Browsing by Author "Vanags, Indulis"

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    Activation of coagulation and fibrinolysis in acute respiratory distress syndrome : a prospective pilot study
    (Vide Leaf, 2020-09-24) Ozoliņa, Agnese; Šarkele, Marina; Sabeļņikovs, Oļegs; Šķesters, Andrejs; Jaunalksne, Inta; Serova, Jeļena; Bjertnaes, Lars J.; Vanags, Indulis; Adeniji, Shola Elijah; Rīga Stradiņš University; Bioķīmijas zinātniskā laboratorija
    Introduction: Coagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS). We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in mechanically ventilated patients at increased risk of developing ARDS. Materials and Methods: We performed an ethically approved prospective observational pilot study. Inclusion criteria: patients with PaO2/FiO2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 hours, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria: age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA and PAI-1 at inclusion (T0) and on third (T3) and seventh day (T7) of the ICU stay with nonparametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic (ROC) curve analysis. Statistical significance: p < 0.05. Results: Of 24 patients at risk, six developed mild ARDS and four of each moderate or severe ARDS, respectively, 3 ± 2 (Mean ± SD) days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO2/FiO2 and PEEP and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0.78, p = 0.02. PAI-1 displayed 64% sensitivity and 100% specificity with a cut off concentration of 117.5 pg/ml and AUC 0.77, p = 0.02. t-PA did not change significantly during the observation time. Conclusions: This pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after seven days in ICU.
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    Activation of coagulation and fibrinolysis in acute respiratory distress syndrome : A prospective pilot study
    (2016) Ozolina, Agnese; Sarkele, Marina; Sabelnikovs, Olegs; Skesters, Andrejs; Jaunalksne, Inta; Serova, Jelena; Ievins, Talis; Bjertnaes, Lars J.; Vanags, Indulis; Rīga Stradiņš University; Bioķīmijas zinātniskā laboratorija
    Introduction: Coagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS). We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) in mechanically ventilated patients at increased risk of developing ARDS. Materials and methods: We performed an ethically approved prospective observational pilot study. Inclusion criteria were patients with PaO 2 /FiO 2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 h, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria were age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA, and PAI-1 at inclusion (tissue) and on third (T 3 ) and seventh day (T 7 ) of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic curve analysis. Statistical significance: p < 0.05. Results: Of 24 patients at risk, 6 developed mild ARDS and 4 of each moderate or severe ARDS, respectively, 3 ± 2 (mean ± SD) days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO 2 /FiO 2 , and positive end-expiratory pressure and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0.78, p = 0.02. PAI-1 displayed 64% sensitivity and 100% specificity with a cut off concentration of 117.5 pg/ml and AUC 0.77, p = 0.02. t-PA did not change significantly during the observation time. Conclusion: This pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after 7 days in ICU.
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    The activity of oxidative stress markers in acute respiratory distress syndrome
    (2014-12-01) Šarkele, Marina; Ozoliņa, Agnese; Sabeļņikovs, Oļegs; Šķesters, Andrejs; Silova, Alise; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations; Bioķīmijas zinātniskā laboratorija
    Acute respiratory distress syndrome is a common complication characterised by severe hypoxemia, which leads to high mortality rates in ICU patients. Imbalance between oxidative stress markers like oxidants and antioxidants may play an important role in pathophysiology of the syndrome. We observed 17 ARDS patients during seven days after inclusion, with the main goal to describe dynamic changes in the level of oxidative stress markers in patients with acute respiratory distress syndrome. We found that there are dynamic differences in the level of malondialdechyde (MDA) and nitric oxide (NO) in patients with acute respiratory distress syndrome. There were also different levels of oxidative stress markers in non-survivor compared with survivor groups. Increased level of an oxidant like a thiobarbituric acid substance with malondialdechyde (TBS-MDA) and antioxidant glutathionperoxidase (GPx) at the first day after inclusion was related with poor outcome in patients with acute respiratory distress syndrome.
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    Anaesthesia and Stress Response to Surgery
    (2008-01) Golubovska, Iveta; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    The body reaction to surgery ranges from minor to massive both locally and generally. General response is in the form of widespread endocrinal, metabolic and biochemical reactions throughout the body. Neuro-endocrinal hormone system and inflammation mediators are involved and this process is called “stress response”. The response has a compensatory mechanism and provides a maximum chance of survival because of increased cardio-vascular functions, fluid preservation and supply of increased demands for energy generating substrates. If the stress response is prolonged, it may result in exhaustion of essential components of the body, fatigue, decreased resistance, delayed ambulation and increased morbidity and mortality. Suppression of immune defense mechanisms has been demonstrated in the postoperative period. Such immune compromise can affect the postoperative infection rate, healing process, and the rate and size of tumour metastases disseminated during surgery. The mechanism of immunosuppression in the postoperative period is not fully understood. The known mediators of immune depression are neuroendocrine response as well as intravenous opioids and inhalational agents, which have shown to increase the susceptibility to infection through a significant cautions in choosing anaesthetic agents, to minimise harm to the patients. In this paper we review the data about the influence of different anaesthetic agents on neuroendocrine, immune and inflammatory response to surgical stress.
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    Arterial stiffness measured by pulse wave velocity in patients with early sepsis
    (2014-12-01) Kazune, Sigita; Grabovskis, Andris; Strīķe, Eva; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Sepsis is characterised by massive inflammatory response, which can affect vascular function. This study was designed to assess the impact of early severe sepsis and septic shock on arterial stiffness and the relationship of this impact to outcome. Twelve patients with severe sepsis and 22 with septic shock were included in the study. We measured carotid to femoral and carotid to radial pulse wave velocity (PWV), an index of aortic and brachial arterial stiffness, in patients with early severe sepsis and septic shock within 24 hours of admission to intensive care unit and repeatedly after 48 hours. No difference was observed between patients with severe sepsis and septic shock regarding carotid to femoral PWV (11.7 ± 2.2 vs. 11.3 ± 3.6 m/s) and carotid to radial PWV (12.0 ± 3.8 vs. 9.5 ± 2.2 m/s). On 48 hour follow-up, PWV did not significantly differ between survivors and non-survivors. A positive, similar correlation occurred between PWV and pulse pressure in all patients (r = 0.35, p = 0.05), and there was a negative correlation between PWV and C-reactive protein levels (r = -0.43, p = 0.04). In conclusion, PWV is not affected by disease severity or prognosis.
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    Artēriju funkcionālo parametru loma multiorgānu disfunkcijas sindroma progresēšanas riska prognozēšanā sepses slimniekiem. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2020) Kazūne, Sigita; Strīķe, Eva; Vanags, Indulis
    Sepse ir masīva organisma reakcija uz infekciju, ko raksturo dzīvību apdraudošs orgānu bojājums. Fizioloģiskas nestabilitātes un augstā mirstības riska dēļ sepses pacientus bieži stacionē intensīvās terapijas nodaļās. Asinsvadu disfunkcijai, kas rodas samazinātas NO biopieejamības rezultātā, ir nozīmīga loma sepses un multiplu orgānu mazspējas patoģenēzē. Maģistrālo artēriju elastība nepieciešama, lai nodrošinātu efektīvu asiņu izsviedi no sirds, un to plūsmas optimizāciju perifērijā atbilstoši audu metabolajām vajadzībām. Izmantojot izolētus artēriju segmentus laboratorijas pētījumos un eksperimentos ar dzīvniekiem, pierādīts, ka akūts sistēmisks iekaisums ietekmē gan elastīgās, gan muskuļu tipa artērijas. Elastīgajā artērijās, īpaši aortā, pieaug cietība, bet muskuļu tipa artērijās novēro samazinātu vazoreaktivitāti. Darba “Artēriju funkcionālo parametru loma multiorgānu disfunkcijas sindroma progresēšanas riska prognozēšanā” mērķis ir raksturot sepses izraisītās artēriju funkcionālo parametru pārmaiņas, lai izveidotu diagnostikas un monitorēšanas paņēmienus, ar mērķi uzlabot multiplu orgānu mazspējas progresēšanas un mirstības riska prognozēšanu. Pētījums veidots no trim sadaļām. Pirmajā sadaļā sagatavots sistemātisks literatūras apskats un metaanalīze par sepses pacientu endoteliālās funkcijas izvērtēšanu ar vazoreaktivitātes testiem un šo testu rezultātu izmantošanu slimības klīniskās gaitas prognozēšanai. Otrajā sadaļā veikta a.carotis-a. femoralis pulsa viļņa izplatīšanās ātruma izpēte intensīvās terapijas pacientiem ar agrīnu sepsi. Pētījumā iesaistīti 45 pieauguši sepses pacienti pirmajās 24 stundās pēc stacionēšanas intensīvās terapijas nodaļā. A.carotis-a. femoralis pulsa viļņa izplatīšanās ātrums reģistrēts pēc pacientu stāvokļa sākotnējas stabilizācijas. Pacienti novēroti dinamikā līdz izrakstīšanai no stacionāra vai letālam iznākumam. Pētījumā pierādīts, ka pacientiem ar smagu sepsi un septisku šoku augstu pulsa viļņa izplatīšanās ātrumu, kas liecina par artēriju cietības pieaugumu, novēro biežāk kā vispārējā populācijā. Saistība starp agrīni mērītu pulsa viļņa izplatīšanās ātrumu un multiplas orgānu mazpējas progresēšanu vai mirstību netika atrasta, tomēr pacientiem, kam novēroja pulsa viļņa izplatīšanās ātrumu virs 24,7 m/s, bija īsāks izdzīvošanas laiks. Trešajā daļā elastīgo un muskuļu tipa artēriju īpašības pētītas dinamikā, izdarot mērījumus divos laika periodos, iestāšanās dienā un pēc 48 stundu intensīvās terapijas. Šajā pētījumā izzināti arī faktori, kuru pārmaiņas saistās ar pārmaiņām a.carotis-a. femoralis un a.carotis-a. radialis pulsa viļņa izplatīšanās ātrumā. Šajā pētījumā konstatēts, ka augšējās ekstremitātes artēriju cietība sepses pacientiem pārsniedz maģistrālo artēriju cietību abos laika periodos. Augsts a.carotis-a. radialis pulsa viļņa izplatīšanās ātrums asociējas augstāku vidējo arteriālo spiedienu un zemāku C reaktīvā proteīna koncentrāciju asinīs. Pacientiem, kas izdzīvo, pulsa viļņa izplatīšanās ātrums pēc 48 stundu intensīvās terapijas dinamikā mazinās, kurpretim pacientiem, kas nomirst, a.carotis-a. radialis pulsa viļņa izplatīšanās ātrums dinamikā saglabājas augsts. Kopsavilkumā, šajā pētījumā pierādīts, ka sepses pacientiem ir izmainīti artēriju funkcionālie parametri, un šīs pārmaiņas asociējas ar nelabvēlīgu iznākumu. Pētītajiem neinvazīvajiem artērijas raksturojošiem testiem, augsta riska pacientu identifikācijai a.carotisa. radialis pulsa viļņa izplatīšanās ātruma monitorēšanai dinamikā ir vislielākais prognostiskais potenciāls.
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    Association between increased arterial stiffness and clinical outcomes in patients with early sepsis : a prospective observational cohort study
    (2019-05-16) Kazune, Sigita; Grabovskis, Andris; Cescon, Corrado; Strīķe, Eva; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Background: Conduit arteries, especially the aorta, play a major role in ensuring efficient cardiac function and optimal microvascular flow due to their viscoelastic properties. Studies in animals and on isolated arteries show that acute systemic inflammation can cause aortic stiffening which affects hemodynamic efficiency. Carotid-femoral pulse wave velocity, a measure of aortic stiffness, may be useful as a bedside investigational method in patients with early sepsis admitted to intensive care, as circulatory changes can lead to multiple organ failure and increased mortality. This study aims to investigate arterial stiffness in early sepsis and its association with clinical outcomes. Methods: This prospective observational study included adult patients with severe sepsis or septic shock admitted to our intensive care unit (n = 45). Their carotidfemoral pulse wave velocity was measured within 24 h of admission. We assessed the progression of multiple organ as well as cardiovascular failure by sequential SOFA scores. Prediction models for the progression of multiple organ and cardiovascular failure were constructed using multivariate logistic regression with pulse wave velocity and vasopressor use as predictors. A Cox proportional hazards model was used to examine the relationship between pulse wave velocity and survival time. Results: The median pulse wave velocity for the cohort was 14.6 (8.1–24.7) m/s. There was no association between pulse wave velocity and the progression of multiple organ failure, before or after adjustment for vasopressor use. No association was found between pulse wave velocity and subsequent improvement in cardiovascular failure in the subgroup of patients who had cardiovascular instability at baseline. Cox regression and survival analyses with age, APACHE II, and baseline SOFA as confounders showed a shorter hospital survival time for patients with pulse wave velocity > 24.7 m/s (HR = 9.45, 95% CI 1.24–72.2; P = 0.03). Conclusions: Patients with severe sepsis and septic shock admitted to intensive care have higher arterial stiffness than in the general population. No convincing association was found between pulse wave velocity at admission and the progression of multiple organ or cardiovascular failure, although the group with pulse wave velocity > 24.7 m/s had shorter survival time.
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    Association of Interleukin 6 Promoter Polymorphism (-174G/C) with IL-6 Level and Outcome in Severe Sepsis
    (2008-01) Sabelnikovs, Olegs; Nikitina-Zake, Liene; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Interleukin (IL-6) is a key cytokine in the pathogenesis of severe sepsis. The importance of a regulatory polymorphism within the IL-6 promoter remains unclear in these patients. The aim of the study was to determine if IL-6 (-174 G/C) promoter polymorphism has an effect on IL-6plasma level and outcome of severe sepsis. The study was conducted in general ICU of Stradiņš Clinical University Hospital. A total of 103 critically ill patients with confirmed severe sepsis were prospectively included. Association analysis of the IL-6 (-174C) allele with serum level and clinical outcome was performed. We found no differences in genotype distribution between survivors and nonsurvivors. The serum IL-6 level was significantly higher in nonsurvivors compared with survivors. We found an association of genotype with the IL-6 level in non survivors, but not in survivors. Our findings show a functional significance of IL-6 promoter polymorphisms in nonsurviving severe sepsis patients.
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    Associations between TNF-α, IL-6 and IL-10 Promoter Polymorphisms and Mortality in Severe Sepsis
    (2012) Sabeļņikovs, Oļegs; Ņikitina-Zaķe, Liene; Krūmiņa, Angelika; Jaunberga, Zane; Klovins, Jānis; Vīksna, Ludmila; Bjertnaes, Lars J.; Kovalchuka, Lilija; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations; Department of Infectology
    Aims: To determine whether an association exists between TNF-α308 A/G,IL-6174G/C, and IL-10-1082 A/G promoter polymorphisms and the corresponding systemic cytokine concentrations and outcome in patients suffering from sepsis. Place and Duration of Study: The study was performed in the Intensive Care Unit (ICU) of Pauls Stradins Clinical University Hospital, Riga. Between 1 August 2006 and 31 July2008. Methodology: We enrolled 103 consecutive intensive care unit patients with sepsis into a prospective case control study. Blood samples were obtained for extraction of DNA amplifying regions of interest by means of polymerase chain reaction technique (PCR)using specific primers for TNF-α, IL-6andIL-10. Simultaneously, plasma cytokines and standard laboratory variables were determined during the first 24 h after the diagnosis. Presence of septic shock, sequential organ failure assessment score (SOFA),demographic data and clinical outcome was noticed P < 0.05 was considered as statistically significant. Results: Non-survivors had significantly higher concentrations of TNF-α, IL-6 and IL-10.The carriage of the IL-6-174C allele and IL-10-1082G allele were associated with a higher risk of mortality in patients with severe sepsis. Presence of the TNF-α-308 A allele did not influence mortality differently from those lacking this allele. Conclusion: The present study demonstrated an association of the IL-6-174 and the IL-10-1082 with increased mortality in patients suffering from severe sepsis. We found no direct association between the examined polymorphisms and the corresponding cytokine levels.
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    Associations of Genetic Polymorphisms with Clinical Course and Mortality in Severe Sepsis. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2011) Sabeļņikovs, Oļegs; Vanags, Indulis; Ņikitina-Zaķe, Liene
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    Cerebral Oxygenation Changes Observed In Patients Undergoing Spinal Neurosurgery in Prone Position Using Near Infrared Spectroscopy
    (2017-07-16) Mūrniece, Sniedze; Vanags, Indulis; Mamaja, Biruta; Rīga Stradiņš University
    Near infrared spectroscopy (NIRS) devices like cerebral oximeters have lately gained their actuality in different fields of medicine. Used intraoperative they can early detect harmful event and gives a possibility to avoid from further brain damage. The goal of study was to determine whether prone position during spinal neurosurgery impacts cerebral oxygen saturation using NIRS.
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    The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database
    (2020-04-23) Vincent, Jean Louis; Ferguson, Andrew; Pickkers, Peter; ICON Investigators; Vanags, Indulis; Liguts, Viesturs
    Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.
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    DIFFICULT AIRWAY PREDICTORS FOR ANTICIPATED OR UNANTICIPATED DIFFICULT AIRWAY IN PATIENTS WITH FIBREOPTIC INTUBATION : A RETROSPECTIVE OBSERVATIONAL STUDY
    (2024-12) Bērziņš, Arvīds; Bine, Evita; Kļučņiks, Andris; Vanags, Indulis; Ozoliņa, Agnese; Rīga Stradiņš University
    Airway management is a cornerstone of anaesthesia. The aim of the study was to identify difficult airway (DA) predictors for patients with fibreoptic intubation (FOI). This retrospective cohort study included 135 adult patients undergoing general anaesthesia with the use of FOI at Rîga East University Hospital from 1 January 2018 to 31 December 2022. For analysis, 135 patients were divided into two groups according to unanticipated (un-DA, n = 33) or anticipated DA: (a-DA, n = 102). Data were analysed using SPSS 26.0, p < 0.05. FOI was used only in 135 cases of 50,186 general anaesthesia cases over the study period. Of 135 FOI cases, 75 (55.6%) were males with a median age of 62 ± 19 years; 24.4% FOI was used in acute and 75.6% in elective surgeries. Those with a-DA had a higher Mallampati score, on average 3.2 vs. 2.1, p = 0.002. Unanticipated DA were reported statistically more frequently in acute admission cases compared to elective surgeries — 39.3% vs 10.8% of cases. Previously known tracheal pathologies such as dislocation (p = 0.001) and stenosis (p = 0.011) were statistically reliable factors for the anticipated DA. Comparing a-DA and un-DA groups for combinations of predictors (Mallampati score, admission and tracheal pathology) we found a sensitivity and specificity 70.3% and 68.7% to predict DA. Mallampati score, acute admission, and previously known tracheal pathology are reliable predictors of DA in patients undergoing FOI. Acute admission had the greatest impact on unanticipated DA.
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    Effects of Different Epidural Analgesic Compositions on Postoperative Pain Relief and Systemic Response to Surgery
    (2008-01) Golubovska, Iveta; Studers, Peteris; Jaunalksne, Inta; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Despite many achievements during the last decade, postoperative pain remains the dominant complaint after major surgery and has great potential to be influenced by the anaesthesiologist. Reports suggest that short-term effective anaesthesia and analgesia can have long-lasting beneficial effects on recovery from surgery. The aim of our study is to compare the effect of epidural analgesia, using different compositions, including glucocorticoids (methylprednisolone), and habitual composition of bupivacaine-morphine, in regard to analgesic and anti-inflammatory properties. A total of 129 patients participated in the study in four different treatment groups: patients from Group I received glucocorticoid methylprednisolone succinate and long-acting opioid morphine hydrochloride, Group II received local anaesthetic bupivacaine hydrochloride and morphine hydrochloride, Group III received methylprednisolone succinate and short-acting opioid fentanyl, and Group IV received glucocorticoid methylprednisolone succinate. We obtained good analgesic profiles in all groups. However, significantly better results were achieved using the combination of methylprednisolone and morphine. Epidural methylprednisolone in dose 80 mg/24 h is more effective, compared to the conventional local anaesthetics-opioid composition, when administered as a part of multimodal preventive postoperative analgesia after major joint replacement surgery. Epidural methylprednisolone has a reliable anti-inflammatory and immunomodulatory potential. It attenuates profiles of acute inflammatory response markers as Interleukin-6 and C-reactive protein and stress hormone cortisol. The novelty of this study was application of epidural glucocorticoids for acute postoperative pain relief as part of daily perioperative care. By developing studies on anti-inflammatory and immunomodulatory properties of glucocorticoids, we expect to improve patient rehabilitation in the postoperative period.
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    Factors affecting a successful out-of-hospital cardiopulmonary resuscitation
    (2014-12-01) Kalēja, Anita; Šetlers, Kaspars; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    A retrospective patient record analysis of the Emergency Medial Service's Rîga City Regional Centre was provided from January 2012 through December 2013. 1359 adult patients were CPR treated for out-of-hospital cardiac arrest according to ERC Guidelines 2010. A total of 490 patients were excluded from the study. The main outcome measure was survival to hospital admission. Of 869 CPR-treated patients, 60% (n = 521) were men. The mean age of patients was 66.68 ± 15.28 years. The survival rate to hospital admission was 12.9% (n = 112). 54 of survived patients were women. Mean patient age of successful CPR was 63.22 ± 16.21 and unsuccessful CPR 67.20 ± 15.09. At least one related illness was recorded with 63.4% (n = 551) patients. There were 61 survivors in bystander witnessed OHCA and nine survivors in unwitnessed OHCA. The rate of bystander CPR when CA (cardiac arrest) was witnessed was 24.8%. Ventricular fibrillation (VF) as initial heart rhythm was significantly associated with survival to hospital admission in 54 cases (p < 0.0001). Age and gender affected return of spontaneous circulation. Survival to hospital admission had rhythm-specific outcome. Presence of OHCA witnesses improved outcome compared to bystander CPR. The objective of this study was to report patient characteristics, the role of witnesses in out-of-hospital cardiac arrest (OHCA) and outcome of adult cardiopulmonary resuscitation.
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    Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery
    (2016-12-01) Stepanovs, Jevgeņijs; Ozolina, Agnese; Rovite, Vita; Mamaja, Biruta; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations
    Microvascular free flap surgery, has become an important part of reconstructive surgery during the last decades, as it allows closure of various tissue defects and recovery of organs function. Despite surgical progress resulting in high rates of transferred tissue survival, the risk of pedicle vessels thrombosis still remains a significant problem. A total of 108 articles from Pubmed and Science Direct databases published in 2005-2015 were analysed. This review of the literature assessed the influence of patient-dependent risk factors and different perioperative management strategies on development of microvascular free flap thrombosis. Sufficient evidence for risk associated with hypercoagulation, advanced age and certain comorbidities was identified. Presently, rotational thromboelastometry allows early hypercoagulability detection, significantly changing further patient management. Identification of flap thrombosis promoting surgery-related aspects is also essential in preoperative settings. Choice of anaesthesia and postoperative analgesia, administration of different types and amounts of fluids, blood products and vasoactive agents, temperature control are no less important in perioperative anaesthesiological management. More attention should be focused on timely preoperative evaluation of patient-dependent risk factors, which can influence anaesthesiological and surgical tactics during and after microvascular free flap surgery. Perioperative anaesthesiological management strategy continues to be controversial and therefore it should be performed based on thrombotic risk assessment and patient individual needs, thus improving flap survival rates and surgical outcome.
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    Fibrinolytic system changes in liver surgery : A pilot observational study
    (2018) Ozolina, Agnese; Nemme, Janis; Ozolins, Arturs; Bjertnæs, Lars J.; Vanags, Indulis; Gardovskis, Janis; Viksna, Ludmila; Krumina, Angelika; Rīga Stradiņš University
    Introduction: Bleeding occurs frequently in liver surgery. Unbalance between tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) concentrations might increase bleeding. Our aim was to analyze perioperative fibrinolytic changes during liver surgery. Materials and Methods: We evaluated 15 patients for inclusion into a prospective pilot study of liver surgery. We assessed fibrinolysis by plasma PAI-1 and t-PA: before surgery (T1), before Pringle maneuver (PM;T2), at the end of surgery (T3) and 24 h postoperatively (T4), and registered demographic and laboratory data, extent and duration of surgery, hemodynamic parameters, blood loss, and transfused volumes of blood products. Data presented as mean ± SD. Significance at P < 0.05. Results: After exclusion of six patients only undergoing biopsies, we included six women and three men aged 49.1 ± 19.6 years; two patients with liver metastases of colorectal cancer and hepatocellular carcinoma, respectively, two with focal nodular hyperplasia, two with hepatic hemangioma, and one with angiomyolipoma. Six patients underwent PM. PAI-1 plasma concentration (n = 9) rose from 6.25 ± 2.25 at T1 through 17.30 ± 14.59 ng/ml at T2 and 28.74 ± 20.4 (p = 0.007) and 22.5 ± 16.0 ng/ml (p = 0.04), respectively, at T3 and T4. Correspondingly, t-PA plasma concentration (n = 9) increased from 4.76 ± 3.08 ng/ml at T1 through 8.00 ± 5.10 ng/ml (p = 0.012) at T2 and decreased to 4.25 ± 2.29 ng/ml and 3.04 ± 3.09 at T3 and T4, respectively. Plasma t-PA level at T2 was significantly different from those at T1, T3, and T4 (p < 0.004). In PM patients, t-PA levels increased from T1, peaked at T2 (p = 0.001), and subsequently decreased at T3 and T4 (p = 0.011 and p = 0.037), respectively. Mean blood loss was 1,377.7 ± 1,062.8 ml; seven patients received blood products. Patients with higher PAI-1 levels at T3 received more fresh frozen plasma (r = 0.79; p = 0.01) and red blood cells (r = 0.88; p = 0.002). Conclusions: During liver surgery, fibrinolysis increased, as evidenced by rises in plasma PAI-1and t-PA, especially after start of surgery and following PM. Transfused volumes of blood products correlated with higher plasma concentrations of PAI-1. Confirming this tendency requires a larger cohort of patients.