Low-dose spinal versus epidural anaesthesia for delivery and expected caesarean section

Regional anaesthesia is associated with significantlly lower mortality among obstetric patients, but the optimal technique for delivery and cesarean section remains to be determined. Conventional epidural analgesia has disadvantage of slow onset and higher rate of instrumental delivery while spinal anaesthesia in standard doses causes hypotension and bradycardia which might further compromise critical foetal condition. Combined spinal-epidural (CSE) analgesia with low dose of intrathecal local anaesthetic or/and opioid offers theoretical advantages of faster onset and lower incidence of side effect associated with standard spinal anaesthesia. The optimal intrathecal dose which balances effective analgesia and haemodynamic stability varies in literature. CSE anaesthesia seems to be particularly suitable for caeserean section in parturiens with significant cardiac comorbidites like aortic stenosis or Eisemenger syndrome due to less haemodynamic compromise. Therefore, although in the latest Cochrane database research of clinical trials, CSE technique was not found superior to standard epidural analgesia, it might have advantages in some subgroups of obstetric patients. The definitive role of low-spinal anaesthesia as a part of CSE in clinical practice remains to be clarified

Low-dose spinal versus epidural anaesthesia for delivery and expected caesarean section

Regional anaesthesia is associated with significantlly lower mortality among obstetric patients, but the optimal technique for delivery and cesarean section remains to be determined. Conventional epidural analgesia has disadvantage of slow onset and higher rate of instrumental delivery while spinal anaesthesia in standard doses causes hypotension and bradycardia which might further compromise critical foetal condition. Combined spinal-epidural (CSE) analgesia with low dose of intrathecal local anaesthetic or/and opioid offers theoretical advantages of faster onset and lower incidence of side effect associated with standard spinal anaesthesia. The optimal intrathecal dose which balances effective analgesia and haemodynamic stability varies in literature. CSE anaesthesia seems to be particularly suitable for caeserean section in parturiens with significant cardiac comorbidites like aortic stenosis or Eisemenger syndrome due to less haemodynamic compromise. Therefore, although in the latest Cochrane database research of clinical trials, CSE technique was not found superior to standard epidural analgesia, it might have advantages in some subgroups of obstetric patients. The definitive role of low-spinal anaesthesia as a part of CSE in clinical practice remains to be clarified

Clinical significance of intraabdominal pressure and abdominal perfusion pressure in patients with acute abdominal syndrome

Elevated intraabdominal pressure (IAP) has been claimed to play a role in abdominal compartment syndrome. We assessed the correlation between the values of IAP, abdominal perfusion pressure (APP) and clinical scoring systems including SIRS, MODS and APACHE II and the patients\u27 survival rate in patients admitted to the ICU with acute abdomen due to ileus, intestinal perforation, peritonitis and trauma. We measured IAP and APP in 50 surgical patients. In this study the IAP was measured in a non-invasive manner via urinary bladder pressure. The APP was calculated as the difference between mean arterial pressure and IAP values. A significantly higher IAP was found in the non-survivors\u27 group in comparison with the survivors\u27 group. On the other hand, the APP inversely correlated with disease severity scores including SIRS, MODS and APACHE II, whereas IAP values did not show any correlation to these clinical parameters. These findings suggest that IAP and APP may be useful tools in the clinical evaluation of patients with acute abdomen

DOES THE ANESTHESIOLOGIST SLEP SOUNDLY?

Rad u smjenama i noćni rad utječu na zdravlje, raspoloženje i kognitivne funkcije. Specijalizanti i specijalisti anesteziologije rade u dugim smjenama i noću. Promjena kognitivnih funkcija može smanjiti kvalitetu rada anesteziologa, povećati broj grešaka u radu i ugroziti bolesnika. Promjena bioloških ritmova može ugroziti i zdravlje anesteziologa. Zabilježene su promjene cirkulacije, metabolizma, memorije, fine motorike, raspoloženja i pažnje. Nakon noćnog rada raste vjerojatnost prometnih nezgoda. Negativne učinke noćnog rada se pokušalo smanjiti tako da je skraćena ukupna dužina radnog tjedna. Rasprave o učinkovitnosti toga poteza živahne su i trajne. Osobito su zanimljive u tom smislu sljedeće sastavnice: kvaliteta izobrazbe liječnika na specijalizaciji, učestalost grešaka u radu i kvaliteta skrbi o bolesniku. Nakon skraćenja radnog tjedna nema jasnih pokazatelja u navedenim smjerovima koji bi sa sigurnošću potvrdili učinkovitost takve odluke. Skraćenje radnog tjedna uklapa se u “kulturu sigurnosti” u anesteziologiji.Working in night shifts influences human health, mood, and cognitive functions. Anesthesia residents and consultants work in long shifts that include the night. Changes of cognitive functions may diminish the quality of anesthesiologist’s work, increase the number of errors, and endanger the patient. Changes of biological rhythms can influence health of the anesthesiologist himself. The alterations in circulation, metabolism, memory, fine motor control, mood and attention have been recorded. After night work, the possibility of car accident for an anesthesiologist is higher. Attempts have been made to reduce negative influences of night work by shortening the number of working hours during the week. The debate about this step is vivid and still present. From this viewpoint, the most interesting aspects are the quality of educational process, the number of errors in practical work, and the quality of health care. After shortening of working hours, there are no clear indicators of the positive effects in any of these fields. Shortening of the working week is part of ‘the culture of safety’ in anesthesiology

Clinical significance of intraabdominal pressure and abdominal perfusion pressure in patients with acute abdominal syndrome

Elevated intraabdominal pressure (IAP) has been claimed to play a role in abdominal compartment syndrome. We assessed the correlation between the values of IAP, abdominal perfusion pressure (APP) and clinical scoring systems including SIRS, MODS and APACHE II and the patients\u27 survival rate in patients admitted to the ICU with acute abdomen due to ileus, intestinal perforation, peritonitis and trauma. We measured IAP and APP in 50 surgical patients. In this study the IAP was measured in a non-invasive manner via urinary bladder pressure. The APP was calculated as the difference between mean arterial pressure and IAP values. A significantly higher IAP was found in the non-survivors\u27 group in comparison with the survivors\u27 group. On the other hand, the APP inversely correlated with disease severity scores including SIRS, MODS and APACHE II, whereas IAP values did not show any correlation to these clinical parameters. These findings suggest that IAP and APP may be useful tools in the clinical evaluation of patients with acute abdomen

DOES THE ANESTHESIOLOGIST SLEP SOUNDLY?

Rad u smjenama i noćni rad utječu na zdravlje, raspoloženje i kognitivne funkcije. Specijalizanti i specijalisti anesteziologije rade u dugim smjenama i noću. Promjena kognitivnih funkcija može smanjiti kvalitetu rada anesteziologa, povećati broj grešaka u radu i ugroziti bolesnika. Promjena bioloških ritmova može ugroziti i zdravlje anesteziologa. Zabilježene su promjene cirkulacije, metabolizma, memorije, fine motorike, raspoloženja i pažnje. Nakon noćnog rada raste vjerojatnost prometnih nezgoda. Negativne učinke noćnog rada se pokušalo smanjiti tako da je skraćena ukupna dužina radnog tjedna. Rasprave o učinkovitnosti toga poteza živahne su i trajne. Osobito su zanimljive u tom smislu sljedeće sastavnice: kvaliteta izobrazbe liječnika na specijalizaciji, učestalost grešaka u radu i kvaliteta skrbi o bolesniku. Nakon skraćenja radnog tjedna nema jasnih pokazatelja u navedenim smjerovima koji bi sa sigurnošću potvrdili učinkovitost takve odluke. Skraćenje radnog tjedna uklapa se u “kulturu sigurnosti” u anesteziologiji.Working in night shifts influences human health, mood, and cognitive functions. Anesthesia residents and consultants work in long shifts that include the night. Changes of cognitive functions may diminish the quality of anesthesiologist’s work, increase the number of errors, and endanger the patient. Changes of biological rhythms can influence health of the anesthesiologist himself. The alterations in circulation, metabolism, memory, fine motor control, mood and attention have been recorded. After night work, the possibility of car accident for an anesthesiologist is higher. Attempts have been made to reduce negative influences of night work by shortening the number of working hours during the week. The debate about this step is vivid and still present. From this viewpoint, the most interesting aspects are the quality of educational process, the number of errors in practical work, and the quality of health care. After shortening of working hours, there are no clear indicators of the positive effects in any of these fields. Shortening of the working week is part of ‘the culture of safety’ in anesthesiology

Dob i individualne značajke spavanja utječu na kognitivne sposobnosti specijalizanata anesteziologije nakon 24-satne smjene

Previous research has shown that both shift work and sleep deprivation have an adverse influence on various aspects of human cognitive performance. The aim of this study was to explore changes in cognitive functioning and subjective sleepiness of anesthesiology residents after a 24-hour shift. Twenty-six anesthesiology residents completed a set of psychological instruments at the beginning and at the end of the shift, as well as a questionnaire regarding information about the shift, Stanford Sleepiness Scale, and Circadian Type Questionnaire. There was a significant decline in cognitive performance measured by the Auditory Verbal Learning Test after the shift. The effect was stronger in older participants and in those with high scores on rigidity of sleep scale and low scores on the ability to overcome sleepiness scale. There were no differences in the digits forward test (a measure of concentration), while digits backward test (a measure of working memory) even showed an improved performance after the shift. Although participants reported being significantly sleepier after the shift, the subjective sleepiness did not correlate with any of the objective measures of cognitive performance. In conclusion, the performance in short tasks involving concentration and working memory was not impaired, while performance in long-term and monotone tasks declined after sleep deprivation, and the magnitude of this decline depended on the specific individual characteristicsof sleep and on age. Surprisingly, age seemed to have an important impact on cognitive functions after shift work even in the relatively age-homogeneous population of young anesthesiology residents.Istraživanja su pokazala da i rad u smjenama i deprivacija spavanja nepovoljno utječu na različite aspekte kognitivnog funkcioniranja. Cilj ovoga istraživanja bio je ispitati promjene u kognitivnom funkcioniranju i subjektivnoj pospanosti specijalizanata anesteziologije nakon 24-satnog dežurstva. Dvadeset i šestoro specijalizanata anesteziologije ispunilo je bateriju psihologijskih instrumenata na početku i na kraju dežurstva te upitnik s pitanjima o proteklom dežurstvu, Stanfordsku ljestvicu pospanosti i Upitnik cirkadijarnih tipova. Nakon dežurstva došlo je do značajnog pada kognitivnog uratka izmjerenog Auditivno-verbalnim testom učenja, koji je bio izraženiji kod starijih sudionika te onih s visokim rezultatom na ljestvici rigidnosti spavanja i niskim rezultatom na ljestvici prevladavanja pospanosti. Nisu utvrđene razlike u pamćenju brojeva unaprijed (koncentracija pažnje), dok je u pamćenju brojeva unatrag (radno pamćenje) čak došlo do poboljšanja uratka nakon dežurstva. Iako su na kraju dežurstva sudionici procjenjivali da su značajno pospaniji nego na početku dežurstva, ova subjektivna procjena pospanosti nije bila u korelaciji ni s jednom objektivnom mjerom kognitivnog uratka. Zaključno, uradak u kratkim zadacima koji zahtijevaju koncentraciju pažnje i radno pamćenje nije se pogoršao nakon dežurstva, dok je uradak u zadacima koji su dugotrajniji i monotoni bio značajno niži nakon deprivacije spavanja, pričem je to pogoršanje ovisilo o specifičnim individualnim značajkama spavanja te o dobi. Iznenađujuće je da je dob bila značajan čimbenik u smanjenju kognitivnog uratka nakon dežurstva čak i u relativno dobno homogenom uzorku mladih specijalizanata anesteziologije

Dob i individualne značajke spavanja utječu na kognitivne sposobnosti specijalizanata anesteziologije nakon 24-satne smjene

Previous research has shown that both shift work and sleep deprivation have an adverse influence on various aspects of human cognitive performance. The aim of this study was to explore changes in cognitive functioning and subjective sleepiness of anesthesiology residents after a 24-hour shift. Twenty-six anesthesiology residents completed a set of psychological instruments at the beginning and at the end of the shift, as well as a questionnaire regarding information about the shift, Stanford Sleepiness Scale, and Circadian Type Questionnaire. There was a significant decline in cognitive performance measured by the Auditory Verbal Learning Test after the shift. The effect was stronger in older participants and in those with high scores on rigidity of sleep scale and low scores on the ability to overcome sleepiness scale. There were no differences in the digits forward test (a measure of concentration), while digits backward test (a measure of working memory) even showed an improved performance after the shift. Although participants reported being significantly sleepier after the shift, the subjective sleepiness did not correlate with any of the objective measures of cognitive performance. In conclusion, the performance in short tasks involving concentration and working memory was not impaired, while performance in long-term and monotone tasks declined after sleep deprivation, and the magnitude of this decline depended on the specific individual characteristicsof sleep and on age. Surprisingly, age seemed to have an important impact on cognitive functions after shift work even in the relatively age-homogeneous population of young anesthesiology residents.Istraživanja su pokazala da i rad u smjenama i deprivacija spavanja nepovoljno utječu na različite aspekte kognitivnog funkcioniranja. Cilj ovoga istraživanja bio je ispitati promjene u kognitivnom funkcioniranju i subjektivnoj pospanosti specijalizanata anesteziologije nakon 24-satnog dežurstva. Dvadeset i šestoro specijalizanata anesteziologije ispunilo je bateriju psihologijskih instrumenata na početku i na kraju dežurstva te upitnik s pitanjima o proteklom dežurstvu, Stanfordsku ljestvicu pospanosti i Upitnik cirkadijarnih tipova. Nakon dežurstva došlo je do značajnog pada kognitivnog uratka izmjerenog Auditivno-verbalnim testom učenja, koji je bio izraženiji kod starijih sudionika te onih s visokim rezultatom na ljestvici rigidnosti spavanja i niskim rezultatom na ljestvici prevladavanja pospanosti. Nisu utvrđene razlike u pamćenju brojeva unaprijed (koncentracija pažnje), dok je u pamćenju brojeva unatrag (radno pamćenje) čak došlo do poboljšanja uratka nakon dežurstva. Iako su na kraju dežurstva sudionici procjenjivali da su značajno pospaniji nego na početku dežurstva, ova subjektivna procjena pospanosti nije bila u korelaciji ni s jednom objektivnom mjerom kognitivnog uratka. Zaključno, uradak u kratkim zadacima koji zahtijevaju koncentraciju pažnje i radno pamćenje nije se pogoršao nakon dežurstva, dok je uradak u zadacima koji su dugotrajniji i monotoni bio značajno niži nakon deprivacije spavanja, pričem je to pogoršanje ovisilo o specifičnim individualnim značajkama spavanja te o dobi. Iznenađujuće je da je dob bila značajan čimbenik u smanjenju kognitivnog uratka nakon dežurstva čak i u relativno dobno homogenom uzorku mladih specijalizanata anesteziologije

Dob i individualne značajke spavanja utječu na kognitivne sposobnosti specijalizanata anesteziologije nakon 24-satne smjene

Previous research has shown that both shift work and sleep deprivation have an adverse influence on various aspects of human cognitive performance. The aim of this study was to explore changes in cognitive functioning and subjective sleepiness of anesthesiology residents after a 24-hour shift. Twenty-six anesthesiology residents completed a set of psychological instruments at the beginning and at the end of the shift, as well as a questionnaire regarding information about the shift, Stanford Sleepiness Scale, and Circadian Type Questionnaire. There was a significant decline in cognitive performance measured by the Auditory Verbal Learning Test after the shift. The effect was stronger in older participants and in those with high scores on rigidity of sleep scale and low scores on the ability to overcome sleepiness scale. There were no differences in the digits forward test (a measure of concentration), while digits backward test (a measure of working memory) even showed an improved performance after the shift. Although participants reported being significantly sleepier after the shift, the subjective sleepiness did not correlate with any of the objective measures of cognitive performance. In conclusion, the performance in short tasks involving concentration and working memory was not impaired, while performance in long-term and monotone tasks declined after sleep deprivation, and the magnitude of this decline depended on the specific individual characteristicsof sleep and on age. Surprisingly, age seemed to have an important impact on cognitive functions after shift work even in the relatively age-homogeneous population of young anesthesiology residents.Istraživanja su pokazala da i rad u smjenama i deprivacija spavanja nepovoljno utječu na različite aspekte kognitivnog funkcioniranja. Cilj ovoga istraživanja bio je ispitati promjene u kognitivnom funkcioniranju i subjektivnoj pospanosti specijalizanata anesteziologije nakon 24-satnog dežurstva. Dvadeset i šestoro specijalizanata anesteziologije ispunilo je bateriju psihologijskih instrumenata na početku i na kraju dežurstva te upitnik s pitanjima o proteklom dežurstvu, Stanfordsku ljestvicu pospanosti i Upitnik cirkadijarnih tipova. Nakon dežurstva došlo je do značajnog pada kognitivnog uratka izmjerenog Auditivno-verbalnim testom učenja, koji je bio izraženiji kod starijih sudionika te onih s visokim rezultatom na ljestvici rigidnosti spavanja i niskim rezultatom na ljestvici prevladavanja pospanosti. Nisu utvrđene razlike u pamćenju brojeva unaprijed (koncentracija pažnje), dok je u pamćenju brojeva unatrag (radno pamćenje) čak došlo do poboljšanja uratka nakon dežurstva. Iako su na kraju dežurstva sudionici procjenjivali da su značajno pospaniji nego na početku dežurstva, ova subjektivna procjena pospanosti nije bila u korelaciji ni s jednom objektivnom mjerom kognitivnog uratka. Zaključno, uradak u kratkim zadacima koji zahtijevaju koncentraciju pažnje i radno pamćenje nije se pogoršao nakon dežurstva, dok je uradak u zadacima koji su dugotrajniji i monotoni bio značajno niži nakon deprivacije spavanja, pričem je to pogoršanje ovisilo o specifičnim individualnim značajkama spavanja te o dobi. Iznenađujuće je da je dob bila značajan čimbenik u smanjenju kognitivnog uratka nakon dežurstva čak i u relativno dobno homogenom uzorku mladih specijalizanata anesteziologije

The use of laryngeal mask after failed intubation in thyroid surgery

Prema suvremenim algoritmima za zbrinjavanje otežanoga dišnog puta laringalna maska predstavlja sredstvo izbora za održavanje dišnoga puta. Međutim, laringalna maska nije uobičajeno sredstvo za održavanje dišnoga puta u kirurgiji štitnjače. U ovom radu prikazujemo dva slučaja uspješne primjene klasične laringalne maske u kirurgiji štitnjače nakon nemogućnosti endotrahealne intubacije.According to modern algorithms for difficult airway management, laryngeal mask is the tool of choice for maintenance of airway. However, laryngeal mask is not usually a device for maintaining airway in thyroid surgery. We present two cases of successful application of the classic laryngeal mask in thyroid surgery after impossible endotracheal intubation