One lung ventilation: double-lumen tube with vs. without carinal hook

Background. One lung ventilation (OLV) has become a standard procedure for the vast majority of interventions in pulmonary surgery. Te most commonly used are lef sided double-lumen tubes (DLTs) which are placed into the lef main bronchus and the right or lef lung can be isolated. Te aim of our study was to compare DLTs with and without a hook. Materials and methods. Fify-four patients undergoing lung resection were included in the randomized, controlled, single-blinded study. Recruited patients were randomly allocated to each group (hook/without hook). Demographic data, procedural data, type of tube used, and difcult intubation criteria were recorded. Complications, according to intubation and position of the tube, were also recorded. Afer the operation, we aske patients about a sore throat, hoarseness, haemoptysis and their satisfaction with the procedure. Results. Baseline characteristics were well balanced between groups. Time to place DLT was shorter in the group without a hook (47.7±45.5 vs 15.8±15.1s; P=0.01). Te incidence of adequate positioning at the frst attempt was higher in the group with a hook and the repositioning rate was higher in the group without a hook (22.22 vs 59.25%; P=0.004). Patients in both groups sufered similar incidences of hoarseness, sore throat or postoperative haemoptysis (5/5/1 vs 3/3/0; P=0.44). Patient satisfaction was higher in the group without a hook (31.85% vs 34.81%;0.03). Conclusion. Te study showed the advantage of DLTs without a hook in comparison with DLTs with a hook. In our institution we decided to use DLTs without a hook, with fberoptic control

Uporaba deksmedetomidina v paliativni medicini: prikaz primera

Deksmedetomidin je učinkovina, ki jo že več kot 10 let uporabljamo za sediranje in analgezijo. Je zelo močan agonist adrenergičnih receptorjev α2. Učinkovit je pri varčevanju z opioidi, tudi pri t. i. brezopioidni anesteziji (angl. opioid-free anesthesy, OFA), in okrepi analgezijo. Klinične izkušnje so pokazale, da je učinkovit tudi pri obvladovanju delirija pri bolnikih v enotah za intenzivno terapijo (EIT). Izkazal se je tudi kot odlična alternativa ostalim sedativom in analgetikom, kot sta midazolam in remifentanil. V prispevku predstavljamo primer obvladovanja delirija z deksmedetomidinom pri bolnici v paliativni oskrbi. Opisano področje uporabe je še v veliki meri neraziskano in odpira nove možnosti uporabe deksmedetomidina. Ugotavljamo, da bi deksmedetomidin glede na njegove farmakološke lastnosti lahko uporabljali bolj pogosto kot doslej in se poleg klasičnega dajanja v veno začeli posluževati tudi alternativnih, a še ne priporočenih poti, npr. v nos in pod kožo. Potrebne so nadaljnje raziskave tega področja uporabe deksmedetomidina

Remifentanil target-controlled infusion with intranasal dexmedetomidine for vitreoretinal procedures: a randomized controlled trial

Aim To evaluate the consumption of remifentanil (as a primary end-point), analgesia, sedation, hemodynamics, respiratory effects, and surgeon and patient satisfaction (as a secondary end-point) with dexmedetomidine sedation compared with those of remifentanil sedation in patients undergoing vitreoretinal surgery. Methods Patients subjected to retinal ophthalmic surgical procedures were randomized to one of two intraoperative sedation groups: one group (n=21) received intranasal dexmedetomidine plus intravenous remifentanil (DEX-REMI group), and the other group (n=19) received intravenous remifentanil only (REM group). The treatment was placebo-controlled. The sedation level was controlled according to the bispectral index, with target values between 80%-90%. Patient levels of comfort, sedation, and pain were documented. The number of intraoperative complications and the level of satisfaction were assessed. Remifentanil consumption and hemodynamic parameters were also included in the statistical analysis. Results The level of remifentanil consumption was significantly lower in the DEX-REMI group, but combination sedation improved the surgeon’s, anesthesiologist’s, and patients’ satisfaction scores. Importantly, the number of complications was zero in the DEX-REMI group, while eight cases of complications were noted in the REM group. The DEX-REMI group showed lower mean minimal arterial pressure, but it was still in the normotensive range. Conclusions For patients undergoing ophthalmic procedures, sedation with a combination of intranasal dexmedetomidine and an intravenous infusion of remifentanil provides lower remifentanil consumption, better satisfaction scores, and a lower complication rate than sedation with a remifentanil infusion alone

Do Inhalational Anesthetic Agents Still Hold Their Place in Modern Anesthesia Practice?

Inhalational anesthetic agents are chemical substances that are administered into the body via lungs and distributed to organs and tissues by blood circulation. The main site of their action is the brain, but they also affect other parts of central nervous system. Volatile and intravenous anesthetics alike have nearly reached the characteristics of an ideal anesthetic, but at a first glance, the increase in use of intravenous anesthetics could likely push out their volatile counterparts. Looking at the situation more thoroughly, positive side effects of volatile anesthetics that are not found in their intravenous counterparts, still give them a place in modern anesthesia practice. It is also possible to combine both techniques to reduce negative adverse effects, while making use of the positive ones

Haemodynamic changes after induction of anaesthesia with sevoflurane vs. propofol

Inhalation induction with sevoflurane would appear to offer several objective advantages compared to induction with propofol. In our study, the hemodynamic results of sevoflurane vs. propofol induction in patients undergoing thoracotomy were studied. In a prospective, randomized, blinded study 24 patients were randomly allocated to one of 2 groups: sevoflurane (S) and propofol (P) (n=12 each). For hemodynamic monitoring the LIDCO plus system was used. Patients in group S were induced into anaesthesia with sevofluran, remifentanil and vecuronium, whereas patients in group P with propofol, remifentanil and vecuronium. The anaesthesia was maintained with the same agents. Hemodynamic stability was guided using a special algorithm. The goal was oxygen delivery index (DO2I) > 500 mL min-1 m-2. According to the algorithm, patients received colloids or vasoactive drugs. Hemodynamic parameters were recorded before induction, 3 minutes after induction and 3 minutes after intubation and commencement of one lung ventilation. The consumption of vasoactive drugs and colloids and the time from the beginning of induction to intubation were documented. No statistically significant differences in measured hemodynamic parameters, remifentanil and colloid consumption between the S and P group were found. In group P, statistically more ephedrine was used (S: 4.2, P:20.8, p<0.05). Patients undergoing thoracotomy induced with sevoflurane are circulatory more stable than those induced with propofol

Phenolic compounds in two subspecies of Drypis spinosa L. (Caryophyllaceae) in Croatia

As a contribution to chemotaxonomic relations, a quantitative analysis of bioactive phenolic compounds was carried out for the first time in Drypis spinosa L. subsp. spinosa and D. spinosa subsp. jacquiniana Murb. et Wettst. ex Murb. in Croatia. Total polyphenols (TP), tannins (T) and total flavonoids (TF) were determined in samples of leaves, stems, and roots using UV-Vis spectrophotometric methods. For the subsp. spinosa, the highest content of TF was in leaves (0.09%), as was the highest amount of TP (2.36%) and T (1.12%). In the subsp. jacquiniana, the highest contents of TF (0.10%), TP (1.96%), and T (0.88%) were measured in stems. Coumaric, ferulic and rosmarinic acid were identified and quantified by HPLC analysis in both subspecies. Quercetin and sinapic acid were identified only in subsp. spinosa, while rutin and naringenin were found only in subsp. jacquiniana. Among them, ferulic acid was identified only in flowers of both subspecies. The results of this study represent a useful basis for further research of phytochemical and eventually phytotherapeutic potential of D. spinosa

Mobile palliative care team of Oncology Institute of Ljubljana

Izhodišče: Del celostne obravnave bolnika z napredovalim rakom je tudi paliativna oskrba, ki bolniku in njegovim bližnjim omogoča kakovostno življenje. Paliativna oskrba se izvaja na dveh ravneh: osnovni in specializirani. Na Onkološkem inštitutu Ljubljana v okviru specializirane paliativne oskrbe izvajamo več dejavnosti: bolnišnično obravnavo bolnikov z najkompleksnejšimi težavami, ambulantno obravnavo za zgodnjo paliativno oskrbo, konziliarno (svetovalno) dejavnost in za bolnike doma telefonsko podporo ter obiske na domu. Mobilna paliativna enota je najnovejša dejavnost, ki se izvaja od septembra 2021. Metode: Analizirali smo podatke vseh bolnikov, vključenih v specializirano paliativno oskrbo med septembrom 2021, od pričetka delovanja mobilne paliativne enote, in koncem avgusta 2022. Opazovali smo starost, spol, kraj stalnega prebivališča, diagnozo ter kraj smrti in primerjali skupino bolnikov, ki so bili obravnavani v okviru specializirane paliativne oskrbe s podporo obiskov na domu, in skupino brez nje. Rezultati: Med opazovanim obdobjem je bilo v vse dejavnosti specializirane paliativne oskrbe Onkološkega inštituta vključenih 1086 bolnikov, od tega smo pri 347 bolnikih (32 % vseh) opravili 574 obiskov na domu (povprečno 1,7 obiska na bolnika (razpon 1–8)). 317 (91 %) bolnikov je imelo svoje stalno prebivališče v osrednjeslovenski regiji, 9 % obiskov je bilo izvedenih izven meja osrednjeslovenske regije. Primerjava skupin bolnikov, napotenih v specializirano paliativno oskrbo z vključitvijo mobilne paliativne enote ali brez nje, jasno kaže večji delež umrlih v domačem okolju, kadar podporo izvajamo tudi z obiski na domu (80 % v primerjavi z 62 %). Zaključek: Mobilna paliativna enota predstavlja pomemben element mreže paliativne oskrbe in zagotavlja pogostejše umiranje v domačem okolju.Backgound: Palliative care is a part of the holistic treatment of a patient with advanced cancer, which enables the patient and his or her relatives to live a quality life. In Slovenia, palliative care is provided at two levels: basic and specialized palliative care. As a specialized palliative care hospital, the Institute of Oncology Ljubljana provides care for patients with the most complex problems, an outpatient clinic for early palliative care, and a counselling service, as well as telephone support and home visits for patients at home. The mobile palliative care unit, which was implemented in September 2021, is the latest activity. Methods: We analyzed the data of all patients involved in specialized palliative care throughout the year, from the beginning of the operation of the mobile palliative unit until the end of August 2022. We observed age, gender, place of permanent residence, diagnosis, and place of death, and compared groups of patients who were monitored in the context of specialized palliative care with or without the support of the mobile palliative team. Results: Between September 2021 and August 2022 1,086 patients were included in all specialized palliative care activities at the Institute of Oncology Ljubljana, of which 347 patients (32%) received a total of 574 home visits (an average of 1.7 visits per patient (range 1-8)). 317 (91%) patients had their permanent residence in the Central Slovenia region, while 9% were visited outside the borders. A comparison of groups of patients referred to specialized palliative care with or without the activation of a mobile palliative unit clearly shows a higher proportion of those who died at home when support was provided by home visits (80% vs 62%) of the mobile palliative team. Conclusion: The mobile palliative care unit represents an important element of the palliative care network and ensures more frequent dying in the home environment