Feasibility study of determing a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators

Objective: To test a feasible and reliable model for diagnosing obstructive sleep apnea (OSA) in children, based on clinically relevant parameters, in comparison to a polysomnography. Methods: A total of 94 children with the suspected underlying OSA were included in the analyses. An association between clinical parameters (modified Mallampati score, tonsil size, adenoid size, age, gender, and body mass index) and apnea-hypopnea index (AHI) obtained following an overnight polysomnography was assessed, and significant variables were incorporated in the logistic regression model. Also, the sensitivity and specificity calculations of the model with the inclusion of ROC curve analysis were performed. Results: All three local clinical parameters were significantly associated with AHI (p<0.001). The most significant correlation with AHI was shown with the modified Mallampati score (r=0.723), following with tonsil size (r=0.673), and adenoid size (r=0.502). The sensitivity of the tested model was 84%, and specificity was 74%. Conclusion: This study derived a model based on the local clinical findings that significantly overlapped with the results of an overnight polysomnography, in diagnosing OSA in children

Anesthesia in Plastic Surgery: Intersurgical I-gel Placement in a Prone Position

Anesthesia is a specialization which in past history has branched off of surgery. It needs to be very creative in its delivery, in order to accommodate the many operating positions, needed by the surgeon. The patient positions must also be safe and adequate for proper ventilation, throughout the operative procedure. There are times when multiple positions must be used, turning the patient over, even several times. Careful planning and team discussions prior to an operation are absolutely necessary, to form anesthetic and operative plans. The aim of the supraglottic airway device (Intersurgical i-gel) prone position induction method is to describe, detail and present its safe efficacy for certain planned operative procedures. Patient fasting preparation is a must, nil by mouth for 8 h. This method and sequence alleviates the use of muscle relaxants for patient rotation. This increases patient safety by keeping muscle tone normal, reduced drug use, minimizing rotation of the patient, and reduces possible injury of patient and among staff involved in rotating. Some may say induction in the prone position may be unsafe due to aspiration risks, but knowing anatomy and gravitational physics, in the event of any secretions projected, they will project forwards onto the operating table (through the gastric port of the i-gel), not into the tracheal area. This similar technique and principle are seen and used for the recovery position, to aid in free drainage of fluid from within the oral cavity. The method is used for a variety of operations worldwide and introduced in 2018 at Poliklinika Bagatin (PB). Approximately, 80 prone position inductions or 10% of all general anesthesias are performed every year at PB. More than 240 anesthesized patients in the prone position with an i-gel have used this method, since it was introduced. All have been with excellent results, minimal risk and appropriate ventilation of patients. I-gel placement in prone position was successful everytime. This method is advantageous to avoid multiple rotations of patients and avoid the use of muscle relaxants, otherwise used, with classic endotracheal intubation methods. The exact process will be discussed in more detail and described within the chapter

Rezultati liječenja prijeloma klavikula u djece

Treatment of clavicle fracture is principally outpatient. Operative treatment is accompanied by the need for more x-rays and possible complications. Fractures with absolute indications for operative treatment occur only sporadically and these indications are relatively clear, but children often undergo surgery because of relative indications (shortening, fragment displacement, multifragmentary fractures), which are open to debate. In a retrospective study on 256 children, of 44 (17%) patients that received operative treatment only one 17-year-old boy had an absolute indication for surgical intervention. Other indications were fragment distraction (22 mm on average), age, associated injuries, and multifragmentary fracture. The placement of K-wire of appropriate thickness is often difficult, since the wire tends to bend and break, and patients have to undergo two additional operations of plate and screw fixation and later removal. In this retrospective study, we considered the advantages of using titanium or an elastic steel pin. All patients had favorable outcome, although some experienced numbness around the operation scar (4.5%), skin infections around the wire (15%), and/or the implanted K-wire damage (7%).Liječenje fraktura klavikule je prevenstveno ambulantno. Operativno liječenje zahtijeva dodatne rentgenske snimke i praćeno je mogućim komplikacijama. Frakture s apsolutnom indikacijom za operativno liječenje se pojavljuju sporadično i te indikacije su jasne, ali često djeca budu operirana zbog relativnih indikacija koje nisu sasvim jasne. U retrospektivnoj studiji na 256 djece, od kojih je 44 (17%) operativno liječeno, samo jedan dječak od 17 godina je imao apsolutnu indikaciju za operaciju. Ostale indikacije su bile distrakcija (prosječno 22 mm), dob, udružene ozljede i multifragmentarne frakture. Postavljanje Kirschnerove žice odgovarajuće debljine je često nemoguće zbog savijanja i pucanja žice pa bolesnici moraju ići na dva dodatna zahvata, fiksaciju pločicom i vijcima i vađenje osteosintetskog materijala. U sklopu ove studije razmotrili smo prednosti korištenja titanskog čavla. Svi bolesnici su imali dobar ishod, iako se u određenom broju operiranih pojavila utrnutost oko ožiljka (4,5%), infekcija rane (15%) i oštećenje Kirschnerove žice (7%)

Nonelective surgery at night and in-hospital mortality - Prospective observational data from the European Surgical Outcomes Study

BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care. DESIGN A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study). SETTING Four hundred and ninety-eight hospitals in 28 European countries. PATIENTS Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure. INTERVENTION None. MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission. RESULTS Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)]. CONCLUSION In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed