Strateški pristup ekstubaciji nakon otežane intubacije

Airway management relates to the period of tracheal intubation, maintenance of endotracheal tube in situ, and finally extubation. Problems related to difficult extubation still pose significant challenge for both anesthesiologists and intensivists. This article reviews current approach to extubation strategy following difficult intubation. Guidelines and algorithm may be helpful in order to ensure safe management of the patient during this delicate period of airway management.Osiguravanje dišnog puta odnosi se na razdoblje intubacije, održavanje endotrahealnog tubusa in situ i konačno na razdoblje ekstubacije. Problemi u vezi s otežanom ekstubacijom još uvijek predstavljaju značajan izazov za anesteziologe i intenziviste. Ovaj članak prikazuje suvremeni strateški pristup ekstubaciji nakon otežane intubacije. Smjernice i algoritmi mogu biti korisni za održavanje sigurnosti bolesnika u tom osjetljivom razdoblju osiguravanja dišnog puta

Effectivity of flavonoids on animal model psoriasis – thermographic evaluation

Background and purpose: Psoriasiform lesions are characterized by hyperproliferation and aberrant differentiation of epidermal keratinocytes, accompanied by inflammation, leading to a disrupted skin barrier with an abnormal stratum corneum. Psoriasis is a chronic inflammatory disease whose etiopathogenesis has not yet been fully resolved, and therefore there is no standardized therapeutical approach. This study examined the possible positive effects of propolis and its polyphenolic/flavonoid compounds on animal model psoriasis, induced by the Di-n-Propyl Disulfide iritant (PPD), and the possibility to assess usefulness of thermography in psoriatic lesion regression. Material and methods: We monitored the inflammation process by monitoring the total number of inflammatory cells in peritoneal cavity, macrophage spreading index and thermographic scanning. Thermographic is scanning an effective and simplemethod which reproducibly records thermographic images of the examined area. The tested animals were divided into sixteen groups and locally processed during five days with PPD, water and ethanolic extract (WSDP or EEP) of propolis preparations and flavonoids (Epigallocatechin 3-gallate, Quercetin, Chrisin, Curcumin). Results: The results of thermal imaging showed no statistically significant differences in temperature changes on skin locuses of psoriasis formed lesions among the examined groups. The total number of inflammatory cells in peritoneal cavity and the macrophage spreading index were reduced in psoriatic mice treated with test components. Conclusions: These results demonstrate that topical application of propolis and the flavonoids present in propolis may improve psoriatic-like skin lesions by suppressing functional activity of macrophages and ROS production. Taken toghether, it is suggested that propolis and flavonoids offer some protection against psoriatic complications through their roles as inhibitors of inflammation and as free radical scavengers. Thermal imaging was realistic, and can be applicable in examining the inflammatory process in psoriasis and in evaluating the effectiveness of tested substances

Effectivity of flavonoids on animal model psoriasis – thermographic evaluation

Background and purpose: Psoriasiform lesions are characterized by hyperproliferation and aberrant differentiation of epidermal keratinocytes, accompanied by inflammation, leading to a disrupted skin barrier with an abnormal stratum corneum. Psoriasis is a chronic inflammatory disease whose etiopathogenesis has not yet been fully resolved, and therefore there is no standardized therapeutical approach. This study examined the possible positive effects of propolis and its polyphenolic/flavonoid compounds on animal model psoriasis, induced by the Di-n-Propyl Disulfide iritant (PPD), and the possibility to assess usefulness of thermography in psoriatic lesion regression. Material and methods: We monitored the inflammation process by monitoring the total number of inflammatory cells in peritoneal cavity, macrophage spreading index and thermographic scanning. Thermographic is scanning an effective and simplemethod which reproducibly records thermographic images of the examined area. The tested animals were divided into sixteen groups and locally processed during five days with PPD, water and ethanolic extract (WSDP or EEP) of propolis preparations and flavonoids (Epigallocatechin 3-gallate, Quercetin, Chrisin, Curcumin). Results: The results of thermal imaging showed no statistically significant differences in temperature changes on skin locuses of psoriasis formed lesions among the examined groups. The total number of inflammatory cells in peritoneal cavity and the macrophage spreading index were reduced in psoriatic mice treated with test components. Conclusions: These results demonstrate that topical application of propolis and the flavonoids present in propolis may improve psoriatic-like skin lesions by suppressing functional activity of macrophages and ROS production. Taken toghether, it is suggested that propolis and flavonoids offer some protection against psoriatic complications through their roles as inhibitors of inflammation and as free radical scavengers. Thermal imaging was realistic, and can be applicable in examining the inflammatory process in psoriasis and in evaluating the effectiveness of tested substances

Incidence and clinical significance of post-dural puncture headache in young orthopaedic patients and parturients

Background and Aims: Post-dural puncture headache (PDPH) is a complication of spinal anaesthesia, influenced mostly by patient’s age, spinal needle size and design and, possibly, female gender. The purpose of this prospective observational study was to compare the frequency and clinical significance of PDPH in two patient groups at high risk for the development of PDPH, namely young parturients and orthopaedic patients, using 26-G and 27-G Quincke needles. Patients and Methods: The study included 56 parturients undergoing Caesarean section and 59 orthopaedic patients undergoing arthroscopic knee surgery, who received standard spinal anaesthesia using 26-G or 27-G Quincke needles. All patients were less than 40 years of age. The patients were visited on postoperative days 1, 2, and 4 or contacted by telephone and evaluated for the presence, characteristics and severity of headache, backache and other possible complications. Only posture dependent headache was regarded as PDPH with severity graded as mild, moderate and severe. Patient satisfaction was assessed by theirwillingness to have spinal anaesthesia in the future. Results: Orthopaedic patients were predominantly male (81.4%) and significantly younger than parturients (27.8±5.5 vs. 33.7±4.7 years, P<0.0001). Both groups had similar use of 26-G and 27-G needles, one attempt success rate at dural puncture, and high quality of spinal block. The incidence of PDPH in parturients was 14.3% and in orthopaedic patients 13.6%, which was not significantly different. Also, the severity of PDPH was similar, with mild headache in four out of eight PDPH patients in each group. The rate was similar with 26-G and 27-G needles. No patient required an epidural blood patch. Both orthopaedic patients and parturients expressed high satisfaction rate with spinal anaesthesia (96.6% and 94.6%, respectively). Conclusion: The rate of PDPH was similar in young orthopaedic patients and parturients but higher than in the literature. Low rate of severe headache, no need for epidural blood patch, and high patient satisfaction with spinal anaesthesia, make 26-G and 27-G Quincke needles an acceptable technique where pencil point needles are not available

Oxidative stress and inflammation caused by n-Hexyl salicylate in mouse skin: the effectiveness of flavonoids

Reactive oxygen species (ROS) play a role in a numbered of degenerative conditions including psoriasis. Psoriasis is a chronic inflammatory disease who’s the etiopathogenesis is not yet completely understood, and therefore there is no standardized therapeutical approach. Flavonoids, recognized as potent antioxidants, are multifunctional molecules that can act as anti-inflammatory and antiproliferative agents through the modulation of multiple signaling pathways. The present study was designed to investigate the protective role of flavonoids [quercetin, chrysin, curcumin or Epigallocatechin 3-gallate (EGCG)] against n-Hexyl salicylate (HXS)-induced oxidative stress and inflammation in skin. Anti-oxidative and anti-inflammatory effect of flavonoids is quantified by histopathological assessment of skin, measuring the levels of lipid peroxidation and glutathione (GSH) in the skin, total number of inflammatory cells in peritoneal cavity, macrophage spreading index, and hematological and biochemical parameters.Topically applied of n-Hexyl salicylate caused significant increase in lipid peroxidation and decrease in GSH, which is accompanied by an increase total number of inflammatory cells in skin and peritoneal cavity, functional activity of macrophages, and enzymatic activity of ALP and AST. In contrast, topically applied 5 % preparation of flavonoids (quercetin, chrysin, curcumin or EGCG) with HXS effectively prevented these alterations and maintained the antioxidant status.The results suggest that flavonoid preparations can serve as a potent antioxidant and anti-inflammatory agents in psoriatic-like skin lesions, without toxic effects