Papers by Georgios Karpetas
Case report
complications. Postoperative pain was easily controlled with paracetamol and low-dose tramadol. C... more complications. Postoperative pain was easily controlled with paracetamol and low-dose tramadol. Conclusions Patients with severe aortic stenosis remain a challenge for anesthesiologists when presenting for orthopedic surgery. Continuous spinal anesthesia with peripheral nerve block is a safe and effective technique for these patients.
Cardiovascular Revascularization Medicine
JACC: Cardiovascular Interventions, 2022
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, Feb 1, 2021
Aim To investigate analgesic effect of three different regimens of combination of analgesics admi... more Aim To investigate analgesic effect of three different regimens of combination of analgesics administered to patients undergoing laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomy were randomly allocated to one of three groups on admission, depending of a prescribed post-operative analgesic regimen. Patients allocated to the group A received a combination of intravenous (IV) acetaminophen and intramuscular (IM) pethidine, patients in the group B received a combination of IV acetaminophen and IV parecoxib, and the patients of the group C received IV acetaminophen monotherapy. Analgesic therapy was administered at regular intervals. Pain was evaluated utilizing the numeric rating scale (NRS) at 5 time points: the first assessment was done at 45 minutes, the second, third, fourth and fifth at 2, 6, 12, and 24 hours post-administration, respectively. Postoperative pain intensity was measured by NRS within the groups and between the groups at each time they analysed using one-way repeat measured ANOVA and Post Hoc Test-Bonferroni Correlation. Results A total of 316 patients were enrolled. The analgesic regimens of groups A and B (combination regimens consisting of IV acetaminophen and intramuscular pethidine and IV acetaminophen and IV parecoxib, respectively) were found to be of equivalent efficacy (p=1.000). In contrast, patients in group C (acetaminophen monotherapy) had higher NRS scores, compared to both patients in groups A (p<0.01) and B (p<0.01). Conclusion This study confirms the notion of a significant opioid-sparing effect of parecoxib in postoperative pain management after laparoscopic cholecystectomy.
Research Square (Research Square), May 17, 2022
Background/Purpose Coronary angiography and percutaneous coronary intervention (PCI) procedural d... more Background/Purpose Coronary angiography and percutaneous coronary intervention (PCI) procedural details in swine are similar to those performed to humans, since their heart and coronary anatomy closely resembles. However, only a few detailed descriptions of the procedure are available, containing notable differences. We present a feasible and reproducible protocol for percutaneous coronary interventions in porcine experimental models, utilizing ultrasound-guided femoral approach. Methods/Materials Nine female pigs were studied to explore the feasibility of super cial femoral arterial (SFA) access for coronary angiography and provisional PCI, as well as the most suitable guiding coronary catheters and angiographic projections for the above interventions. Experiments were performed under general anesthesia, using ultrasound-guided puncture of the SFA to gain arterial access. The Amplatzer AR1® catheter, and the Right Coronary Bypass® catheter were used for the selective engagement of the right and the left coronary artery respectively. Results Successful arterial access and subsequent cardiac catheterization were performed in all pigs. Only one animal required a second puncture for femoral artery access. None of the 9 animals presented any signi cant tachycardia or hypotensive episode. One animal developed an access site-related complication following the rst catheterization procedure. During follow-up, 100% success of SFA catheterization was achieved using the same ultrasound-guided technique. Conclusions The ultrasound-guided super cial femoral artery access for coronary angiography and provisional interventions in porcine models is a quick and safe alternative to the carotid artery approach. The RCB and AR1 catheters may be the best choice for the quick and easy selective coronary engagement of the right and left ostia respectively.
Journal of Musculoskeletal & Neuronal Interactions, Mar 1, 2021
Objectives: To evaluate three different analgesic techniques, continuous epidural analgesia (EA),... more Objectives: To evaluate three different analgesic techniques, continuous epidural analgesia (EA), continuous intraarticular (IA) infusion analgesia and continuous femoral nerve block (FNB) in postoperative pain management, length of hospital stay (LOS), and time of patient mobilization after total knee arthroplasty (TKA). Methods: Seventy-two patients undergoing TKA were randomly allocated into three groups according to the analgesic technique used for postoperative pain management. Group EA patients received epidural analgesia (control group), group IA received intra-articular infusion and group FNB received femoral nerve block. Results: Upon analyzing the Numerical Rating Scale (NRS) scores at rest, at passive and active movement, up to 3 days postoperatively, we observed no statistically significant differences at any time point among the three groups. Similarly, no association among these analgesic techniques (EA, IA, FNB) was revealed regarding LOS. However, significant differences emerged concerning the time of mobilization. Patients who received IA achieved earlier mobilization compared to FNB and EA. Conclusions: Both IA and FNB generate similar analgesic effect with EA for postoperative pain management after TKA. However, IA appears to be significantly more effective in early mobilization compared to EA and FNB. Finally, no clinically important differences could be detected regarding LOS among the techniques studied.
Scientific Reports
Coronary angiography and percutaneous coronary intervention (PCI) procedural details in swine are... more Coronary angiography and percutaneous coronary intervention (PCI) procedural details in swine are similar to those performed to humans, since their heart and coronary anatomy closely resembles. However, only a few detailed descriptions of the procedure are available, containing notable differences. We present a feasible and reproducible protocol for percutaneous coronary interventions in porcine experimental models, utilizing ultrasound-guided femoral approach. Nine female pigs were studied to explore the feasibility of superficial femoral arterial (SFA) access for coronary angiography and provisional PCI, as well as the most suitable guiding coronary catheters and angiographic projections for the above interventions. Experiments were performed under general anesthesia, using ultrasound-guided puncture of the SFA to gain arterial access. The Amplatzer AR1® catheter, and the Right Coronary Bypass® catheter were used for the selective engagement of the right and the left coronary arte...
Journal of Vascular and Interventional Radiology, 2019
Purpose: This was a two-stage experimental animal study investigating the safety and effectivenes... more Purpose: This was a two-stage experimental animal study investigating the safety and effectiveness (experiment A) together with the pharmacokinetic properties (experiment B) of a novel Drug-Coated Balloon (DCBn) using a 3.5 μg/mm 2 paclitaxel coating on a cellulose-based excipient. Materials: In experiment A, DCBn was compared with a control non-DCB and two different DCBs available in the market. The arterial system of swine was used (12swine, 6vessels in each animal; 72treatment sites in total). Randomization was performed in a 3:1:1:1 proportion (Group DCBn: 36balloons, Group non-DCB: 12balloons, Group market-DCB1: 12balloons, Group market-DCB2: 12balloons). Optical coherence tomography was performed immediately after balloon dilatation and at 3 months. Primary endpoint was cross-sectional vessel wall area difference between baseline and 3 months. In experiment B, 38rabbits were used to assess DCBn's pharmacokinetic properties. Two vessels were used in every animal (76 treatment sites). DCBn and market-DCB1 were used in 18 animals and 20 animals had only DCBn. Animals were euthanized at 1hour, 24hours, 7days and 28days and vascular tissue was removed. Paclitaxel tissue concentration was determined by high-performance liquid chromatography/tandem mass spectrometry. Results: Paired median differences over baseline were-0.09mm 2 for DCBn (p¼0.33), +0.52mm 2 for Group non-DCB (p¼0.04), +0.32mm 2 for Group DCB1 (p¼0.14) and +0.32mm 2 (p¼0.33) for Group DCB2. Paclitaxel was detectable at a concentration of 0.10±0.18 ng/mg of tissue at 28days. Conclusions: In this experimental study, the use of this novel DCB in both animal models was safe. Additionally, a significantly less cross-sectional vessel wall area difference was observed compared to non-DCB. Paclitaxel was detectable in the vascular tissue at 28 days.
American Journal of Case Reports, 2018
Unusual clinical course Background: Renal cell carcinoma (RCC) is the most common malignancy of t... more Unusual clinical course Background: Renal cell carcinoma (RCC) is the most common malignancy of the kidney, with clear cell (ccRCC) subtype identified in 85% of the cases; one-third of these patients experience synchronous metastatic disease, while 20-30% of the remaining patients develop metachronous metastatic RCC. The axial skeleton (pelvis and sacrum) is the second most common location (following the lungs), with a reported incidence of 35%. Diaphysis of the long bones is rarely involved, with the tibia being an even rarer site of metastasis. Case Report: We present a rare case of solitary diaphyseal tibial metachronous metastasis from RCC in a 54-year-old male that appeared 8 years after nephrectomy without any previous evidence of disease. He underwent segmental skeletal resection, intercalary allograft over locked reamed intramedullary nailing, and soleus flap coverage. Thirty months later he presented with hardware failure and nonunion at the distal part of the allograft site. He was successfully treated with exchange nailing, fibular osteotomy, and bone grafting, showing excellent clinical and radiological outcome without any evidence of recurrence 5 years after the index operation. Conclusions: Wide resection and biological reconstruction using intramedullary nailing and incorporated allograft is a good option for metachronous solitary RCC tumors.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021
Aim To investigate analgesic effect of three different regimens of combination of analgesics admi... more Aim To investigate analgesic effect of three different regimens of combination of analgesics administered to patients undergoing laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomy were randomly allocated to one of three groups on admission, depending of a prescribed post-operative analgesic regimen. Patients allocated to the group A received a combination of intravenous (IV) acetaminophen and intramuscular (IM) pethidine, patients in the group B received a combination of IV acetaminophen and IV parecoxib, and the patients of the group C received IV acetaminophen monotherapy. Analgesic therapy was administered at regular intervals. Pain was evaluated utilizing the numeric rating scale (NRS) at 5 time points: the first assessment was done at 45 minutes, the second, third, fourth and fifth at 2, 6, 12, and 24 hours post-administration, respectively. Postoperative pain intensity was measured by NRS within the groups and between the groups at each time...
Objectives: To evaluate three different analgesic techniques, continuous epidural analgesia (EA),... more Objectives: To evaluate three different analgesic techniques, continuous epidural analgesia (EA), continuous intra-articular (IA) infusion analgesia and continuous femoral nerve block (FNB) in postoperative pain management, length of hospital stay (LOS), and time of patient mobilization after total knee arthroplasty (TKA). Methods: Seventy-two patients undergoing TKA were randomly allocated into three groups according to the analgesic technique used for postoperative pain management. Group EA patients received epidural analgesia (control group), group IA received intra-articular infusion and group FNB received femoral nerve block. Results: Upon analyzing the Numerical Rating Scale (NRS) scores at rest, at passive and active movement, up to 3 days postoperatively, we observed no statistically significant differences at any time point among the three groups. Similarly, no association among these analgesic techniques (EA, IA, FNB) was revealed regarding LOS. However, significant differ...
Diagnostic Microbiology and Infectious Disease, 2018
A matched 1:2 case-control study was conducted among critically ill patients in order to identify... more A matched 1:2 case-control study was conducted among critically ill patients in order to identify the risk factors of colistin or tigecycline-resistant carbapenemase-producing Klebsiella pneumoniae (ColR-Kp, TigR-Kp) bacteraemia. MIC to colistin and tigecycline were determined by Etest. From 224 bacteraemic patients, 46.4% and 29.5% were resistant to colistin and tigecycline, respectively. PCR revealed that 199 isolates carried the blaKPC gene. PCR revealed that no isolate carried the mcr-1 gene. Risk factors for ColR-Kp bacteraemia as compared to patients with bacteraemia by a colistin-susceptible isolate or patients without carbapenemase-producing K. pneumoniae bacteraemia were colistin or tigecycline administration and tracheostomy, while TigR-Kp bacteraemia as compared to either patients with bacteraemia by tigecycline-susceptible isolate or patients without carbapenemase-producing K. pneumoniae bacteraemia were colistin or tigecycline administration, number of comorbidities and prior bacteraemia by a Gram-negative pathogen. Administration of colistin and tigecycline predisposed to development of bacteraemia by either ColR-Kp or TigR-Kp.
Background and aims While the elderly population continues to increase, more octogenarians requir... more Background and aims While the elderly population continues to increase, more octogenarians require surgery. Anesthesia management becomes more challenging for the elderly since the prevalence of comorbid diseases is higher. We present a case report of an 84 year old woman, with severe COPD, undergoing left colectomy under single epidural anesthesia. Our aim is to demonstrate the efficacy of epidural anesthesia in patients, on high risk for cardio-pulmonary complications, undergoing abdominal surgery.
Infection, 2017
The aim of the present study is to identify risk factors for development and predictors of mortal... more The aim of the present study is to identify risk factors for development and predictors of mortality of candidaemia among critically ill patients. A 1:7 case-control study was conducted during a 4-year period (2012-2015) in a Greek Intensive Care Unit (ICU). Candidaemia was confirmed by positive blood cultures. All yeasts were identified using API 20C AUX System or Vitek 2 Advanced Expert System. Epidemiologic data were collected from the ICU computerized database and patients' chart reviews. Fifty-three patients developed candidaemia with non-albicans species being the predominant ones (33 patients, 62.3%). Multivariate analysis found that prior emergency surgery, malignancy, hospitalization during summer months, prior septic shock by KPC-producing Klebsiella pneumoniae and number of antibiotics administered were independently associated with candidaemia, while, prior administration of azole was a protective factor. Non-albicans candidaemia was associated with number of antibio...
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Papers by Georgios Karpetas