TY - JOUR AU - Szántó, Dorottya AU - Luterán, Péter AU - Kóti, Nikolett AU - Siró, Péter AU - Simon, Éva AU - Jakab, Zsuzsa AU - Gál, Judit AU - Kappelmayer, János AU - Fülesdi, Béla AU - Molnár, Csilla TI - Correlation of Inflammatory Parameters with the Development of Cerebral Vasospasm, Takotsubo Cardiomyopathy, and Functional Outcome after Spontaneous Subarachnoid Hemorrhage JF - JOURNAL OF CLINICAL MEDICINE J2 - J CLIN MED VL - 13 PY - 2024 IS - 7 SP - 1955 SN - 2077-0383 DO - 10.3390/jcm13071955 UR - https://m2.mtmt.hu/api/publication/34791210 ID - 34791210 AB - Background: The present work aimed to determine whether a relationship exists between inflammatory parameters and the development of vasospasm (VS) and Takotsubo cardiomyopathy (TTC), as well as clinical outcome, in patients suffering from spontaneous subarachnoid hemorrhage (SAH). Methods: In this study, the authors processed the prospectively collected laboratory and clinical data of spontaneous SAH patients admitted to the neurointensive care unit between March 2015 and October 2023. The highest values of neutrophils (NEUpeak), monocytes (MONOpeak), neutrophil-to-lymphocyte ratio (NLRpeak), and CRP (CRPpeak) during the initial 7 days were correlated with the occurrence of VS and TTC, and with the outcome measures at day 30 after onset. Results: Data were collected from 175 SAH patients. Based on ROC analysis, for the development of VS, MONOpeak was the most accurate indicator (AUC: 0.619, optimal cut-off: 1.45 G/L). TTC with severe left ventricular dysfunction (ejection fraction < 40%) was indicated most sensitively by NEUpeak (ROC: 0.763, optimal cut-off: 12.34 G/L). Both for GOS and Barthel Index at day 30, CRPpeak was the best predictor for the outcome (GOS: ROC: 0.846, optimal cut-off: 78.33 mg/L and Barthel Index: ROC: 0.819, optimal cut-off: 78.33 mg/L). Conclusions: Laboratory parameters referring to inflammation during the initial 7 days after SAH correlate with the development of VS and TTC, and thus may predict functional outcome. LA - English DB - MTMT ER - TY - JOUR AU - Simon, Éva AU - Csipkés, Csaba AU - Andráskó, Dániel AU - Kovács, Veronika AU - Szabó-Maák, Zoltán AU - Tankó, Béla AU - Buchholcz, Gyula AU - Fülesdi, Béla AU - Molnár, Csilla TI - Preoperatively administered single dose of dexketoprofen decreases pain intensity on the first 5 days after craniotomy: A single-centre placebo-controlled, randomized trial JF - TRANSLATIONAL NEUROSCIENCE J2 - TRANSL NEUROSCI VL - 14 PY - 2023 IS - 1 PG - 8 SN - 2081-3856 DO - 10.1515/tnsci-2022-0323 UR - https://m2.mtmt.hu/api/publication/34451054 ID - 34451054 LA - English DB - MTMT ER - TY - JOUR AU - Szántó, Dorottya AU - Kóti, Nikolett AU - Gál, Judit AU - Fülesdi, Béla AU - Molnár, Csilla TI - Correlation of Various Laboratory Parameters with Vasospasm and Outcome in Acute Non-traumatic Subarachnoid Hemorrhage JF - EUROPEAN JOURNAL OF NEUROLOGY J2 - EUR J NEUROL VL - 30 PY - 2023 IS - Suppl_1 SP - 319 SN - 1351-5101 UR - https://m2.mtmt.hu/api/publication/34391827 ID - 34391827 LA - English DB - MTMT ER - TY - JOUR AU - Szántó, Dorottya AU - Luterán, Péter AU - Gál, Judit AU - Nagy, Endre AU - Fülesdi, Béla AU - Molnár, Csilla TI - Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review JF - REVIEWS IN CARDIOVASCULAR MEDICINE J2 - REV CARDIOVASC MED VL - 24 PY - 2023 IS - 6 PG - 12 SN - 1530-6550 DO - 10.31083/j.rcm2406177 UR - https://m2.mtmt.hu/api/publication/34039103 ID - 34039103 AB - Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neuro-logical 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 evi-dence 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 con-sidered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery. LA - English DB - MTMT ER - TY - JOUR AU - Szántó, Dorottya AU - Gál, Judit AU - Tankó, Béla AU - Siró, Péter AU - Jakab, Zsuzsa AU - Luterán, Péter AU - Fülesdi, Béla AU - Molnár, Csilla TI - Pediatric Neuroanesthesia — a Review of the Recent Literature JF - CURRENT ANESTHESIOLOGY REPORTS J2 - CURR ANESTHESIOL REP VL - 12 PY - 2022 IS - 4 SP - 467 EP - 475 PG - 9 SN - 1523-3855 DO - 10.1007/s40140-022-00540-2 UR - https://m2.mtmt.hu/api/publication/33215868 ID - 33215868 LA - English DB - MTMT ER - TY - JOUR AU - László, István AU - Végh, Tamás AU - Szántó, Dorottya AU - Véghné Juhász, Marianna Beáta AU - Molnár, Csilla AU - Fülesdi, Béla TI - Preparing the Patient for ICU Transfer: What Is the Anesthesiologist’s Role? JF - CURRENT ANESTHESIOLOGY REPORTS J2 - CURR ANESTHESIOL REP VL - 12 PY - 2022 IS - 4 SP - 461 EP - 466 PG - 6 SN - 1523-3855 DO - 10.1007/s40140-022-00543-z UR - https://m2.mtmt.hu/api/publication/33123777 ID - 33123777 AB - 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 LA - English DB - MTMT ER - TY - JOUR AU - Molnár, Csilla AU - Gál, Judit AU - Szántó, Dorottya AU - Fülöp, László AU - Szegedi, Andrea AU - Siró, Péter AU - Nagy, Endre V. AU - Lengyel, Szabolcs AU - Kappelmayer, János AU - Fülesdi, Béla TI - Takotsubo cardiomyopathy in patients suffering from acute non-traumatic subarachnoid hemorrhage—A single center follow-up study JF - PLOS ONE J2 - PLOS ONE VL - 17 PY - 2022 IS - 5 SP - e0268525 SN - 1932-6203 DO - 10.1371/journal.pone.0268525 UR - https://m2.mtmt.hu/api/publication/32845414 ID - 32845414 AB - 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. LA - English DB - MTMT ER - TY - CHAP AU - Fülesdi, Béla AU - Molnár, Csilla ED - Bogár, Lajos TI - Idegsebészeti anesztézia T2 - Aneszteziológia és intenzív terápia PB - Medicina Könyvkiadó CY - Budapest SN - 9789632268026 PY - 2021 SP - 358 EP - 368 PG - 11 UR - https://m2.mtmt.hu/api/publication/32561409 ID - 32561409 N1 - 4. átdolgozott és bővített kiadás LA - Hungarian DB - MTMT ER - TY - JOUR AU - Véghné Juhász, Marianna Beáta AU - Páll, Dénes AU - Fülesdi, Béla AU - Molnár, Levente AU - Végh, Tamás AU - Molnár, Csilla TI - The effect of propofol-sufentanil intravenous anesthesia on systemic and cerebral circulation, cerebral autoregulation and CO2 reactivity – a case-series JF - BRAZILIAN JOURNAL OF ANESTHESIOLOGY J2 - BRAZ J ANESTH VL - 71 PY - 2021 IS - 5 SP - 558 EP - 564 PG - 7 SN - 0104-0014 DO - 10.1016/j.bjane.2021.04.002 UR - https://m2.mtmt.hu/api/publication/31991553 ID - 31991553 AB - Background and objectives The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia. Methods 27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35 and 30 mmHg EtCO2 for 5-minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. Results Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia. Conclusions Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation. Trial registration The study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014. LA - English DB - MTMT ER - TY - JOUR AU - Kanyári, Zsolt AU - Cservenyák, Dóra AU - Tankó, Béla AU - Nemes, Balázs AU - Fülesdi, Béla AU - Molnár, Csilla TI - Knowledge and Attitudes of Health Care Professionals and Laypeople in Relation to Brain Death Diagnosis and Organ Donation in Hungary: A Questionnaire Study JF - TRANSPLANTATION PROCEEDINGS J2 - TRANSPLANT PROC VL - 53 PY - 2021 IS - 5 SP - 1402 EP - 1408 PG - 7 SN - 0041-1345 DO - 10.1016/j.transproceed.2021.01.045 UR - https://m2.mtmt.hu/api/publication/31962646 ID - 31962646 N1 - The Article in Press AB - Objectives.The aim of the present work was to assess the knowledge and attitudes of differenthealth care workers and laypeople toward the donation and transplantation procedure.Subjects and methods.A survey consisting of questions regarding brain death diagnosis,legal organization or organ donation, and the transplantation procedure were sent to participants:56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320general practitioners (GPs). Laypeople were also asked to complete the survey.Results.The majority of participants reported being aware of legal regulations for organ dona-tion in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses(34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs(22.4%) and medical students (20%) performed even worse on this item. The willingness of ICUspecialists (57%) and ICU nurses (45%) to support donating their own organs was moderate.Conclusions.The results of this survey indicate a need for graduate and postgraduateeducation and regular teaching programs regarding organ donation and transplantation.More active use of modern media is proposed to improve public awareness and acceptanceof organ donation. LA - English DB - MTMT ER -