Background. Sufficient preoxygenation prevents arterial oxygen desaturation prior to intubation. An optimally sealed facemask is necessary for fast preoxygenation. The study was aimed at comparing the efficiency of preoxygenation using two different face masks. Materials and methods. In 2018, a prospective study was conducted. Patients were classified into two groups: group A – Intersurgical Economy face masks, group B – Intersurgical QuadraLite masks. The circuit was flushed with 100% O2 for 30s, preoxygenation started with flow of 8l/min, FiO2100. The patients were asked to breathe deeply. Fentanyl (1–2 mcg/kg) was administered to increase mask toleration. End-tidal oxygen concentration (EtO2) ≥90% was the goal. EtO2 was monitored after 30, 60, 90, 120, 180, 210, 240, 270 and 300 seconds. Data was analyzed using the Independent-Samples T-test and the Mann-Whitney-U test. Results. Twelve patients were enrolled in group A and 19 in group B. Differences in sex, age, BMI and Mallampati class in the groups were statistically insignificant (p = 0.13, 0.39, 0.65, 0.43 respectively). Patients assigned to ASA I – 25.8% (n = 8–>2/6), ASA II – 71.0% (n = 22–>10/12), ASA III – 3.2% (n = 1–>0/1), p = 0.64. The success rate of preoxygenation to EtO290 within 5 min was statistically significantly different in the groups, with 33.3% in group A and 94.7% in group B (p < 0.01). Mean time to EtO290 was 228.3 ± 104.0/164.4 ± 84.3. Mean EtO2 after: 30s – 56.0 ± 13.5/69.3 ± 11.2 (p < 0.01); 60s – 63.8 ± 15.3/76.1 ± 11.7 (p = 0.02), 90s – 67.8 ± 17.7/80.7 ± 10.1 (p = 0.03); 120s– 69.6 ± 18.2/83.4 ± 10.0 (p = 0.03), 150s–71.1 ± 19.0/87.1 ± 6.5 (p = 0.01); 180s – 72.9 ± 16.8/88.5 ± 5.3 (p = 0.01), 210s – 72.6 ± 18.0/89.2 ± 5.1 (p < 0.01); 240s – 74.17 ± 15.4/90.0 ± 4.3 (p < 0.01), 270s-76.3 ± 16.3/90.2 ± 3.6; 300s – 77.8 ± 14.6/90.2 ± 1.5 (p < 0.01). Conclusions. Preoxygenation was significantly more efficient and faster with Intersurgical QuadraLite face masks.

Background and objectives Deleterious effects on short‐term and long‐term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low‐risk surgery of thyroid gland. Materials and methods Eighty‐two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. Results Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (–2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = –0.35, p = .007). Conclusions Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low‐risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.

Background International application of existing guidelines and recommendations on anesthesia-specific informed consent is limited by differences in healthcare and legal systems. Understanding national and regional variations is necessary to determine future guidelines. Material/Methods Anonymous paper surveys on their practices regarding anesthesia-specific patient informed consent were sent to anesthesiologists in Estonia, Latvia, and Lithuania. Results A total of 233 responses were received, representing 36%, 26%, and 24% of the practicing anesthesiologists in Lithuania, Latvia, and Estonia, respectively. Although 85% of responders in Lithuania reported using separate forms to secure patient informed consent for anesthesia, 54.5% of responders in Estonia and 50% in Latvia reported using joint forms to secure patient informed consent for surgery and anesthesia. Incident rates were understated by 14.2% of responders and overstated by 66.4% ( P <0.001), with the latter frequently quoting incident rates that are several to tens of times higher than those published internationally. Physicians obtaining consent in the outpatient setting were more satisfied with the process than those obtaining consent on the day of surgery, with 62.5% and 42.6%, respectively, agreeing that the informed consent forms provided a satisfactory description of complications ( P =0.03). Patients were significantly less likely to read consent information when signing forms on the day of surgery than at earlier times (8.5% vs. 67.5%, P <0.001). Only 46.2% of respondents felt legally protected by the current consent process. Conclusions Anesthesia-specific informed patient consent practices differ significantly in the 3 Baltic states, with these practices often falling short of legal requirements. Efforts should be made to improving information accuracy, patient autonomy, and compliance with existing legal standards.

Informuoto asmens sutikimas tampa vis svarbesnis kasdienėje anesteziologo praktikoje dėl nuolat didėjančių reikalavimų sveikatos apsaugos standartams. Tačiau šiuo metu nėra vieningos formos. Dažnai anesteziologai, remdamiesi savo patirtimi, patys nusprendžia, apie kokias anestezijos rizikas kalbėti su pacientu, o tokia praktika neatitinka šiuo metu propaguojamos įrodymais grįstos medicinos reikalavimų. Šio tyrimo tikslas buvo įvertinti informuoto asmens sutikimo atlikti anesteziją gavimo praktiką ir anestezijos komplikacijų vertinimą tarp Lietuvos anesteziologų. Atlikta savanoriška ir anoniminė anesteziologų-reanimatologų apklausa. Respondentai turėjo atsakyti į klausimus apie sutikimo atlikti anesteziją gavimo praktiką jų darbovietėje bei atskleidžiančius jų žinias apie informuoto paciento sutikimą. Apklausą užpildė 146 respondentai. Respondentų demografiniai duomenys atspindėjo Lietuvos anesteziologų-reanimatologų bendruomenės demografinę sudėtį. Bemaž 90% pacientų pasirašo sutikimą tą pačią dieną prieš operaciją. 91% respondentų teigė, kad pacientai neperskaito formoje nurodytos informacijos, bet tik 32% manė, kad tai yra todėl, kad jų naudojama sutikimo atlikti anesteziją forma per daug sudėtinga. Dauguma gydytojų nurodė nuo 6 iki 20 kartų didesnį sunkių anestezijos komplikacijų dažnį, nei nurodoma tarptautinėje literatūroje ir vidutiniškai tik 17,3% pateikė tikslius atsakymus. Tik 43,8% respondentų mano, kad esama sutikimo atlikti anesteziją forma apsaugo gydytoją skundų ir teisinio nagrinėjimo atvejais. Informuoto asmens sutikimo atlikti anesteziją procedūra Lietuvoje dažnai neatitinka saugios anestezijos reikalavimų. Gydytojai yra linkę pervertinti komplikacijų riziką, todėl pacientams pateikiama informacija gali ženkliai skirtis. Reikalinga nauja sistema, kuri leistų užtikrinti pilnavertišką paciento sutikimą atlikti anesteziją.

Optimal preoxygenation (PO) prior to tracheal intubation reduces the risk of arterial desaturation and prolongs the period of safe apnoea. The common methods of PO are mask ventilation with 100% O2 for 3–5 minutes or, alternatively, asking the patient to take eight deep breaths in a minute. Our study group conducted a prospective study to assess the impact of the most common risk factors on PO and to compare the efficiency of PO in patients undergoing elective and emergency abdominal surgery without premedication. PO was performed using mask ventilation with 6 l/min of 100% oxygen for 5 minutes. End-tidal oxygen (EtO2) was documented in 30-second increments. We found that optimal PO (EtO2 > 90%) was not achieved by almost half of the patients (46%) and that this was more common in the elective surgery group. Effective PO was not impacted by any of the evaluated risk factors for suboptimal oxygenation. Despite these findings, we believe that the identification of potential risk factors is crucial in the pre-anaesthesia stage, given the benefits of optimal PO.