50 research outputs found
Alternativni ureÄaji za intubaciju
The Macintosh laryngoscope has been the most widely used device for intubation since its invention by Foregger in the 1940s. Recently, video and optic laryngoscopy assisted tracheal intubation has been used widely in patients with difficult airways. Their routine use, however, is not widely practiced. This review will summarize some of the newly available devices to assist tracheal intubation, with their advantages and disadvantages when compared with conventional laryngoscopes. It also presents the reasons to support their use in both elective and emergency airway management.Macintoshov laringoskop je najÄeÅ”Äe koriÅ”teni ureÄaj za intubaciju koji je prvi puta primijenio Foregger 1940. godine. Kasnije su uvedeni video i optiÄki laringoskopi koji pomažu pri intubaciji u bolesnika s otežanim diÅ”nim putem. MeÄutim, njihova rutinska uporaba nije Å”iroko prihvaÄena u praksi. U ovom Älanku se sažeto iznose prednosti i nedostaci novih dostupnih ureÄaja koji pomažu tijekom intubacije u usporedbi s konvencionalnim laringoskopima. Dodatno se iznose razlozi za uporabu novih ureÄaja kod elektivnog i hitnog zbrinjavanja diÅ”noga puta
Otežani diÅ”ni put kod uznapredovale Behterevljeve bolesti: prikaz sluÄaja
Advanced Bechterewās disease presents with increasing ossification of spinal column, from lower lumbar segments upwards, first causing impossibility to place spinal block in lumbar region, and later, due to stiffness of cervical spine, difficult intubation because of inability to extend and/or flex the neck during direct laryngoscopy and intubation. Mask ventilation, on the other hand, usually is possible. We report a case of a 77-year-old man scheduled for elective hernioplasty, with recently advanced Bechterewās disease. According to the recently accepted Mainz algorithm, we first intended to perform awake intubation through the nose by fiber bronchoscope. The bronchoscope passed easily down to tracheal bifurcation, but placing the endotracheal tube was unexpectedly impossible due to the consequences of broken nose the patient had suffered at the age of 8. Fiber bronchoscope was therefore retracted, and we used the Bonfils rigid fiberscope after induction of general anesthesia, achieving intubation in first attempt.ZnaÄajke uznapredovale Behterevljeve bolesti (ankilozirajuÄi spondilits) su sve veÄa osifikacija kralježnice od donjih, lumbalnih dijelova prema viÅ”im, cervikalnim Å”to uzrokuje prvo nemoguÄnost izvoÄenja spinalnog bloka u lumbalnoj regiji, a kasnije, zbog ukoÄenosti vratnog dijela kralježnice, otežanu intubaciju zbog nemoguÄnosti ekstenzije i/ili fleksije vrata u tijeku direktne laringoskopije i intubacije. S druge strane, ventilacija na masku je obiÄno izvediva. Ovdje prikazujemo 77-godiÅ”njeg bolesnika koji je bio predviÄen za elektivnu operaciju ingvinalne hernije, a Äiji je ankilozirajuÄi spondilitis u posljednje vrijeme jako uznapredovao. U skladu s nedavno prihvaÄenim āMainz algoritmomā najprije smo pokuÅ”ali intubirati fleksibilnim fiberbronhoskopom na budnom bolesniku. Bronhoskop je lako proÅ”ao sve do bifurkacije traheje, ali je neoÄekivano postavljanje endotrahealnog tubusa zapelo na preuskoj nosnici zbog prijeloma nosa koji je bolesnik zadobio u dobi od 8 godina. Zato smo izvukli fiberbronhoskop i nakon indukcije opÄe anestezije uspjeli intubirati u prvom pokuÅ”aju rigidnim fiberskopom po Bonfilsu
Otežani diÅ”ni put kod uznapredovale Behterevljeve bolesti: prikaz sluÄaja
Advanced Bechterewās disease presents with increasing ossification of spinal column, from lower lumbar segments upwards, first causing impossibility to place spinal block in lumbar region, and later, due to stiffness of cervical spine, difficult intubation because of inability to extend and/or flex the neck during direct laryngoscopy and intubation. Mask ventilation, on the other hand, usually is possible. We report a case of a 77-year-old man scheduled for elective hernioplasty, with recently advanced Bechterewās disease. According to the recently accepted Mainz algorithm, we first intended to perform awake intubation through the nose by fiber bronchoscope. The bronchoscope passed easily down to tracheal bifurcation, but placing the endotracheal tube was unexpectedly impossible due to the consequences of broken nose the patient had suffered at the age of 8. Fiber bronchoscope was therefore retracted, and we used the Bonfils rigid fiberscope after induction of general anesthesia, achieving intubation in first attempt.ZnaÄajke uznapredovale Behterevljeve bolesti (ankilozirajuÄi spondilits) su sve veÄa osifikacija kralježnice od donjih, lumbalnih dijelova prema viÅ”im, cervikalnim Å”to uzrokuje prvo nemoguÄnost izvoÄenja spinalnog bloka u lumbalnoj regiji, a kasnije, zbog ukoÄenosti vratnog dijela kralježnice, otežanu intubaciju zbog nemoguÄnosti ekstenzije i/ili fleksije vrata u tijeku direktne laringoskopije i intubacije. S druge strane, ventilacija na masku je obiÄno izvediva. Ovdje prikazujemo 77-godiÅ”njeg bolesnika koji je bio predviÄen za elektivnu operaciju ingvinalne hernije, a Äiji je ankilozirajuÄi spondilitis u posljednje vrijeme jako uznapredovao. U skladu s nedavno prihvaÄenim āMainz algoritmomā najprije smo pokuÅ”ali intubirati fleksibilnim fiberbronhoskopom na budnom bolesniku. Bronhoskop je lako proÅ”ao sve do bifurkacije traheje, ali je neoÄekivano postavljanje endotrahealnog tubusa zapelo na preuskoj nosnici zbog prijeloma nosa koji je bolesnik zadobio u dobi od 8 godina. Zato smo izvukli fiberbronhoskop i nakon indukcije opÄe anestezije uspjeli intubirati u prvom pokuÅ”aju rigidnim fiberskopom po Bonfilsu
Izazovi u uporabi video laringoskopa
Despite the lack of uniformity and the need of further investigation, video laryngoscopy continues to gain popularity both inside and outside the operating room. It has quickly become a first line strategy for potential and/or encountered difficult intubation. It is well established that video laryngoscope improves laryngeal view as compared with direct laryngoscopy in patients with suspected difficult intubation and simulated difficult airway scenarios. For novices and experienced anesthesiologists alike, video laryngoscopy is easy to use and the skills involved are easy to master. However, it is important to say that video laryngoscopes may be used in a variety of clinical scenarios and settings because of the video laryngoscope design offering an alternative intubation technique in both anaesthetized and awake patients. The aim of this article is to show and highlight clinical situations in which the use of video laryngoscope is a challenge for an experienced anesthesiologist in solving the airway. Challenges in the use of video laryngoscope with which we deal and encounter in everyday clinical practice that are discussed in this paper are intubation in the prehospital setting and emergency departments, intubation in Intensive Care Unit, intubation in a patient with cervical spine immobilization, and awake video laryngoscopy-assisted tracheal intubation in the obese. We also point out the important role of video laryngoscope as a tool for teaching and training in airway education. Training and education in difficult airway management is essential to improve patient safety at endotracheal intubation in emergency situation.UnatoÄ nedostatku ujednaÄenosti proizvoda na tržiÅ”tu i potrebe za daljnjim istraživanjem, video laringoskopi i dalje su popularni unutar i izvan operacijske dvorane. Oni su postali prva linija u strategiji za potencijalne i/ili teÅ”ke intubacije. Dobro je poznato da video laringoskopi poboljÅ”avaju prikaz larinksa u usporedbi s direktnom laringoskopijom u bolesnika sa sumnjom na otežanu intubaciju i kod simuliranih teÅ”kih pristupa diÅ”nome putu. Za poÄetnike i iskusne anesteziologe podjednako video laringoskop je jednostavan za koriÅ”tenje, a vjeÅ”tine koje su potrebne za rad s njim su lako savladive. Osobitost video laringoskopa je da se može koristiti u razliÄitim kliniÄkim situacijama s obzirom na to da su osmiÅ”ljeni tako da nude alternativnu tehniku i u anesteziranih i kod budnih bolesnika. U ovom radu želimo ukazati na kliniÄke situacije u kojima koriÅ”tenje video laringoskopa predstavlja izazov za iskusne anesteziologe u rjeÅ”avanju otežanoga pristupa diÅ”nome putu. SpecifiÄne indikacije za koriÅ”tenje video laringoskopa u svakodnevnoj kliniÄkoj praksi su: intubacija u pre-hospitalnim uvjetima i hitnim odijelima; intubacija u jedinici intenzivnog lijeÄenja; intubacija bolesnika s imobiliziranom vratnom kralježnicom te budna intubacija u pretilih bolesnika. U radu takoÄer istiÄemo važnu ulogu laringoskopa u edukaciji prikaza i tehniÄkog savladavanja pristupa diÅ”nome putu. Obuka i obrazovanje u zbrinjavanju otežanoga diÅ”nog puta je nužna radi poboljÅ”anja sigurnosti bolesnika u hitnim stanjima kod kojih je neophodna uspostava diÅ”noga puta
Zbrinjavanje otežanog diÅ”nog puta kod politraumatiziranog bolesnika s teÅ”kim deformitetima kralježnice i prsnog koÅ”a te teÅ”kom kifoskoliozom : prikaz sluÄaja
Airway management in a polytraumatized patient with severe spinal and thoracic deformities demands detailed investigation of anatomical characteristics of the head, neck and airways, as well as thoracic configuration, before attempting endotracheal intubation. This enables the physician to predict a difficult airway and prepare for difficult airway management. We present a case of a 50-year-old polytraumatized patient with multiple congenital bone deformities associated with the syndrome of osteogenesis imperfecta and severe kyphoscoliosis, unable of lying on his back due to gibbus, who was successfully intubated in first attempt using video laryngoscope and only mild sedation. In patients with such severe multiple deformities, the use of video laryngoscope or Bonfils rigid endoscope should be mandatory in order to ensure success of intubation in first attempt and to avoid the possible aspiration of gastric contents.Zbrinjavanje diÅ”nog puta kod politraumatiziranog bolesnika s teÅ”kim deformitetima kralježnice i prsnog koÅ”a zahtijeva detaljan pregled anatomskih karakteristika glave, vrata i diÅ”nih putova, kao i konfiguracije prsnog koÅ”a prije pokuÅ”aja endotrahealne intubacije. To omoguÄava lijeÄniku da se pripremi za zbrinjavanje eventualnog otežanog diÅ”nog puta. Prikazuje se sluÄaj 50-godiÅ”njeg politraumatiziranog bolesnika s viÅ”estrukim priroÄenim deformitetima kostiju povezanim sa sindromom osteogenesis imperfecta i teÅ”kom kifoskoliozom, nesposobnog da leži na leÄima zbog velikog gibusa, koji je uspjeÅ”no intubiran u prvom pokuÅ”aju uz upotrebu videolaringoskopa, samo uz blagu sedaciju. U sluÄaju zbrinjavanja bolesnika s viÅ”estrukim deformitetima videolaringoskop ili Bonfils rigidni endoskop bi se trebao redovno rabiti zbog sigurnosti intubacije u prvom pokuÅ”aju i izbjegavanja moguÄe aspiracije želuÄanog sadržaja
Evaluating the analgesic efficacy of two anesthetic techniques during arthroscopic knee surgery
Background and Purpose: The aim of the study was to compare unilateral spinal and local anesthesia with respect to intraoperative and postoperative pain control, safety and complications for knee arthroscopies in outpatients.
Methods: We studied 70 ASA I or II patients scheduled for outpatient
knee arthroscopic surgery. The patients were allocated into two groups to receive either local (LA group = 35) or unilateral spinal (SA group = 35) anesthesia during a year period. The unilateral SA group received hyperbaric bupivacaine 7.5 mg (1.5 mL). The LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: perioperative pain (10 cm VAS: 0 = no pain, 10 = extreme pain), surgical operating conditions, patient satisfaction score (1=very satisfied,
4=very unsatisfied), postoperative analgesia, and time to discharge.
Results: In the LA group, 94.3% (33/35) of patients experienced no pain throughout the procedure. Only two (5.7%) patients required conversion to general anesthesia. In the unilateral SA group, one patient required conversion to general anesthesia. The need for postoperative analgesics was higher in the unilateral SA group compared with the LA group (p<0.01). The mean postoperative stay was significantly shorter in the LA than the unilateral
SA group (p<0.05). The rate of complications differed significantly
between the LA and unilateral SA groups (p<0.05).
Conclusion: LA provides good pain relief following arthroscopic knee
surgery compared to conventional unilateral spinal anesthesia. Major LA advantages are hemodynamic stability, patient satisfaction and faster anesthetic
recovery
AnestezioloÅ”ki pristup kod akutne ozljede vratne kralježnice u trudnoÄi
The incidence of traumatic spinal cord injury is 11,000 per year, with 55% of the injuries occurring between the age of 16 and 33, 18% of these in women of reproductive age. Diagnostic and early spinal decompression along with maintaining the mean arterial pressure to improve spinal cord perfusion and a high progesterone level in pregnancy for its neuroprotective and anti-inflammatory effect have the leading role in neurological recovery and clinical outcome.
We present a case of a patient in the 17th week of pregnancy who sustained luxation fracture of the C5 and C6 vertebrae and tetraplegia as passenger in a road accident. The early operative treatment and appropriate anesthetic procedure resulted in good clinical outcome with complete neurological recovery.UÄestalost traumatskih ozljeda kralježnice je 11.000 na godinu, a 55% ozljeda nastaje u dobi od 16 do 33 godine, od toga 18% u žena reproduktivne dobi. RadioloÅ”ka dijagnostika, uz ranu kirurÅ”ku dekompresiju kralježnice s održavanjem srednjeg arterijskog tlaka za oÄuvanje perfuzije leÄne moždine, uz progesteron kao neuroprotektivni i protuupalni faktor u akutnoj traumi leÄne moždine, ima vodeÄe mjesto u neuroloÅ”kom oporavku i dobrom kliniÄkom ishodu. Donosimo prikaz sluÄaja trudnice u 17. tjednu trudnoÄe koja je zadobila luksacijsku frakturu petog i Å”estog vratnog kraljeÅ”ka s razvojem tetraplegije, kod koje su rano operacijsko lijeÄenje i odgovarajuÄi anestezioloÅ”ki postupak doveli do dobrog kliniÄkog ishoda
Successful Use of Recombinant Factor VIIa in Traumatic Liver Injury ā A Case Report
The paper describe the use of rFVIIa in the management of massive bleeding in a patient with polytrauma involving
liver injury. An 18-year-old girl with severe polytrauma sustained during a busācar collision. She had multiple musculoskeletal
injuries, severe concussion of the liver with amputation of the left liver lobe, disruption of the left hepatic
vein from the inferior vena cava, and impaired hemostasis. Acute bleeding (>5 L) was not improved by conservative
methods and a single dose of rFVIIa 90 g/kg was administered. Infusion of rFVIIa resulted in an immediate clinical effect
with rapid improvements in blood laboratory measurements and coagulation parameters. rFVIIa should be considered
as an adjunctive treatment for the control of hemorrhage in severely injured patients with uncontrolled bleeding
and impaired hemostasis
Successful Use of Recombinant Factor VIIa in Traumatic Liver Injury ā A Case Report
The paper describe the use of rFVIIa in the management of massive bleeding in a patient with polytrauma involving
liver injury. An 18-year-old girl with severe polytrauma sustained during a busācar collision. She had multiple musculoskeletal
injuries, severe concussion of the liver with amputation of the left liver lobe, disruption of the left hepatic
vein from the inferior vena cava, and impaired hemostasis. Acute bleeding (>5 L) was not improved by conservative
methods and a single dose of rFVIIa 90 g/kg was administered. Infusion of rFVIIa resulted in an immediate clinical effect
with rapid improvements in blood laboratory measurements and coagulation parameters. rFVIIa should be considered
as an adjunctive treatment for the control of hemorrhage in severely injured patients with uncontrolled bleeding
and impaired hemostasis
StrateŔki pristup ekstubaciji nakon otežane intubacije
Airway management relates to the period of tracheal intubation, maintenance of endotracheal tube in situ, and finally extubation. Problems related to difficult extubation still pose significant challenge for both anesthesiologists and intensivists. This article reviews current approach to extubation strategy following difficult intubation. Guidelines and algorithm may be helpful in order to ensure safe management of the patient during this delicate period of airway management.Osiguravanje diÅ”nog puta odnosi se na razdoblje intubacije, održavanje endotrahealnog tubusa in situ i konaÄno na razdoblje ekstubacije. Problemi u vezi s otežanom ekstubacijom joÅ” uvijek predstavljaju znaÄajan izazov za anesteziologe i intenziviste. Ovaj Älanak prikazuje suvremeni strateÅ”ki pristup ekstubaciji nakon otežane intubacije. Smjernice i algoritmi mogu biti korisni za održavanje sigurnosti bolesnika u tom osjetljivom razdoblju osiguravanja diÅ”nog puta