Comparation of early continuous epidural and intravenous opioid analgesia on haemodynamic changes after several pelvic fractures

Background and Purpose: Continuous epidural analgesia improves excellent pain control in trauma patients with multiple pelvic fractures. Rezidual haemodynamic instability followed by retroperitoneal hemorrhagie in the first 48 hours often post-pones its application with need for parenteral use of high dose of opioids. The aim was to compere the influence of early continuous epidural and intravenous opioid analgesia on haemodynamic changes in these patients. Materials and Methods: After Ethic Committee approval, fifty trauma patients with isolated multiple pelvic fractures were divided in two equal groups and included in prospective, randomized study. In bought groups initial analgesia was started with sufentanil 10 μg h–1 in the first 24h. After that, in Group EP continuous epidural analgesia (levibupivacain O.125%, 5–7 mL h–1) and in Group O continuous infusion of opioid (sufentanil 5–10 μg h–1) was started. The analgesics dose was titrated following the VAS score under 3. PICCO monitoring was established. MAP, CI, HR, SVRI, ITBVI and ELWI was measured during four days. Statistic analysis was done by SPSS 11.0. Results: Study groups were statistic comparable. In the first 24 hours during continuous opioid anaesthesia, bought groups had high need for fluid replacement (Group EP=3.2 ± 0.3, Group O=3.0 ± 0.5 L/24h) (P=0.0928). Second day, SVRI was lower in O Group (1300–1520; EP Group=1700–1810)(P=0.0243) and recovered with 500–750mLof crystalloids infusion. ITBVI was statistical more stable inGroup EP (950 ± 50; Group O (1100 ± 30)(P=0.0002). Only 10% of patients with low CI (<3.0) in Group EP (Group O=32%) needed catecholamin support. Conclusion: Early continuous epidural analgesia with 0.125% levibupivacain is safe as continuous opioid analgesia in patients with multiple pelvic fractures but without opioids complications and better haemodynamic stability

Single or double-injection technique in axillary block: the success of motor and sensor blockade

Background and Purpose: Axillary brachial plexus block is the method of choice for surgical procedures of upper arm except shoulder region. Distribution of local anaesthetic toward neurovascular space may be a reason for failed block. We investigated the axillary block effectiveness by singeand double-injection technique. Materials and Methods: Ninety patients (21–81 old; ASA I-IV) scheduled for upper arm surgery were divided in three equal groups during prospective, double-blind study. Nerve position was located with neurostimulator (Stimuplex® HNS 11)(0.5 mA, 2Hz and 0.1 ms). In Group S (single-shot), mixture of 30 mL (15 mL 0.5% bupivacaine and 15 mL 2% lidocaine) was injected only above axillary artery (25 mL around median and 5 mL around musculocutaneus nerve). In Group U and R (double-shot), the same mixture of local anaesthetic was applied above (10 mL around median and 5 mL around musculocutaneus nerve) and below axillary artery (15 mL around radial or ulnar nerve). Motor and sensor block were determined (Bromage scale, Pinprick method). Statistic analysis was done (SSP11.0). Results and Conclusions: Effective block analgesia and anaesthesia was achieved in shorter time in Group R (18+/4 and 26+/–3 min)(Group U: 34+/–4 and 41+/–3 min, Group S: 35+/–4 and 45+/–2 min) (P=0.0000) (Table 2). Block effectiveness was significantly higher after radial nerve stimulation (92%)(Group U 88% and S 76%) (P=0.630). Faster motor block was achieved in Group R (18+/–4)(Group U 26+/–3 and S 35+/–4 min) (P=0.000). Double-shot technique with primar radial nerve stimulation, allows better motor and sensor axillary block in comparison with single-shot technique

PRESSURE ULCER TREATMENT EXPERIENCE AT CLINICAL DEPARTMENT OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY, DUBRAVA UNIVERSITY HOSPITAL: COMPARISON OF RESULTS RECORDED IN THE 2011-2016 AND 2003-2008 PERIOD

Prikazani rezultati kirurškog liječenja dekubitusa na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju KB Dubrava u vremenu od 2011. do 2016. nisu bitno različiti u odnosu na rezultate kirurškog liječenja iste patologije u studiji iz vremena 2003.-2008., što dokazuje i dalje odličnu planiranost i izvedivost kirurških zahvata, odgovarajuću pripremu bolesnika i adekvatnu postoperacijsku skrb. Unatoč manjem broju hospitaliziranih bolesnika s dekubitusom u studiji 2011.-2016. (31 bolesnik; 42 rekonstrukcijska zahvata) i dalje je učinjen sličan broj rekonstrukcijskih zahvata uspoređujući sa studijom 2003.-2008. (47 bolesnika; 57 rekonstrukcijskih zahvata). Kod rekonstrukcije dekubitusa na sakralnoj regiji kod naših bolesnika najbolje rekonstrukcijske rezultate postigli smo i dalje kliznim fasciokutanim, odnosno mišićnokutanim režnjevima. Kada je god to moguće, ovisno o kliničkoj slici defekta trebalo bi dati prednost mišićnokutanim režnjevima, posebno u slučajevima recidiva dekubitusa. Kod rekonstrukcije dekubitusa u području ishijadičnih zona vrlo dobri rezultati postignuti su uporabom mišićnih režnjeva semimembranozusa i /ili semitendinozusa koji se mobiliziraju u defekt, dok za područje trohanterne regije koristimo transpozicijski režanj fascije late. Liječenje bolesnika s dekubitusom je multidisciplinarno s naglaskom na kirurško liječenje koje se sastoji od radikalnog debridmana, ostektomije i egzaktno planirane i učinjene rekonstrukcije. Konzervativno liječenje mora biti podrška kirurškom liječenju s naglaskom na njegu i visoke higijenske mjere bolesnika. U novije vrijeme (studija 2011.-2016.) sve kvalitetnija uporaba konzervativnog načina tretmana dekubitalnih rana realno je dovela do smanjenja potrebe za hospitalizacijom i kirurškim liječenjem. Daljnjim edukacijama medicinskih sestara u smislu „wound care“-a u zdravstvenim učilištima i bolnicama trebalo bi dati posebno značenje što bi dovelo do prevencije, ali i pravodobnog početka liječenja bolesnika s dekubitusom.Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further ‘wound care’ nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment

Association between neurological soft signs and antioxidant enzyme activity in schizophrenic patients

To determine the relationship between alterations in the activity of the enzymes participating in antioxidative defense system and neurological soft signs (NSS) in schizophrenic patients with the first episode psychosis (S-FE, n = 19), patients in relapse (S-R, n = 46), and healthy controls (HC, n = 20). NSS intensity and enzymatic plasma activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX) were compared between S-FE, S-R and HC subjects and a follow-up correlation analyses between the enzyme activities and NSS intensity was performed. NSS intensity was increased four times in schizophrenic patients compared with healthy controls. Activities of SOD and CAT were 40% decreased in S-FE and these reductions were ameliorated by antipsychotic treatment. GPX activity was 20% decreased in both patient groups compared with controls. A negative correlation between NSS intensity and GPX activity was specifically found in the S-FE patients. The data in this report argue that a reduction of GPX activity might be one of the causes for the emergence of NSS at the onset of schizophrenia, and provide the evidence that antipsychotic therapy can attenuate activity reductions of SOD and CAT, but not the activity reduction of GPX and the intensity of NSS

Determinants of quality of life among individuals seeking mental health care after termination of state of emergency due to the coronavirus disease 2019 pandemic

Prompted by the need to measure the impact of the coronavirus disease 2019 on main areas of quality of life related to mental health (MH), the COV-19-impact on quality of life (COV19-QoL) scale has been developed recently. We measured how patients seeking face-to-face MH care perceived the coronavirus disease 2019 impact on QoL and how socio-demographic factors, stress, and personality contributed to QoL in this diagnostically diverse population. Patients aged 18 to 65 years (n = 251) who came for the first time to the outpatient units during the 6-week index-period (May 21-July 1, 2020) were included. The cross-sectional assessment involved sociodemographic variables, working diagnosis, personality traits (7-dimension model, including HEXACO and DELTA), stress (list of threatening experiences and proximity to virus), and COV19-QoL. The perceived impact of the pandemic on QoL was above the theoretical mean of a 5-point scale (COV19-Qol = 3.1 +/- 1.2). No association between total COV19-QoL score, sociodemographic parameters, and working diagnoses was found in the present sample. After testing whether positional (threatening experiences), or dispositional (personality) factors were predominant in the perceived impact of COV-19 on QoL, significant predictors of the outcome were personality traits Disintegration (B = 0.52; P lt .01) and Emotionality (B = 0.18; P lt .05). It seems that pervasiveness and uncertainty of the pandemic threat triggers-especially in those high on Disintegration trait-a chain of mental events with the decrease of QoL as a final result. Present findings could be used to establish a profile of MH help seeking population in relation to this biological disaster, and to further explore QoL and personality in different contexts