TAPENTADOL THERAPY IN CHRONIC PAIN MANAGEMENT: OUR EXPERIENCE

Tapentadol je novi lijek registriran u retard obliku za umjerenu i jaku kroničnu bol koji svojim spektrom djelovanja pokriva i nociceptivnu i neuropatsku komponentu boli. Analgetski se učinak postiže djelovanjem dvaju sinergističkih mehanizama: agonističkim učinkom na mi opioidne receptore (MOR-agonizam) i inhibicijom ponovnog preuzimanja noradrenalina (NRI). Cilj: Usporediti naša iskustva o učinkovitosti i podnošljivosti tapentadola s iskustvima drugih istraživača u svijetu. Metode: U istraživanje su uključena 92 bolesnika iz naše ambulante za bol, kojima je bilo indicirano propisati tapentadol-retard u dozi od dva puta 50 mg ili višoj. Pratili smo povoljni učinak na smanjenje bolova prema vizualno-analognoj ljestvici (VAS) te vrstu i učestalost neželjenih učinaka lijeka. Bilježene su i daljnje preporuke za prilagodbu doze odnosno prekid terapije. Rezultati: Pojava povoljnog djelovanja tapentadola na smanjenje kronične boli kod različitih bolnih sindroma pokazala se u 66 %, ispitanika. Postotak nuspojava, od blažih do težih, iskazalo je 43 % bolesnika. Pedeset i četiri % korisnika tapentadola odustalo je od terapije, 37 % zbog nuspojava, 15 % zbog nezadovoljstva kontrolom boli i 2 % zbog neodobravanja obiteljskog liječnika. Zaključak: Našim istraživanjem potvrđena je dobra učinkovitost tapentadola na smanjenje boli. Nuspojave se u ukupnom broju javljaju sličnom učestalošću kao u podatcima iz literature, i to rjeđe nego kod terapije klasičnim opioidima. Uočena je visoka stopa prekida terapije što je u prvom redu pripisano pojavi neželjenih učinaka.Tapentadol is a novel analgesic registered in slow-release form for medium-intensity and intense chronic pain, which targets both the nociceptive and neuropathic component of the pain signal. It utilizes two synergistic mechanisms: MOR – mu opioid receptor agonism and NRI – norepinephrine reuptake inhibition. The goal of this study was to compare the effectiveness of pain management and tolerability of tapentadol in our clinical experience with existing reports from abroad. The study included 92 patients from our pain management clinic who were prescribed slow-release tapentadol in doses of at least 50 mg twice daily. We tracked the effectiveness of pain management recorded using the visual analog scale, as well as the appearance and type of adverse effects. Further directions for dose adjustment or discontinuation of therapy were also recorded. In our experience, 66% of patients reported a satisfactory analgesic effect. The adverse effect rate was 43%; 54% of patients discontinued tapentadol therapy, i.e. 37% due to adverse effects, 15% because of inadequate pain management, and 2% because of a negative attitude of their primary care physician. Our study confi rmed the effi cacy of pain management with tapentadol. The total adverse effect rate was comparable to reports found in the literature and was lower than with classical opioid therapy. A relatively high therapy discontinuation rate was noted primarily due to adverse effects

CLINICAL CHOICE OF INTRAOPERATIVE MECHANICAL CONTROLLED VENTILATION MODE DURING GENERAL ANESTHESIA: A RETROSPECTIVE ANALYSIS AT A SINGLE CLINICAL CENTRE

Mehanička kontrolirana ventilacija je standardni postupak tijekom operacijskog zahvata u općoj anesteziji. Cilj ovog retrospektivnog istraživanja bio je prikazati naša iskustva odabira vrste mehaničke kontrolirane ventilacije za vrijeme različitih kirurških zahvata. U završnu analizu je uključeno 290 bolesnika operirano u općoj anesteziji ili kombinaciji opće i regionalne anestezije u Kliničkoj bolnici Sveti Duh u jednom mjesecu 2016. godine. Metodom slučajnog odabira za reprezentativni uzorak uzeti su bolesnici anestezirani u prosincu 2016. godine. U većini slučajeva kontrolirane intraoperacijske ventilacije koristila se volumska kontrolirana ventilacija (204 bolesnika; 70,3 %). Tlačna kontrolirana ventilacija bila je metoda odabira u 84 bolesnika (29,0 %). U jednom slučaju (0,3 %) zabilježena je kombinacija tlačne i volumske kontrolirane ventilacije. Također u jednom slučaju (0,3 %) zabilježena je manualna kontrolirana ventilacija. Medijan zadanog disajnog volumena pri volumskoj kontroliranoj ventilaciji bio je 525 mL (500-575 mL, interkvartilni raspon). Medijan zadane frekvencije disanja u minuti pri volumskoj kontroliranoj ventilaciji bio je 12 (12-12, interkvartilni raspon). Medijan zadanog tlaka upuhivanja pri tlačnoj kontroliranoj ventilaciji bio je 14 cm H2O (11-16 cm H2O, interkvartilni raspon). Medijan zadane frekvencije disanja u minuti pri tlačnoj kontroliranoj ventilaciji bio je 12 (12-13, interkvartilni raspon). Prigodom volumski kontrolirane ventilacije parametri zadanog volumena udisanja prilagođavali su se u 37 slučajeva (18,1 %), a frekvencija u 75 (36,8 %). Prigodom tlačne kontrolirane ventilacije parametri zadanog tlaka udisanja su se prilagođavali u 30 slučajeva (35,7 %), a frekvencija u 24 (28,6 %). Prilagodba parametra frekvencije bila je značajno češća prilikom volumski kontrolirane ventilacije (P<0,001). Rezultati ovog istraživanja pokazuju da se tijekom kirurških zahvata u općoj anesteziji i dalje češće koristi tradicionalna volumski kontrolirana ventilacija koja zahtijeva veći angažman anesteziologa u smislu korekcije zadane frekvencije disanja da bi se postigle ciljane intraoperacijske vrijednosti parametara ventilacije.Mechanical controlled ventilation is a standard intraoperative procedure during general anesthesia. The aim of this retrospective study was to present our experience of selecting the mode of mechanical controlled ventilation during different surgical procedures. Final analysis included 290 surgical patients in general anesthesia or a combination of general and regional anesthesia at the Sveti Duh University Hospital in one-month period during 2016. Random method for a representative sample was used to select the patients anaesthetized during December 2016. Volume controlled ventilation (204 patients, 70.3%) was the most frequently used mode of controlled intraoperative ventilation. Pressure controlled ventilation was used in 84 (29.0%) patients. The combination of volume- and pressure-controlled ventilation and manually controlled ventilation were used in one case (0.3%) each. The median of tidal volume during volume controlled ventilation was 525 mL (500-575 mL, interquartile range), with the median of breathing rate per minute 12 (interquartile range, 12-12). The median inspiratory pressure during pressure controlled ventilation was 14 cm H2O (11-16 cm H2O, interquartile range), with the median of breathing rate per minute 12 (12-13, interquartile range). During volume controlled ventilation, tidal volumes were adjusted in 37 (18.1%) and the rates in 75 (36.8%) cases. During pressure controlled ventilation, the inspiratory pressure parameters were adjusted in 30 (35.7%) and the rates in 24 (28.6%) cases. Adjustment of the breathing rate parameter was signifi cantly more frequent in volume controlled ventilation (p<0.001). The results of this study demonstrate that during surgery under general anesthesia, we still more often use the traditional volume controlled ventilation that requires more anesthesiologist’s engagement in adjusting breathing rate to reach the target intraoperative ventilation parameters

CLINICAL CHOICE OF INTRAOPERATIVE MECHANICAL CONTROLLED VENTILATION MODE DURING GENERAL ANESTHESIA: A RETROSPECTIVE ANALYSIS AT A SINGLE CLINICAL CENTRE

Mehanička kontrolirana ventilacija je standardni postupak tijekom operacijskog zahvata u općoj anesteziji. Cilj ovog retrospektivnog istraživanja bio je prikazati naša iskustva odabira vrste mehaničke kontrolirane ventilacije za vrijeme različitih kirurških zahvata. U završnu analizu je uključeno 290 bolesnika operirano u općoj anesteziji ili kombinaciji opće i regionalne anestezije u Kliničkoj bolnici Sveti Duh u jednom mjesecu 2016. godine. Metodom slučajnog odabira za reprezentativni uzorak uzeti su bolesnici anestezirani u prosincu 2016. godine. U većini slučajeva kontrolirane intraoperacijske ventilacije koristila se volumska kontrolirana ventilacija (204 bolesnika; 70,3 %). Tlačna kontrolirana ventilacija bila je metoda odabira u 84 bolesnika (29,0 %). U jednom slučaju (0,3 %) zabilježena je kombinacija tlačne i volumske kontrolirane ventilacije. Također u jednom slučaju (0,3 %) zabilježena je manualna kontrolirana ventilacija. Medijan zadanog disajnog volumena pri volumskoj kontroliranoj ventilaciji bio je 525 mL (500-575 mL, interkvartilni raspon). Medijan zadane frekvencije disanja u minuti pri volumskoj kontroliranoj ventilaciji bio je 12 (12-12, interkvartilni raspon). Medijan zadanog tlaka upuhivanja pri tlačnoj kontroliranoj ventilaciji bio je 14 cm H2O (11-16 cm H2O, interkvartilni raspon). Medijan zadane frekvencije disanja u minuti pri tlačnoj kontroliranoj ventilaciji bio je 12 (12-13, interkvartilni raspon). Prigodom volumski kontrolirane ventilacije parametri zadanog volumena udisanja prilagođavali su se u 37 slučajeva (18,1 %), a frekvencija u 75 (36,8 %). Prigodom tlačne kontrolirane ventilacije parametri zadanog tlaka udisanja su se prilagođavali u 30 slučajeva (35,7 %), a frekvencija u 24 (28,6 %). Prilagodba parametra frekvencije bila je značajno češća prilikom volumski kontrolirane ventilacije (P<0,001). Rezultati ovog istraživanja pokazuju da se tijekom kirurških zahvata u općoj anesteziji i dalje češće koristi tradicionalna volumski kontrolirana ventilacija koja zahtijeva veći angažman anesteziologa u smislu korekcije zadane frekvencije disanja da bi se postigle ciljane intraoperacijske vrijednosti parametara ventilacije.Mechanical controlled ventilation is a standard intraoperative procedure during general anesthesia. The aim of this retrospective study was to present our experience of selecting the mode of mechanical controlled ventilation during different surgical procedures. Final analysis included 290 surgical patients in general anesthesia or a combination of general and regional anesthesia at the Sveti Duh University Hospital in one-month period during 2016. Random method for a representative sample was used to select the patients anaesthetized during December 2016. Volume controlled ventilation (204 patients, 70.3%) was the most frequently used mode of controlled intraoperative ventilation. Pressure controlled ventilation was used in 84 (29.0%) patients. The combination of volume- and pressure-controlled ventilation and manually controlled ventilation were used in one case (0.3%) each. The median of tidal volume during volume controlled ventilation was 525 mL (500-575 mL, interquartile range), with the median of breathing rate per minute 12 (interquartile range, 12-12). The median inspiratory pressure during pressure controlled ventilation was 14 cm H2O (11-16 cm H2O, interquartile range), with the median of breathing rate per minute 12 (12-13, interquartile range). During volume controlled ventilation, tidal volumes were adjusted in 37 (18.1%) and the rates in 75 (36.8%) cases. During pressure controlled ventilation, the inspiratory pressure parameters were adjusted in 30 (35.7%) and the rates in 24 (28.6%) cases. Adjustment of the breathing rate parameter was signifi cantly more frequent in volume controlled ventilation (p<0.001). The results of this study demonstrate that during surgery under general anesthesia, we still more often use the traditional volume controlled ventilation that requires more anesthesiologist’s engagement in adjusting breathing rate to reach the target intraoperative ventilation parameters

Lung ultrasonography for early detection of extravascular lung water overload in intensive care patients early afer surgery: a preliminary study

Aim. To investigate whether lung ultrasound can be used to detect extravascular lung water overload in the intensive care unit early afer surgery. Methods. Tis prospective study involved 60 patients without known cardiac or pulmonary diseases admitted to the intensive care unit at our Hospital afer elective abdominal or vascular surgery. PaO2/FiO2 ratio, and appearance of B-lines were determined upon admission to the intensive care unit and at 6, 12, and 24 h later. Fluid overload was defned as the presence of Blines ≤7 mm. Tissue oxygenation impairment was defned as a PaO2/FiO2 ratio < 200. Results. Fluid overload was detected in 42 patients (70%). Te dense B-lines predicted fuid overload around the same time as drop of PaO2/FiO2 ratio (p = 0.115). Appearance of dense B lines correlated strongly with PaO2/FiO2 ratio (p < 0.001). Conclusion. Our preliminary results suggest that lung ultrasonography may be a promising non-invasive method for early detection of extravascular lung water overload in spontaneous breathing intensive care patients soon afer surgery. Our fndings should be verifed in larger studies

TAPENTADOL THERAPY IN CHRONIC PAIN MANAGEMENT: OUR EXPERIENCE

Tapentadol je novi lijek registriran u retard obliku za umjerenu i jaku kroničnu bol koji svojim spektrom djelovanja pokriva i nociceptivnu i neuropatsku komponentu boli. Analgetski se učinak postiže djelovanjem dvaju sinergističkih mehanizama: agonističkim učinkom na mi opioidne receptore (MOR-agonizam) i inhibicijom ponovnog preuzimanja noradrenalina (NRI). Cilj: Usporediti naša iskustva o učinkovitosti i podnošljivosti tapentadola s iskustvima drugih istraživača u svijetu. Metode: U istraživanje su uključena 92 bolesnika iz naše ambulante za bol, kojima je bilo indicirano propisati tapentadol-retard u dozi od dva puta 50 mg ili višoj. Pratili smo povoljni učinak na smanjenje bolova prema vizualno-analognoj ljestvici (VAS) te vrstu i učestalost neželjenih učinaka lijeka. Bilježene su i daljnje preporuke za prilagodbu doze odnosno prekid terapije. Rezultati: Pojava povoljnog djelovanja tapentadola na smanjenje kronične boli kod različitih bolnih sindroma pokazala se u 66 %, ispitanika. Postotak nuspojava, od blažih do težih, iskazalo je 43 % bolesnika. Pedeset i četiri % korisnika tapentadola odustalo je od terapije, 37 % zbog nuspojava, 15 % zbog nezadovoljstva kontrolom boli i 2 % zbog neodobravanja obiteljskog liječnika. Zaključak: Našim istraživanjem potvrđena je dobra učinkovitost tapentadola na smanjenje boli. Nuspojave se u ukupnom broju javljaju sličnom učestalošću kao u podatcima iz literature, i to rjeđe nego kod terapije klasičnim opioidima. Uočena je visoka stopa prekida terapije što je u prvom redu pripisano pojavi neželjenih učinaka.Tapentadol is a novel analgesic registered in slow-release form for medium-intensity and intense chronic pain, which targets both the nociceptive and neuropathic component of the pain signal. It utilizes two synergistic mechanisms: MOR – mu opioid receptor agonism and NRI – norepinephrine reuptake inhibition. The goal of this study was to compare the effectiveness of pain management and tolerability of tapentadol in our clinical experience with existing reports from abroad. The study included 92 patients from our pain management clinic who were prescribed slow-release tapentadol in doses of at least 50 mg twice daily. We tracked the effectiveness of pain management recorded using the visual analog scale, as well as the appearance and type of adverse effects. Further directions for dose adjustment or discontinuation of therapy were also recorded. In our experience, 66% of patients reported a satisfactory analgesic effect. The adverse effect rate was 43%; 54% of patients discontinued tapentadol therapy, i.e. 37% due to adverse effects, 15% because of inadequate pain management, and 2% because of a negative attitude of their primary care physician. Our study confi rmed the effi cacy of pain management with tapentadol. The total adverse effect rate was comparable to reports found in the literature and was lower than with classical opioid therapy. A relatively high therapy discontinuation rate was noted primarily due to adverse effects