Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients

Mechanical ventilation in chronic obstructive pulmonary disease patients, noninvasive vs. invasive method (randomized prospective study) [Usporedba neinvazivne i invazivne umjetne ventilacije kod bolesnika s kroničnom opstruktivnom plućnom bolesti: prospektivna randomizirana studija]

Acute respiratory failure due to chronic obstructive pulmonary disease (COPD) presents an increasing problem throughout the world. The aim of this study was to compare invasive and non-invasive mechanical ventilation (MV) for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit for the period of 36 months and included 156 patients with COPD. MV procedure was performed using standard methods, and was applied as either invasive MV (IMV) or noninvasive MV (NIMV). Patients were randomized in two groups for application of MV using closed, nontransparent envelops. Comparison was made based on patient characteristics, objective parameters on admission and 1h, 4h, 24h, and 48h after admission and based on treatment outcome. We have confirmed that NIMV method is superior to IMV for patients with COPD. MV duration NIMV:IMV was 94:172 hours, p<0.001, time spent in Intensive Care Unit 120:223 hours, p<0.001. Ventilator associated pneumonia 5(6%):29(37%), p<0.001.The advantage of NIMV in COPD patients, especially in the early stages was confirmed

Deksametazon- intratekalni reducens jednostavnih hematoloških biomarkera stresa

Proximal femoral fractures are the most common cause of emergency admission to hospital with high postoperative morbidity. The hypothesis was that a single shot of intrathecal dexamethasone and levobupivacaine in anaesthesia for surgical correction of proximal femoral fracture in elderly patients reduces surgical stress with better quality hospitalisation. The study included sixty elderly patients with proximal femoral fracture, ASA status 2 and 3, randomised into two groups. The study group of thirty patients received 8 mg of dexamethasone and 12,5 mg of levobupivacaine 0,5 % intrathecally, DLSA group, and the parallel group of thirty patients received 12,5 mg of levobupivacaine 0,5 % intrathecally, LSA group. Plasma cortisol and glucose concentrations were assessed before and after anaesthesia, pain intensity was evaluated using Visual Analogue Scale score and hospitalisation was analysed. Results showed decreased cortisol concentrations, longer analgesia duration and shorter hospitalisation in the DLSA group. Glucose concentrations did not differ significantly between the patients in either group. Enlightening the study results collected, single shot of intrathecal administration of dexamethasone in spinal anaesthesia for surgical treatment of proximal femoral fractures reduces the stress response by decreasing plasma cortisol concentrations prolonging analgesia with better rehabilitation possibilities, hence shortening hospitalisation which explains this pattern of anaesthesia.Proksimalni prijelomi bedrene kosti su najčešći uzrok prijma u bolnicu s visokim poslijeoperacijskim morbiditetom. Hipoteza je da jedna intratekalna doza deksametazona s levobupivakainom za kiruršku korekciju prijeloma proksimalnog dijela bedrene kosti smanjuje kirurški stres sa kvalitetnijim boravkom u bolnici. U istraživanje je bilo uključeno šezdeset pacijenata starije dobi s prijelomom proksimalnog dijela bedrene kosti, ASA status 2 i 3, te su bili randomizirani u dvije skupine. Trideset pacijenata je primilo 8 mg deksametazona i 12,5 mg 0,5 % levobupivakaina intratekalno, DLSA skupina, trideset pacijenata u usporednoj skupini je primilo 12,5 mg 0,5 % levobupivakaina intratekalno, LSA skupina; tijekom anestezije za kiruršku korekciju. Plazmatske koncentracije kortizola i glukoze mjerene su prije i poslije kirurškog zahvata, intenzitet boli je određivan zbrojem VAS, te je analizirano trajanje hospitalizacije. Rezultati istraživanja su prikazali smanjene koncentracije kortizola, dulje trajanje analgezije te kraće trajanje hospitalizacije u DLSA skupini u usporedbi sa LSA skupinom. Koncentracije serumske glukoze nisu se značajnije razlikovale između skupina. Rasvjetljavanjem skupljenih rezultata, jedna intratekalna injekcija deksametazona u spinalnoj anesteziji za kiruršku korekciju prijeloma proksimalnog dijela bedrene kosti snižava stresni odgovor smanjenjem plazmatske koncentracije kortizola s duljim analgetskim učinkom te boljim mogućnostima rehabilitacije, skraćujući time hospitalizaciju što opravdava ovaj anesteziološki obrazac kao metodu izbora

Učinak lokalne infiltracijske anestezije na liječenje poslijeoperacijske boli kod rinoplastike u dnevnoj kirurgiji

Use of local infiltration anaesthesia with 2% lidocaine in combination with epinephrine 1/100000 in rhinoplasty and 0.25% levobupivacaine in this research as an adjunct to general anaesthesia is compared analysing the need for postoperative analgesia in rhinoplasty patients. 30 patients received lidocaine combined with epinephrine (LA) and other 30 patients received levobupivacaine (LB). Comparison is done with Visual Analogue Scale in 30 min and 1, 3, 6 h postoperatively. Also 24 h need for analgesic treatment was recorded. In conclusion postoperative analgesia in LB group with general anaesthesia was significantly prolonged (P = 0.038).Preoperativnu lokalnu infiltracijsku anesteziju sa 2% lidokainom u kombinaciji sa epinefrinom 1/100000 i 0,25 % levobupivakainom kao dodatku općoj anesteziji uspoređivali smo mjerenjem potrebe za postoperativnom analgezijom u pacijenata koji su se podvrgli operativnom zahvatu korekcije nosa. 30 pacijenata je primilo lidokain u kombinaciji sa epinefrinom (LA), a drugih 30 pacijenata je primilo levobupivakain (LB). PremaVisualnoj analgnoj skali s (VAS) mjerena je razina boli nakon 30 min, 1, 3, 6 sati. Isto tako unutar 24 sata mjerena je potreba za analgetskom terapijom. Poslijeoperacijska analgezija je trajala značajno dulje u skupini pacijenata LB u kojoj je primijenjen levobupivakain u kombinaciji sa općom anestezijom (P = 0.038)

In vitro effect of subinhibitory concentrations of ceftazidime and meropenem on the serum sensitivity of Pseudomonas aeruginosa strains

The aim of this study was to determine the effect of subminimal inhibitory concentrations (subMICs) of ceftazidime, meropenem and gentamicin on the in vitro serum sensitivity of Pseudomonas aeruginosa strains isolated from a variety of isolation sites at two medical wards and an intensive care unit in a government university hospital in Croatia. A total of 20 serum-resistant P aeruginosa strains isolated from different clinical specimens were selected. Bacteria were exposed to 1/2, 1/4, 1/8, 1/16, and 1/32 x MIC of each antibiotic tested. Sensitivity of P. aeruginosa strains to bactericidal activity of normal human serum before and after bacterial exposure to subMICs was determined. Significant difference in serum sensitivity of the strains was observed after the bacteria were exposed to subMICs of ceftazidime and meropenem (p < 0.01), while the exposure to subMICs of gentamicin did not affect significantly the resistance of tested strains to the serum bactericidal activity. Comparing the number of serum-resistant strains before and after exposure to subMICs of antibiotics, statistically significant differences were determined (p < 0.01) after exposure of the strains to 1/2, 1/4, 1/8 and 1/16 x MIC of meropenem, and after exposure to 1/2, 1/4 and 1/8 x MIC of ceftazidime. SubMICs of ceftazidime and meropenem affected not only the resistance to serum bactericidal activity of bacteria, but also their morphology. The alterations in bacterial morphology caused by subMICs of ceftazidime and meropenem could be connected with consecutive bacterial serum sensitivity

Zadovoljstvo rodilja epiduralnom analgezijom tijekom poroda: analiza ankete u jednom bolničkom centru

Epidural analgesia is one of the most common methods of relieving labor pain. The objective of this study was to examine the effectiveness of epidural analgesia, maternal satisfaction and relationship between the effectiveness of epidural analgesia and various factors. Data were analyzed retrospectively and collected during 2022. A total of 60 parturients participated in the study. Data were collected through a questionnaire before the parturient was discharged from the hospital. The mean assessment of pain on a 1–10 numeric rating scale before epidural analgesia was 7.7 and 3.4 after administration of epidural analgesia. The median assessment of pain before epidural analgesia was 8 (7¬¬–8), and the median assessment of pain after epidural analgesia was 3 (2–5). The average satisfaction with epidural analgesia on a 1–10 scale was 8.11, and the median satisfaction was 10 (7–10). Total of 35 (58.3%) parturients rated satisfaction with 10. Statistically significant association between the effectiveness of epidural analgesia and parity, dilution of administered levobupivacaine, fentanyl administration, and level of education was not found. Childbirth pain is significantly alleviated by the application of epidural analgesia and the satisfaction of parturients is very high.Epiduralna analgezija jedna je od najčešćih metoda ublažavanja porodne boli. Cilj ovog istraživanja bio je ispitati učinkovitost epiduralne analgezije, zadovoljstvo rodilja i povezanost između učinkovitosti epiduralne analgezije i pariteta, razrjeđenja primijenjenog levobupivakaina, primijenjenog fentanila te razine obrazovanja. Podatci su analizirani retrospektivno, prikupljeni su tijekom 2022. godine. Ukupno 60 rodilja sudjelovalo je u istraživanju. Podatci su prikupljani pomoću anketnog upitnika prije otpusta rodilje iz rodilišta. Prosječna procjena boli na numeričkoj skali od 1 do 10 prije primjene epiduralne analgezije iznosi 7,7, a nakon primjene epiduralne analgezije 3,4. Medijan procijenjene boli prije primjene epiduralne analgezije iznosi 8 (7 – 8), a nakon primjene epiduralne 3 (2 – 5). Prosječno zadovoljstvo epiduralnom analgezijom na skali od 1 do 10 iznosi 8,11, medijan zadovoljstva je 10 (interkvartilni raspon od 7 do 10). 35 rodilja je zadovoljstvo ocijenilo sa 10, što čini 58,3% uzorka. Statistički značajna povezanost između učinkovitosti epiduralne analgezije i pariteta, razrjeđenja primijenjenog levobupivakaina, primjene fentanila i razine obrazovanja nije pronađena. Porodna bol je značajno umanjena primjenom epiduralne analgezije i zadovoljstvo rodilja je vrlo visoko

Usporedba učinaka i lokalne infiltracijske analgezije u različitih kirurških zahvata u dnevnoj kirurgiji

Purpose of this study was assessing of local infiltration analgesia (LI A) with levobupivacaine on the trend of acute postoperative pain and outcome in individuals who underwent rhinoplasty procedure and abdominoplasty performed in general anaesthesia. The research was conducted on 60 patients, of which 30 patients underwent rhinoplasty procedure and the other 30 patients underwent abdominoplasty procedure in general anaesthesia with LI A in “Bagatin” Polyclinic in the time period between 01.01.2014. and 01.01.2017. Postoperative analgesics doses on the same day of surgery were noted in 85 % of participants who underwent an abdominoplasty procedure and in 45 % of participants underwent rhinoplasty procedure. Patients who underwent abdominoplasty were discharged from the facility within 48 hours, while all patients who underwent rhinoplasty procedure were discharged on the same day of the surgery. During the first postoperative day patients who underwent a rhinoplasty procedure did not require analgesics, while only 3 % of patients who underwent an abdominal liposuction procedure required an additional dose of analgesics. The research results had shown, when LI A was performed, the manifestation of acute postoperative pain and vomiting did not lead to prolonged stay in day surgery.Svrha studije je procjena djelovanja lokalne infiltracijske analgezije (LI A) s levobupivakainom na promjene akutne poslijeoperacijske boli i ishod za pacijente podvrgnute rinoplastici i abdominoplastici u općoj anesteziji. Istraživanje je provedeno na 60 pacijenata, od kojih je 30 pacijenta bilo podvrgnuto abdominoplastici i 30 pacijenata podvrgnuto rinoplastici sa LI A u općoj anesteziji u Poliklinici Bagatin u vremenskom periodu od 01.01.2014. i 01.01.2017. U 85 % bolesnika podvrgnutih abdominoplastici zabilježena je poslijeoperacijska primjena analgetika, te u 45 % bolesnika podvrgnutih rinoplastici. Pacijenti podvrgnuti abdominoplastici otpušteni su iz poliklinike unutar 48 sati nakon kirurškog zahvata, a svi pacijenti koji su podvrgnuti rinoplastici otpušteni su na isti dan kirurškog zahvata. Tijekom prvog poslijeoperacijskog dana bolesnici podvrgnuti rinoplastici nisu imali potreba za analgeticima, dok je u 3 % bolesnika podvrgnutih abdominoplastici bila potrebna dodatna doza analgetika. Rezultati su studije pokazali da uz primjenu LI A-e poslijeoperacijska bol i povraćanje nakon kirurškog zahvata nisu utjecali na duljinu boravka u ustanovi u kojoj je zahvat učinjen