolving within a day. This case highlights that subcutaneous emphysema can lead to life-threatening deterioration of vital signs and emphasizes how prompt recognition and active support measures can result in a good outcome.

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.

Introduction Multimodal analgesia is globally acknowledged not only as an effective approach to post-operative pain management but also as a strategy to minimize opioid consumption. [1] Unfortunately, not all physicians adopt this approach in their practice, and non-opioid medications are sometimes underused. [2] Objectives To assess the attitudes of anaesthesiologists in Lithuanian tertiary care hospitals towards multimodal analgesia. Materials and methods An anonymous survey with bioethical approval (No. 2025-BEC2-0216) was distributed to LUHS Kaunas Clinics anesthesiologists in February 2025. They answered 18 questions. Data were analyzed using descriptive statistics and chi-square (χ2), with significance set at p < 0.05. Results The survey included a similar proportion of anesthesiologists with over 20 years, 11–20 years, and less than 10 years of experience. Most respondents (74.1%) reported encountering post-operative pain management challenges in less than 20% of patients. Professionals with 0–5 years of experience were more likely to believe that magnesium sulfate significantly reduces opioid requirements (40%), whereas those with more than 20 years of experience were more likely to be unaware (52.4%) or to consider the effect negligible (28.6%) (p < 0.05). Additionally, the majority of doctors who do not know whether gabapentinoids reduce opioid demand also do not know whether magnesium sulfate does (72.2%, p < 0.001). There was also a statistically significant association between the perceived effects of dexamethasone and magnesium sulfate on opioid requirements (p < 0.001). Finally, magnesium sulfate (74.1%), intravenous lidocaine (90.7%), and ketamine (63%) are administered to no more than 25% of patients. Conclusions Anesthesiologists' perceptions of adjunctive analgesics vary by experience, with less experienced professionals more likely to support magnesium sulfate’s opioid-sparing effects. Significant associations were found between the perceived effects of magnesium sulfate, dexamethasone, and gabapentinoids (p < 0.001), while actual use remains low, highlighting the need for better physician education.

2022 m. 2,5 milijardo suaugusiųjų nuo 18 metų amžiaus turėjo antsvorio, iš jų daugiau nei 890 milijonų buvo nutukę [1]. Nutukusių pacientų skaičius chirurgijoje didėja, dėl to kyla specifinių iššūkių ir chirurgams, ir anesteziologams [2]. Nutukimas savaime nėra reikšmingas nepriklausomas rizikos veiksnys, didinantis perioperacinių komplikacijų dažnumą, tačiau, jei jau yra sisteminių sveikatos sutrikimų, siejamų su nutukimu, perioperacinė rizika žymiai didėja. Pagrindinės būklės, dėl kurių nutukusius pacientus prieš operaciją reikia papildomai tirti ir/ar gydyti, yra: a) mažas funkcinis pajėgumas, b) nenormali EKG, c) nekontroliuojami arterinis kraujo spaudimas, stazinis širdies nepakankamumas arba išeminė širdies liga, d) SpO2 <94% be papildomo deguonies, e) kraujo dujų bikarbonatai >27, tikėtinas nutukimo hipoventiliacinis sindromas, f) ankstesnė giliųjų venų trombozė/ plaučių embolija, g) STOP-BANG įvertis >5, h) OS-MRS įvertis >3, i) metabolinis sindromas, j) didelė ACS-NSQIP rizika [3]. Priešoperaciniu laikotarpiu ypatingai naudinga polisomnografija, kurios rezultatai leidžia tiksliai diagnozuoti ir gydyti obstrukcinę miego apnėją, siekiant sumažinti kvėpavimo ir kraujotakos komplikacijas po operacijos [4]. [...].

While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting.

Introduction Multimodalanalgesia is widely recognisedaround the world not only as an effective tool for managingpost-operativepain, but also as a way to reduce opioid use. [1] Unfortunately, not all physicians incorporate this approachinto their practice, and non-opioid medications are sometimes underused.[2] Aim of the study To assess the attitudes of anaesthesiologists in Lithuanian tertiary care hospitals towards multimodal analgesia - the use of systemic non-opioid analgesics, analgesic adjuvants, and regional analgesia for the relief of postoperativepain. Materials and methods An anonymous questionnaire survey with bioethical approval(No. 2025-BEC2-0216) was distributed to all anaesthesiologists working at the Hospital of LUHS Kaunas Clinics in February 2025. The doctors were invited to answer 18 questions, including demographics, items about their subjective opinions on the effectiveness and use of multimodal analgesia. Descriptive statistical analysis and chi-square (χ2) were used for data analysis. Results were considered statisticallysignificant at p<0.05. Results The survey included a similar proportionof anaesthesiologists with over 20 years, 11–20 years, and less than 10 years of experience. Most respondents (70.2%) reported post-operative pain management challenges in less than 20% of patients. Although 85.1% recognised epidural analgesia as highly effective, 66% used it in less than 25% of patients.In contrast, peripheralnerve blocks were more frequentlyused by doctors working in urology and plastic surgery, with 75% applying them to over 76% of patients. Both paracetamol and NSAIDs were widely consideredeffective for reducing overall opioid requirements, with statistically significant results (p < 0.001). Most physicians reported prescribingthese medications to 76–100% of their patients. Practitioners who believed that dexamethasonedid not reduce opioid requirements were likely to hold the same view regarding magnesiumsulphate, and vice versa (p < 0.001). Finally, magnesiumsulphate (70.2%), intravenous lidocaine (91.5%), and ketamine (59.6%) are administeredto no more than 25% of patients. Conclusions The study showed that although most anaesthesiologists recognise the effectiveness of multimodal analgesia methods, such as epidural analgesia and peripheralnerve blocks,their use remains limited in clinicalpractice.While paracetamol and NSAIDs are widely prescribed to reduce opioid requirements, magnesium sulphate, intravenous lidocaine, and ketamine 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.

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 Airway management is critical for safe and successful anaesthesia. Careful preoperative evaluation and planning are essential, especially in cases of difficult airways [1,4]. We present a case of airway compromise caused by orogastric (OG) tube insertion and its management. Case Presentation A 77-year-old male was admitted to HLUHS for melanoma excision of the upper limb and axillary lymphadenectomy. He was 190 cm tall and weighed 135 kg, and general anaesthesia with tracheal intubation and controlled ventilation was planned. His medical history included controlled arterial hypertension and persistent atrial fibrillation. Preanesthetic evaluation revealed a difficult airway: sleep apnea (STOP-BANG questionnaire), Mallampati class IV, the inter-incisor gap of 3.5 cm, and a neck movement range of 90°. Tracheal intubation assisted by videolaryngoscopy was chosen. Anesthesia induction and bag-mask ventilation were successful with an OG tube. Tracheal intubation was uneventful (videolaryngoscopy CL view 2B), and artificial ventilation began. An OG tube was blindly inserted by an anesthesia nurse, after which the anesthesia machine showed a critical airway pressure drop, and the OG tube’s bag inflated. Connections of the breathing circuit were inspected and found intact. Gas flow was increased to maintain ventilation. Attempts to decrease gas flow again revealed airway pressure drops. Videolaryngoscopy confirmed the OG tube had been mistakenly inserted into the trachea, causing a gas leak. The OG tube was removed and reinserted under videolaryngoscopy guidance. The subsequent course was uneventful. Discussion International guidelines recommend thorough planning for difficult airways [1]. Videolaryngoscopy is effective for resolving such cases and has successfully resolved 93 % of difficult airway situations [5,6]. This case highlights that successful intubation does not ensure airway patency, as simple errors like OG tube misplacement can lead to significant complications [2,3]. A systematic evaluation of all possible causes of respiratory insufficiency is vital. Conclusions A thorough evaluation of all potential causes of respiratory insufficiency is essential in airway management to prevent complications and ensure patient safety [1,4].