Pain management in critically ill patients

Pain is a common and distressing symptom in intensive care unit (ICU) patients and despite of pain research, guideline development, numerous awareness campaigns and intense educational efforts, it remains currently under evaluated and undertreated. The pain relief in critically ill patients may be difficult to achieve due to complex interplay between mechanisms of critical illness, drug interactions, organ dysfunctions and factors involved in influencing pain perception. A different medications have been proposed for pain control and they have unique considerations when contemplated for use in the critically ill patient. The purpose of this article is to provide an overview of most important pharmacologic pain treatment in the critically ill patient

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

Preoperative peripheral nerve blockade in the perioperative pain management and early mobilization of patients after anterior cruciate ligament reconstruction

Rekonstrukcija prednje ukrižene sveze koljenskog zgloba jedna je od najčešćih operacija u ortopedskoj kirurgiji. Artroskopski zahvat umanjuje kiruršku traumu, ali poslijeoperacijska bol ostaje i dalje klinički problem u prva 24 sata produžavajući oporavak bolesnika. Dosadašnji standard kontrole poslijeoperacijske boli uključivao je visoke doze parenteralno primijenjenih centralnih analgetika praćene čestim mučninama i povraćanjem i dužim poslijeoperacijskim oporavkom. Cilj ovog rada je istražiti uspješnost poslijeoperacijske analgezije prijeoperacijskom blokadom ciljanih perifernih živaca pod kontrolom ultrazvuka koristeći malu dozu lokalnog anestetika. Slučajno odabranih 150 bolesnika imat će uniformnu anesteziju, a bit ce podijeljeni u tri skupine prema metodi analgezije: intravenska i dva modaliteta regionalne. Očekuje se da će se dokazati razlika u uspješnosti tri vrste analgezije, te njihov utjecaj na brzinu poslijeoperacijskog oporavka.Anterior cruciate ligament (ACL) reconstruction is one of the most frequent arthroscopic procedures done in orthopaedic surgery, and also one of the most painful. Although arthroscopy is associated with less tissue trauma, pain during the first 24-postoperative hours is still a clinical concern. Standardized methods with central analgesics in continuous parenteral infusion were associated with nausea, vomiting and longer hospital stay. The aim of this study is to investigate the success rate of preoperative ultrasound-guided peripheral nerve blockade using low dose of local anesthetic. For this purpose, 150 patients scheduled for the ACL reconstruction will be included in this study. They will be uniformly anesthetized and randomized between three groups: intravenous and two models of regional analgesia. It is expected to find the difference in success rate between the three analgesia techniques and their influence on postoperative recovery and early mobilization

Preoperative peripheral nerve blockade in the perioperative pain management and early mobilization of patients after anterior cruciate ligament reconstruction

Rekonstrukcija prednje ukrižene sveze koljenskog zgloba jedna je od najčešćih operacija u ortopedskoj kirurgiji. Artroskopski zahvat umanjuje kiruršku traumu, ali poslijeoperacijska bol ostaje i dalje klinički problem u prva 24 sata produžavajući oporavak bolesnika. Dosadašnji standard kontrole poslijeoperacijske boli uključivao je visoke doze parenteralno primijenjenih centralnih analgetika praćene čestim mučninama i povraćanjem i dužim poslijeoperacijskim oporavkom. Cilj ovog rada je istražiti uspješnost poslijeoperacijske analgezije prijeoperacijskom blokadom ciljanih perifernih živaca pod kontrolom ultrazvuka koristeći malu dozu lokalnog anestetika. Slučajno odabranih 150 bolesnika imat će uniformnu anesteziju, a bit ce podijeljeni u tri skupine prema metodi analgezije: intravenska i dva modaliteta regionalne. Očekuje se da će se dokazati razlika u uspješnosti tri vrste analgezije, te njihov utjecaj na brzinu poslijeoperacijskog oporavka.Anterior cruciate ligament (ACL) reconstruction is one of the most frequent arthroscopic procedures done in orthopaedic surgery, and also one of the most painful. Although arthroscopy is associated with less tissue trauma, pain during the first 24-postoperative hours is still a clinical concern. Standardized methods with central analgesics in continuous parenteral infusion were associated with nausea, vomiting and longer hospital stay. The aim of this study is to investigate the success rate of preoperative ultrasound-guided peripheral nerve blockade using low dose of local anesthetic. For this purpose, 150 patients scheduled for the ACL reconstruction will be included in this study. They will be uniformly anesthetized and randomized between three groups: intravenous and two models of regional analgesia. It is expected to find the difference in success rate between the three analgesia techniques and their influence on postoperative recovery and early mobilization

Preoperative peripheral nerve blockade in the perioperative pain management and early mobilization of patients after anterior cruciate ligament reconstruction

Rekonstrukcija prednje ukrižene sveze koljenskog zgloba jedna je od najčešćih operacija u ortopedskoj kirurgiji. Artroskopski zahvat umanjuje kiruršku traumu, ali poslijeoperacijska bol ostaje i dalje klinički problem u prva 24 sata produžavajući oporavak bolesnika. Dosadašnji standard kontrole poslijeoperacijske boli uključivao je visoke doze parenteralno primijenjenih centralnih analgetika praćene čestim mučninama i povraćanjem i dužim poslijeoperacijskim oporavkom. Cilj ovog rada je istražiti uspješnost poslijeoperacijske analgezije prijeoperacijskom blokadom ciljanih perifernih živaca pod kontrolom ultrazvuka koristeći malu dozu lokalnog anestetika. Slučajno odabranih 150 bolesnika imat će uniformnu anesteziju, a bit ce podijeljeni u tri skupine prema metodi analgezije: intravenska i dva modaliteta regionalne. Očekuje se da će se dokazati razlika u uspješnosti tri vrste analgezije, te njihov utjecaj na brzinu poslijeoperacijskog oporavka.Anterior cruciate ligament (ACL) reconstruction is one of the most frequent arthroscopic procedures done in orthopaedic surgery, and also one of the most painful. Although arthroscopy is associated with less tissue trauma, pain during the first 24-postoperative hours is still a clinical concern. Standardized methods with central analgesics in continuous parenteral infusion were associated with nausea, vomiting and longer hospital stay. The aim of this study is to investigate the success rate of preoperative ultrasound-guided peripheral nerve blockade using low dose of local anesthetic. For this purpose, 150 patients scheduled for the ACL reconstruction will be included in this study. They will be uniformly anesthetized and randomized between three groups: intravenous and two models of regional analgesia. It is expected to find the difference in success rate between the three analgesia techniques and their influence on postoperative recovery and early mobilization

WORD RECOGNITION TEST AFTER GENERAL ANESTHESIA: THE INFLUENCE OF PREVIOUS ANESTHESIA

Opća anestezija utje.e na pam.enje. U ovoj smo studiji istraživali prepoznavanje riječi prije i poslije opće anestezije, uspoređujući pacijente sa višestrukim anestezijama i pacijente kojima je to bila prva anestezija. U ispitivanje su uključeni samo pacijenti ASA I ili II prosječne dobi od 50 godina, najmanje srednje stručne spreme. Ukupno 51 ispitanik bio je podijeljen u dvije različite skupine. Prva je obuhvaćala pacijente koji nikada prije nisu bili pod anestezijom, dok se druga sastojala od pacijenata koji su barem jednom u životu bili pod anestezijom. Svi su primili iv midazolam 2-3 mg, tiopental 5 mg/kg, fentanil 2 Ęg/kg i pankuronium 0,1 mg/kg. Ventilirani su mehanički mješavinom kisika i dušičnog oksidula u omjeru 70:30. Kao inhalacijski anestetik koristilo se isofluran 0,5-1%. Pacijenti obih skupina testirani su u dva navrata. Za statističku analizu koristio se Ô2 test (1). Razlike u to.nom prepoznavanju ključnih riječi prije i poslije opće anestezije u obje skupine nisu bile statistički značajne. Mnoge studije navode da su anestezija i kirurški zahvati povezani s umanjenjem kognitivnih sposobnosti što u 10%-14% starijih pacijenata traje .3 mjeseca. Autori zaključuju da prijašnja anestezija zajedno s ovom konkretnom anestezijom ne utječe na rezultat testa prepoznavanja riječi.Among other higher brain functions such as consciousness and learning, general anesthesia also affects memory. A number of information retrieval tests are performed to determine the effects of drugs on explicit memory. In this study, we investigated the recognition of words before and after general anesthesia in subjects having and not having received anesthesia on one or more occasions before the present one. The study included 51 patients, ASA physical status I or II, median age 50, at least high-school graduates, without head trauma, known psychiatric or memory disorder, and taking no psychoactive medication. A standardized anesthesia technique, a single surgical procedure and a defined study-test interval were used. We designed our own test as a combination of story recall test and brief word learning test, both widely used in psychological and psychiatric examination. There was no significant difference in word recognition before and after general anesthesia in either patient group. Many studies indicate that anesthesia and surgery are associated with cognitive impairment lasting for ³3 months in 10%-14% of elderly patients. We hypothesized that general anesthetics can cause prolonged cognitive alterations. Study results showed that previous anesthesia in addition to the current one had no significant influence on the word recognition test

Haemodynamic changes and intubating conditions during tracheal intubation in children under anaesthesia: a comparative study of two induction regiments

Aim To compare the haemodynamic changes and intubation conditionsfollowing induction of anaesthesia with alfentanil-propofol-rocuronium with those following alfentanil-propofol combinationin children.Methods A prospective, non-randomized and non blinded trialwas performed in 208 children ( ASA I-II, both gender, aged 2-12years) undergoing elective adenoidectomy with or without tonsillectomy.Children scheduled for tonsillectomy or adenotonsillectomyreceived alfentanil 0.02 mg kg-1, propofol 2 mg kg-1 androcuronium 0.45 mg kg-1 before tracheal intubation (R-group).Children scheduled for adenoidectomy received alfentanil 0.02mg kg-1and propofol 3 mg kg-1 before intubation (C-group). Haemodynamicvalues (heart rate, systolic arterial pressure, diastolicarterial pressure, mean arterial pressure) were recorded at predeterminedtime intervals before surgical incision. The intubatingconditions were evaluated applying the Copenhagen Scoring System(excellent, good, poor).Results There was no statistical difference in haemodynamicbaseline values, neither prior nor after the intubation betweenthe two groups. There was a statistically significant increase inheart rate, systolic and diastolic arterial pressure after intubationin both groups (p<0.05). Mean arterial pressure after the intubationincreased statistically significantly only in R-group (p=0.001).There was no hypotension, bradycardia, hypoxemia or other complications.Overall intubation conditions were scored excellent in72.3%, good in 21.5% and poor in 6.2% patients. There were nosignificant differences in intubation conditions between the twogroups (p=0.244)Conclusion Both induction regiments provided the clinically acceptablehaemodynamics and intubation conditions during trachealintubation in children

Pain management in critically ill patients

Pain is a common and distressing symptom in intensive care unit (ICU) patients and despite of pain research, guideline development, numerous awareness campaigns and intense educational efforts, it remains currently under evaluated and undertreated. The pain relief in critically ill patients may be difficult to achieve due to complex interplay between mechanisms of critical illness, drug interactions, organ dysfunctions and factors involved in influencing pain perception. A different medications have been proposed for pain control and they have unique considerations when contemplated for use in the critically ill patient. The purpose of this article is to provide an overview of most important pharmacologic pain treatment in the critically ill patient

Personalized medicine in modern radiology, neurology, neurosurgery, orthopedics, anesthesiology, physical medicine and rehabilitation and pediatrics: Model of the St. Catherine Hospital

CILJ: Prikazati primjenjivost personalizirane medicine u svakodnevnom kliničkom radu Specijalne bolnice Sv. Katarina kao regionalnom centru izvrsnosti i lideru u primjeni inovativnih metoda dijagnostike i liječenja. METODE: Liječnici različitih specijalnosti: radiolozi, neurolog, neurokirurg i vertebrolog, ortopedi, fizijatar, anesteziolog te molekularni biolog, medicinski biokemičar i pedijatar, u ovome su radu na konkretnim primjerima naveli osnovne principe primjene personalizirane medicine u svome svakodnevnom kliničkom radu kritički se pri tome osvrćući na relevantne radove o navedenoj temi publicirane u recentnoj medicinskoj literaturi. ZAKLJUČCI: Nedvojbeno je da će načela personalizirane medicine odrediti smjernice razvoja dijagnostičkih i terapeutskih postupaka. Isto tako, stanična terapija, liječenje matičnim stanicama, stanično reprogramiranje, tkivni inženjering ili genska terapija postati će metode izbora u liječenju niza bolesti koje smo do sada više ili manje bezuspješno liječili standardnim metodama i postupcima