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1.

001-es BibID:BIBFORM103883
035-os BibID:(scopus)85139221245 (wos)000865207700002
Első szerző:László István (aneszteziológus)
Cím:Preparing the Patient for ICU Transfer : what Is the Anesthesiologist's Role? / László István, Végh Tamás, Szántó Dorottya, Juhász Marianna, Molnár Csilla, Fülesdi Béla
Dátum:2022
ISSN:2167-6275
Megjegyzések:Purpose of Review This review summarizes the anesthesiologist's role in transferring critically ill surgical patients at different phases of care. Recent Findings Early recognition of patients at high intraoperative and postoperative risk is one of the most important first steps, followed by preoperative and intraoperative stabilization measures depending on the individual needs. It mainly is the anesthesiologist's responsibility to decide on postoperative ICU admission. The transfer of the critically ill should be planned; the ICU staff has to be informed as early as possible. Locally developed checklists should be used during the preparation of patient transport. Trained, dedicated staff should be made available in every institution. A detailed handover using dedicated institutional flowcharts should ensure patient safety upon arrival to the ICU. Summary Transfer of critically ill patients from the OR to the ICU is an interdisciplinary task with a high probability of eventual incidents. Anesthesiologists should play a key role in all phases of the procedure to improve patient outcomes.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
High-risk surgery
Critically ill patients
Intrahospital transport
Critical incidents
Transportation team
Handover communication
Megjelenés:Current Anesthesiology Reports. - 12 (2022), p. 461-466. -
További szerzők:Végh Tamás (1975-) (aneszteziológus, intenzív terápiás szakorvos) Szántó Dorottya (1991-) (aneszteziológus, intenzív terápiás szakorvos) Juhász Marianna (1975-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus) Fülesdi Béla (1961-) (aneszteziológus)
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2.

001-es BibID:BIBFORM102086
035-os BibID:(cikkazonosító)e0268525 (WOS)000835048800009 (Scopus)85130851932
Első szerző:Molnár Csilla (aneszteziológus)
Cím:Takotsubo cardiomyopathy in patients suffering from acute non-traumatic subarachnoid hemorrhage : A single center follow-up study / Molnár Csilla, Gál Judit, Szántó Dorottya, Fülöp László, Szegedi Andrea, Siró Péter, Nagy V. Endre, Lengyel Szabolcs, Kappelmayer János, Fülesdi Bela
Dátum:2022
ISSN:1932-6203
Megjegyzések:Background Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), that may delay surgical or endovascular treatment and may influence patient outcome. This prospective follow-up study intended to collect data on the prevalence, severity, influencing factors and long-term outcome of TTC in patients suffering from non-traumatic SAH. Methods Consecutive patients admitted with the diagnosis of non-traumatic SAH were included. Intitial assessment consisted of cranial CT, Hunt-Hess, Fisher and WFNS scoring, 12-lead ECG, transthoracic echocardiography (TTE), transcranial duplex sonography and collecting laboratory parameters (CK, CK-MB, cardiac troponin T, NT-proBNP and urine metanephrine and normetanephrine). Diagnosis of TTC was based on modified Mayo criteria. TTC patients were dichotomized to mild and severe forms. Follow-up of TTE, Glasgow Outcome Scale assessment, Barthel's and Karnofsky scoring occurred on days 30 and 180. Results One hundred thirty six patients were included. The incidence of TTC in the entire cohort was 28.7%; of them, 20.6% and 8.1% were mild and severe, respectively. TTC was more frequent in females (30/39; 77%) than in males (9/39; 23%) and was more severe. The occurrence of TTC was related to mFisher scores and WFNS scores. Although the severity of TTC was related to mFisher score, Hunt-Hess score, WFNS score and GCS, multivariate analysis showed the strongest relationship with mFisher scores. Ejection fraction differences between groups were present on day 30, but disappeared by day 180, whereas wall motion score index was still higher in the severe TTC group at day 180. By the end of the follow-up period (180 days), 70 (74.5%) patients survived in the non-TTC, 22 (81.5%) in the mild TTC and 3 (27%) in the severe TTC group (n = 11) (p = 0.002). At day 180, GOS, Barthel, and Karnofsky outcome scores were higher in patients in the control (non-TTC) and the mild TTC groups than in the severe TTC group. Conclusions Takotsubo cardiomyopathy is a frequent finding in patients with SAH, and severe TTC may be present in 8% of SAH cases. The severity of TTC may be an independent predictor of mortality and outcome at 6 months after disease onset. Therefore, a regular follow-up of ECG and TTE abnormalities is warranted in patients with subrachnoid hemorrhage for early detection of TTC.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Plos One. - 17 : 5 (2022), p. 1-20. -
További szerzők:Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Szántó Dorottya (1991-) (aneszteziológus, intenzív terápiás szakorvos) Fülöp László (1976-) (kardiológus) Szegedi Andrea (kardiológus) Siró Péter (1973-) (neurológus, aneszteziológus, intenzív terápiás szakorvos) Nagy Endre V. (1957-) (belgyógyász, endokrinológus) Lengyel Szabolcs (1981-) (belgyógyász) Kappelmayer János (1960-) (laboratóriumi szakorvos) Fülesdi Béla (1961-) (aneszteziológus)
Pályázati támogatás:Nemzeti Agykutatási Projekt
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Intézményi repozitóriumban (DEA) tárolt változat
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3.

001-es BibID:BIBFORM115392
Első szerző:Szántó Dorottya (aneszteziológus, intenzív terápiás szakorvos)
Cím:Correlation of Various Laboratory Parameters with Vasospasm and Outcome in Acute Non-traumatic Subarachnoid Hemorrhage / Szántó Dorottya, Kóti Nikolett, Gál Judit, Fülesdi Béla, Molnár Csilla
Dátum:2023
ISSN:1351-5101
Megjegyzések:Background and aims: Among patients with acute subarachnoid hemorrhage (SAH) lower hemoglobin (Hgb) levels and elevated white blood cell (WBC) count and C-reactive protein (CRP) levels are common. We aimed to investigate these parameters as possible early indicators of vasospasm (VS) and outcome. Methods: Subgroup analysis of our previous prospective study was performed. In total, 116 acute, non-traumatic SAH patients with daily transcranial color Doppler (TCCD) reports were enrolled in our analysis. VS was defined as >120 cm/s mean blood flow velocity in the medial cerebral artery. The following data were also processed: SAH severity scores (Modified Fisher, Hunt-Hess, WFNS), laboratory parameters on the first week after SAH (WBC, CRP, Hgb), and 1 and 6-month outcome scores (Glasgow Outcome Scale, Barthel Scale). Results: VS was detected in 31% of the cases. Patients with VS have significantly lower Hgb level (p=0.008) and higher WBC count (p=0.002) compared to patients without VS. There was no significant difference in CRP levels (p=0.201). Extended SAH and severe neurological damage were connected to higher CRP and WBC peaks and lower Hgb levels. On 1 and 6-month follow-up anemia, higher CRP and WBC count were related to worse outcome. Conclusion: Based on our results, there is a correlation between lower Hgb level, higher WBC count and VS. WBC count, CRP and Hgb levels may serve as early indicators of outcome. Disclosure: Nothing to disclose.
Tárgyszavak:Orvostudományok Klinikai orvostudományok konferenciacikk
folyóiratcikk
Megjelenés:European Journal of Neurology. - 30 : Suppl. 1 (2023), p. 319. -
További szerzők:Kóti Nikolett (1998-) (orvostanhallgató) Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Fülesdi Béla (1961-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus)
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Intézményi repozitóriumban (DEA) tárolt változat
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4.

001-es BibID:BIBFORM115389
035-os BibID:(cikkazonosító)000240
Első szerző:Szántó Dorottya (aneszteziológus, intenzív terápiás szakorvos)
Cím:Incidence and characteristics of Takotsubo cardiomyopathy in subarachnoid haemorrhage: a prospective study / Szántó Dorottya, Gál Judit, Fülöp László, Szegedi Andrea, Fülesdi Béla, Molnár Csilla
Dátum:2019
ISSN:2197-425X
Megjegyzések:INTRODUCTION. Takotsubo cardiomyopathy (TTC) is an acute, usually reversible heart failure syndrome, precipitated by emotional or physical stressors. The initial presentation of TTC has similar features to acute coronary syndrome, however, coronary angiography usually shows an absence of significant coronary artery disease. TTC has been previously described as a notable complication of SAH because of its impact on cerebral blood flow. OBJECTIVES. The aim of our prospective observational study was to investigate the incidence, predisposing factors and cardiac biomarkers of TTC associated with SAH. Our secondary goal was to evaluate its effect on outcome. METHODS. This study was conducted in our neurosugical intensive care unit between March 2015 and June 2018 (Clinical trials reg. Nr: NCT02659878). We enrolled non-traumatic SAH patients without a history of cardiac disease, who were admitted within 48 hours from symptom onset. On admission we noted the severity of the haemorrhage (modified Fisher score) and neurological state (Hunt-Hess and WFNS scores) and transthoracic echocardiogram was performed. Patients with wall motion abnormality (WMA) were diagnosed as TTC, TTC patients with ejection fraction lower than 40% were classified as severe TTC (sTTC), patients without WMA served as control group (CG). Cardiac necroenzyme detection and transcranial colour duplex was performed on a daily basis. Each patient went through follow-up echocardiograms. We evaluated Glasgow Outcome Scale (GOS) and Barthel Scale (BS) 30 days and 6 months after the onset of SAH. RESULTS. During the study period 136 patients fulfilled inclusion criteria. Incidence of TTC was 28,7% (n=39), sTTC was found in 8,1% (n=11) of the cases. TTC was more common among females than males (female/male: CG 50/47 vs. TTC 30/9, p=0,007). Higher modified Fisher score was more frequent in the TTC group (modified Fisher>2: TTC 32/39 vs. CG 54/97; p=0,004). Higher Hunt-Hess (HH> 3: sTTC 8/11 vs. CG 29/97; p=0,012) and WFNS-score (WFNS>3: sTTC 9/11 vs. CG 29/97; p=0,002) was characteristic for sTTC. Serious vasospasm had higher incidence in the sTTC group (sTTC 3/11 vs. CG 5/97; p=0,04). We found significantly elevated cTnT and NT-proBNP levels in TTC patients. On 1 and 6 month follow-up sTTC was related to increased mortality (sTTC vs. CG: 7/11 vs. 15/95, p<0,001; 8/11 vs. 24/93, p=0,004) and lower GOS score (GOS<4: sTTC vs. CG 11/11 vs 44/95, p=0,002; 9/11 vs. 32/93, p=0,007). At 30th day lower quality of life was observed in the sTTC group (BS<50: sTTC 4/4 vs. CG 23/79, p=0,016). CONCLUSION. TTC is a common cardiac complication of SAH, especially in serious SAH with severe neurological symptoms. cTnT and NT-proBNP properly signs the presence of TTC. The harmful effect of TTC on cerebral circulation may contribute to increased mortality and disability.
Tárgyszavak:Orvostudományok Klinikai orvostudományok konferenciacikk
folyóiratcikk
Megjelenés:Intensive Care Medicine Experimental. - 7 : Suppl. 3 (2019), p. 263. -
További szerzők:Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Fülöp László (1976-) (kardiológus) Szegedi Andrea (kardiológus) Fülesdi Béla (1961-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus)
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Intézményi repozitóriumban (DEA) tárolt változat
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5.

001-es BibID:BIBFORM112757
035-os BibID:(cikkazonosító)177 (WoS)001025509200004 (Scopus)85164007315
Első szerző:Szántó Dorottya (aneszteziológus, intenzív terápiás szakorvos)
Cím:Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage : a Comprehensive Review / Dorottya Szántó, Péter Luterán, Judit Gál, Endre V. Nagy, Béla Fülesdi, Csilla Molnár
Dátum:2023
ISSN:1530-6550 2153-8174
Megjegyzések:Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty in therapy may delay the definitive treatment of the aneurysm, therefore increasing the risk of rebleeding. The purpose of this review is to summarize the latest knowledge on the diagnosis and therapy of TS in SAH and to provide a diagnostic and therapeutic algorithm for the acute phase, promoting the early definitive treatment of the aneurysm. Rapid hemodynamic stabilization and early aneurysm securing are key points in reducing the risk of delayed cerebral ischemia and improving outcomes. In acute SAH noninvasive bedside diagnostic methods are preferred and securing the aneurysm is the priority. The combination of electrocardiography, cardiac biomarkers, and echocardiography is of great importance in differentiating TS from acute myocardial infarction. The risk-benefit ratio of coronary angiography should be carefully and individually considered and its use should be limited to patients with strong evidence of myocardial ischemia, after the successful endovascular treatment of the aneurysm. Invasive hemodynamic monitoring may be beneficial in cases of cardiogenic shock or pulmonary edema. In patients with hemodynamical instability secondary to TS, the use of non-catecholamine inotropes, especially levosimendan is recommended. In refractory hypotension, mechanical support should be considered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Takotsubo syndrome
subarachnoid hemorrhage
neurogenic stunned myocardium
delayed cerebral ischemia
intracranial aneurysm treatment
Megjelenés:Reviews in Cardiovascular Medicine. - 24 : 6 (2023), p. 177-189. -
További szerzők:Luterán Péter (1991-) (aneszteziológus) Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Nagy Endre V. (1957-) (belgyógyász, endokrinológus) Fülesdi Béla (1961-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus)
Pályázati támogatás:ELKH-DE Cerebrovascular Research Grop
MTA
TKCS-2021/60).
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6.

001-es BibID:BIBFORM104718
Első szerző:Szántó Dorottya (aneszteziológus, intenzív terápiás szakorvos)
Cím:Pediatric Neuroanesthesia : a Review of the Recent Literature / Szántó Dorottya, Gál Judit, Tankó Béla, Siró Péter, Jakab Zsuzsa, Luterán Péter, Fülesdi Béla, Molnár Csilla
Dátum:2022
ISSN:2167-6275
Megjegyzések:Purpose of Review Pediatric neuroanesthesia is a growing and still challenging subspecialty. The purpose of this review is to summarize the available knowledge and highlight the most recent fndings of the literature on non-traumatic pediatric neuroanesthesia care. Recent Findings Several human studies have confrmed the negative efects of early life anesthetic exposure. According to non-human studies, volatile anesthetics and opioids contribute to tumor progression. Tranexamic acid efectively reduces peri operative blood loss; it is used in several diferent doses without standard guidelines on optimal dosing. The widespread use of neuromonitoring has necessitated the development of anesthetic methods that do not afect neuromuscular transmission. Summary Pediatric anesthetic neurotoxicity, management of intraoperative bleeding, and the efect of anesthesia on tumor growth are among the most debated and researched topics in pediatric neuroanesthesia. The lack of evidence and clinical guidelines underlines the need for further large prospective studies in this subspecialty.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Pediatric neuroanesthesia
Craniosynostosis
Brain tumor
Scoliosis surgery
Epilepsy surgery
Procedural sedation
Megjelenés:Current Anesthesiology Reports. - 12 (2022), p. 467-475. -
További szerzők:Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Tankó Béla (1972-) (aneszteziológus) Siró Péter (1973-) (neurológus, aneszteziológus, intenzív terápiás szakorvos) Jakab Zsuzsa (1982-) (aneszteziológus) Luterán Péter (1991-) (aneszteziológus) Fülesdi Béla (1961-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus)
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