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)

Autologous Tissue Grafts in Rhinoplasty

Grafts in rhinoplasty have a wide range of use in different indications. They can be utilized for structural support, augmentation, increasing projection, replacement of over resected structures, smoothing and fine tuning of the dorsum or the tip. Various tissues can be used for those purposes to give the appropriate amount of strength, volume or coverage. We present a series of case reports with the use of autologous tissues in both primary and secondary rhinoplasties performed using both an open and closed approach. The tissues that were used are septal cartilage, conchal cartilage, rib cartilage, temporal fascia, retroauricular soft tissue, bone and fat tissue. Cartilage has been used as full thickness structural grafts, sliced cartilage, diced cartilage or cartilage paste. Fascia and soft tissues have been used as overlay, or as a wrap for diced cartilage. The understanding of the physical properties of each of these tissues and familiarity with the spectrum of use in different indications using different approaches give us the possibility to achieve stabile, aesthetically balanced results without the stigmata of surgery

Does rotation thrombelastometry (ROTEM) improve early prediction of coagulopathy in breast tumor?

Background and purpose: Breast Cancer is the second most common cancer among women after skin carcinoma. Incindence in Croatia in 2012 was 2227 new cases per year with mortality 1033 women per year. One of the most pronaunced caracteristics of cancers in general are changes in coagulation factors. Except usual coagulation factors there is thrombelasometry which is dynamic method for evaluation of coagulation factors. We have been used thrombelastometry to see differences in coagulation factors for carcinomas and benign breast diseases. Materials and methods: We included 132 patients with benign and malignant breast diseases in Institute of Thumors, Clinical Hospital Center “Sisters of Mersy”, Zagreb, Croatia gathered in prospective study in 2012/2013. We compared differences in coagulation parameters with thrombelastometry and usual coagulation factors in earlier mentioned two groups of patients with Mann-Whitney U test what is graficly described with Box and Whiskers plots and correlatio coefficients are described in table with Spearman correlation coefficients. Results: A5,A10,A15,A20,A25 and A30, MCF and AUC intem are significatly higher in malignant breast disease patients. Significant trend of elevation of these values is present in both patients groups, but those are sigificantly higher in patient group with malignant tumors. While in patients group with malignant tumors almost every correlation coefficients between A5-A30, MCF and AUC intem and cogulation markers are significant, those correlations among patients with benign diseases are not significant. Those values suggests that A5-A30, MCF and AUC intem are significatly correlated with most common used coagulation markers only in patients with malignant diseases. Conclusions: There are differences in coagulation factors in patients with benign and malignant breast diseases. Trend of elevation of markers of coagulation values is present in both disease, but significantly higher values are in malignant tumor. Our results are based on small numbers and larger number of patients with precise data of coagulation parameters are still needed

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

Optimalna analgezija za kirurgiju dojke ubrzala je oporavak u dnevnoj kirurgiji

Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.Estetska kirurgija dojke najčešći je operativni zahvat na tijelu u Poliklinici Bagatin. Prema statistici američkog udruženja plastičnih kirurga ( ASPS-u) 2020. povećanje grudi implantatima je bilo na 5-om mjestu svih estetskih operativnih zahvata i na 2-om mjestu operacija na tijelu odmah iza liposukcije i iznosio je 193,073. Uz navedene zahvate popularni su zahvati podizanje grudi (87,051) i smanjenja (redukcije) grudi (33,574). Zbog velike popularnosti ovih zahvata i velikog udjela istih u svakodnevnom operativnom programu bitna je adekvatna analgezija i oporavak pacijentica koje idu na estetske operacije korekcije grudi. Ovaj segment je bitan jer danas više nije dovoljno samo da operacija prođe dobro i da pacijenti imaju dobar rezultat nego je bitan i sam postupak od uvođenja u anesteziju do ranog i kasnog oporavka i brzog povratka svakodnevnim aktivnostima i poslu

Could the choice of regional anaesthesia serve as a cost management indicator within a hospital?

Application of certain economic knowledge and skills in the medical field could help improve organization and functioning of certain hospital departments. By analyzing the use of certain anesthesia techniques, bearing in mind cost benefits of using regional anesthesia, along with benefits for the patient (lower postoperative pain and more effective postoperative pain relief) we will try to demonstrate the benefits of regional anesthesia in comparison to other anesthesia techniques. T he purpose of the data presented in this paper is to illustrate the importance of interdisciplinary approach for achieving optimal quality of medical service and patient satisfaction. The analysis of the reports from University hospital "Sveti Duh" Department of Anesthesiology, reanimatology and Intensive medicine indicates how the use of a particular anesthesia technique can contribute to the rationalization and identify key segments of a business process where there is room for improvement

Utjecaj lokalne infiltracijske analgezije na poslijeoperacijsku bol u pacijenata s abdominoplastikom

The aim of this study was the influence of local infiltrating analgesia with levobupivacaine on acute postoperative pain in patients that underwent abdominoplasty in day surgery. Local infiltration anesthesia is an injection of local anesthetic solution in painful areas. General anesthesia and tumescent fluid solution were performed in all patients. The study included 55 patients within age range from 20 to 72 years old. Study was conducted from January 2016 to February 2019. Postoperative pain after abdominoplasty was evaluated. LIA were performed before closure of abdominal wall after resection of skin and subcutaneous fat in lower part of abdominal wall. Infiltration was performed after plication of rectus abdominis muscles with single shot of 40 ml 0.25 % Bupivacaine. Postoperative pain was reduced in the abdominal wall and in the wound area around umbilicus and in lower abdomen scar after waking from general anesthesia. Occurrence of acute postoperative was noticed in all participants. 85% of patients required an additional dose of analgesics and only in 3% of patients was required during the first postoperative day discharged during 48 hours. The research has shown that the appearance of acute postoperative pain did not lead to prolonged stay in the facility for day surgery.Cilj istraživanja je utjecaj lokalne infiltracijske analgezije s levobupivakainom na akutnu postoperacijsku bol u pacijenata podvrgnutih abdominoplastici u dnevnoj kirurgiji. Lokalna infiltracijska anestezija je injiciranje lokalnog anestetika u bolna područja na kojima operiramo. Opća anestezija učinjena je uz infiltraciju trbušnog potkožnog zida s tumescentnom otopinom. U studiju je uključeno 55 pacijenta u dobi od 20 do 72 godine. Studija se provodila od siječnja 2016. do veljače 2019. godine s evaluacijom poslijeoperacijske boli kod abdominoplastike. LIA se koristila prije zatvaranja trbušne stjenke nakon resekcije kožno-potkožnog tkiva u području donjeg dijela trbušne stjenke sa 40 ml 0,5 % Bupivakaina. Poslijeoperacijska bol u trbušnom zidu i u rani oko pupka i u području donjeg vodoravnog reza bila je manja. Dodatne analgetike poslije kirurškog zahvata dobilo je 85% pacijenata dok prvi poslijeoperacijski dan samo 3% pacijenata koji su otpušteni iz Poliklinike tijekom 48 sati. Istraživanje pokazuje da poslijeoperacijska bol poslije abdominoplastike neće produljiti boravak u poliklinici

Oblikovanje nosa strukturalnim graftovima

Cilj rada je pokazati kako strukturalni graftovi u nosu osiguravaju estetski i funkcijski zadovoljavajući rezultat kod naših bolesnika. Strukturalni graftovi podrazumijevaju “spreader” graftove, graftove za elongaciju nosne pregrade i alarne graftove. Kandidati za strukturalnu rinoplastiku su bolesnici s asimetrijom lica, izražene devijacije nosa, spušteni vršak, deformiteti i malformacije usnice i nosa, bolesnici s debelom kožom vrška, kao i bolesnici starije životne dobi. U svim zahvatima je korišten otvoreni pristup na nos koji osigurava najbolju vidljivost struktura nosa i na taj način osigurava mogućnost preciznijeg kirurškog mijenjanja i rekonstrukcije nosa sa strukturalnim graftovima. Strukturalni graftovi osiguravaju se iz hrskavice nosne pregrade ili, ako ona nije dostupna, koštanim graftovima iz iste, čime se osigurava stabilna struktura nosa. Kao rezultat se vidi osigurana stabilnost centralnog i prednjeg segmenta nosa, uz estetski i funkcijski zadovoljavajući rezultat. Strukturalna rinoplastika osigurava trajan i estetski adekvatan rezultat kod svakog bolesnika

Usporedba hemodinamske funkcije kod dvije vrste lokalne anestezije s vazokonstriktorom u dnevnoj kirurgiji: retrospektivna studija

Abstract - Hemodynamic changes and cardiac arrhythmias are not uncommon in clinical practice, depending on including patient features, surgical treatment and drugs administered. We describe hemodynamic changes developed in young patients, soon after a local infiltration anesthesia in day surgery. Methods - We retrospectively assessed the hemodynamic effect of 2% lidocaine with 0,0125mg/ml adrenaline (Li & AD) administered for septorhinoplasty in 44 participants and combination of 0.5% bupivacaine and 2% lidocaine with 0.0125mg/ml adrenaline (BLi & AD) for breast augmentation in 48 participants. Blood pressure and heart rate were recorded before the introduction of general anesthesia, immediately 5.10 and 20 minutes after administration of local infiltration, anesthetic (LIA) and data were analyzed. Results - The mean systolic blood pressure (SBP) in all observed measurements before general anesthesia (0), immediately, 5 minutes, 10 minutes and 20 minutes after local infiltration anesthesia was higher among patients who underwent septorinoplasty (Li & AD), in relation to patients who underwent breast augmentation (BLi & AD) (p <05). The level of diastolic blood pressure (DBP) in measurement 20 minutes compared to measurement in 10 minutes was increased by 9,52 mmHg. The septorhinoplasty group showed a significant increase in heart rate measured 20 minutes after local infiltration anesthesia with adrenaline. Conclusions - Measured transitory changes in heart rate and blood pressure after local infiltration of vasoconstrictor anesthetics in healthy patients prior to septorinoplasty and breast augmentation may be induced by endogenous and / or exogenous epinephrine. Bupivacaine solution for local infiltration analgesia reduces hemodynamic disturbances and prolongs analgesic effect. We highlight the need for careful preoperative evaluation, including anxiety assessment and treatment in all patients in day surgery.Sažetak Hemodinamske promjene i aritmije srca nisu rijetkost u kliničkoj praksi, ovisne o osobinama bolesnika, kirurškom liječenju i primijenjenim lijekovima. Opisane su hemodinamske promjene koje su se razvile u mlađih bolesnika ubrzo nakon lokalne infiltracije anestezija u dnevnoj kirurgiji Metode Retrospektivno smo procijenili hemodinamski učinak 2% lidokaina s 0,0125 mg/ml adrenalina (Li & AD) primijenjenog za septorinoplastiku u 44 pacijenta i kombinacija od 0,5% bupivakaina i 2% lidokaina s 0,0125 mg/ml adrenalina (BLi & AD) za povećanje dojki u 48 sudionika. Krvni tlak i broj otkucaja srca bilježeni su prije uvoda u opću anesteziju 0, te poslije 5,10 i 20 minuta nakon primjene lokalne infiltracije anestetika (LIA) i podaci su analizirani. Rezultati Srednja vrijednost sistoličkog krvnog tlaka (SRR) u svim promatranim mjerenjima prije opće anestezije (0), odmah 5 minuta, 10 minuta i 20 minuta nakon lokalne infiltracije anestetika bila je viša kod pacijenata podvrgnutih septorinoplastici (Li & AD) u odnosu na pacijentice podvrgnute povećanju dojki, (BLi & AD) skupina (p <05). Vrijednosti dijastoličkog tlaka (DRR) 20 minuta u odnosu na 10 minuta povećane su za 9,52 mmHg(P<0.05). Pacijenti podvrgnuti septorinoplastici imali su značajan porast srčane frekvencije u 20 minuti nakon lokalne infiltracije anestetika s adrenalinom. Zaključci: Izmjerene prolazne promjene otkucaja srca i krvnog tlaka nakon lokalne infiltracije anestetika s vazokonstriktorima u zdravih pacijentica prije septorinoplastike i povećanja grudi mogu biti potaknute endogenim i/ili egzogenim adrenalinom. Bupivakain otopina za lokalnu infiltracijsku analgeziju smanjila je hemodinamske poremećaje i produžila analgetski učinak. Ističemo potrebu za pažljivom preoperativnom evaluacijom, uključujući procjenu anksioznosti i liječenje u svih pacijenata u dnevnoj kirurgiji