Zbrinjavanje otežanog dišnog puta

Management of difficult airway is one of the most challenging tasks for anesthesiologists, and failure of securing it could have fatal consequences. We must be prepared to deal with problems in management of difficult airway at any time. Difficult intubation can either be anticipated or unanticipated. An anesthesiologist must be aware of the possibility of both situations to arise and preparations must be taken to deal with such cases and improve the safety of our patients. Practice guidelines are systematically developed recommendations that help anesthesiologists in the management of difficult airway.Zbrinjavanje otežanog dišnog puta je jedan od najzahtjevnijih postupaka u anesteziologiji i neuspjeh pri tome može imati fatalne posljedice. Anesteziolog mora u svakom trenutku biti pripremljen za ovaj postupak. Teška intubacija može biti očekivana i neočekivana. Posjedovanje posebnih znanja i vještina u zbrinjavanju navedenih situacija je ključni čimbenik za sigurnost bolesnika. Na temelju iskustava i preporuka su nastale smjernice koje pomažu anesteziologu u zbrinjavanju otežanog dišnog puta

Edukacija temeljena na simulacijama regionalne anestezije

Simulation-based training is a technique, which uses technological devices to reproduce different clinical situations like in the real world. Procedures and simulation scenarios performed on simulators can be planned and repeated with no harm for the patient. Simulation-based training introduced new educational applications in medicine to improve patient safety. Simulation education was introduced in the anesthesia curriculum in 2017 as a first specialization in Slovenia.Simulacijska edukacija je tehnika koja koristi tehnološku opremu da ustvari različite kliničke situacije kao u stvarnim kliničnim uvjetima. Zahvati i različiti scenariji izvedeni na simulatorima se mogu planirati i ponavljati bez opasnosti za pacijenta. Simulacijsko učenje uvodi nove edukacijske metode u medicinu kako bi se unaprijedila sigurnost u tretmanu pacijenata. U slovenski kurikulum specijalizacije iz Anesteziologije,reanimatologije i perioperativne intenzivne medicine je simulacijsko učenje uvedeno godine 2017 kao prvo u Sloveniji

The mass fallback rate of the debris in relativistic stellar tidal disruption events

Highly energetic stellar tidal disruption events (TDEs) provide a way to study black hole characteristics and their environment. We simulate TDEs with the PHANTOM code in a general relativistic and Newtonian description of a supermassive black hole's gravity. Stars, which are placed on parabolic orbits with different parameters $\beta$, are constructed with the stellar evolution code MESA and therefore have realistic stellar density profiles. We study the mass fallback rate of the debris $\dot{M}$ and its dependence on the $\beta$, stellar mass and age as well as the black hole's spin and the choice of the gravity's description. We calculate peak value $\dot{M}_\mathrm{peak}$, time to the peak $t_\mathrm{peak}$, duration of the super-Eddington phase $t_\mathrm{Edd}$, time $t_{>0.5\dot{M}_\mathrm{peak}}$ during which $\dot{M}>0.5\dot{M}_\mathrm{peak}$, early rise-time $\tau_\mathrm{rise}$ and late-time slope $n_\infty$. We recover the trends of $\dot{M}_\mathrm{peak}$, $t_\mathrm{peak}$, $\tau_\mathrm{rise}$ and $n_\infty$ with $\beta$, stellar mass and age, which were obtained in previous studies. We find that $t_\mathrm{Edd}$, at a fixed $\beta$, scales primarily with the stellar mass, while $t_{>0.5\dot{M}_\mathrm{peak}}$ scales with the compactness of stars. The effect of SMBH's rotation depends on the orientation of its rotational axis relative to the direction of the stellar motion on the initial orbit. Encounters on prograde orbits result in narrower $\dot{M}$ curves with higher $\dot{M}_\mathrm{peak}$, while the opposite occurs for retrograde orbits. We find that disruptions, at the same pericenter distance, are stronger in a relativistic tidal field than in a Newtonian. Therefore, relativistic $\dot{M}$ curves have higher $\dot{M}_\mathrm{peak}$, and shorter $t_\mathrm{peak}$ and $t_\mathrm{Edd}$.Comment: 18 pages, 11 figures, accepted for publication in Ap

Evaluation of simplified procedures for estimation of the natural vibration periods of buildings

The simplified methods for estimation of the natural vibration periods of buildings were evaluated by\ud means of three examples of tall buildings. Procedure for determination of the total base shear force\ud according to SIST EN 1998-1:2005 and some simplified procedures for estimation of the natural\ud vibration periods of buildings are presented in the theoretical part of the thesis. In the second part of\ud the thesis, the three examples of multistory buildings are then analyzed using ETABS in order to\ud compute natural vibration periods according to theoretically adequate procedure. These results were\ud used as point of comparison. Later on, many different simplified methods were applied in order to\ud assess natural vibration periods of reinforced concrete buildings, whereas for the steel building, only\ud the methods prescribed in SIST EN 1998-1:2005 were used. Based on the results of this comparative\ud study it can be concluded that the simplified procedures provide estimates for natural vibration periods\ud which are not sufficiently accurate. The simplified period-height relationship should therefore be used\ud only for the purpose of preliminary analysis or for seismic performance assessment of building stock,\ud since in the later case structural models of buildings are not available

O djelu Jána Čaploviča

Prijevod sa slovačkog ulomaka djela: Jankovič, Vendelín: Ján Čaplovič – život, osobnost’, dielo (Turčiansky Svätý Martin, 1945)

Otežani dišni put i ventilacija jednog pluća

The number of indications for lung collapse during different procedures is rising. Difficult upper airway is more often encountered with the need for single lung ventilation. In patients with difficult airway, the safest approach is by placing a single-lumen endotracheal tube with the aid of a flexible fiberoptic bronchoscope. Lung isolation in these patients is then achieved by means of a bronchial blocker. An alternative technique is exchanging the single-lumen for a double-lumen tube using an airway exchange catheter. When there is a tracheostomy in place, an independent bronchial blocker is recommended.Broj indikacija za kolaps pluća tijekom različitih kirurških postupaka je u porastu. Otežani gornji dišni put je češće povezan s potrebom ventilacije jednog pluća. U bolesnika s otežanim dišnim putom najsigurniji pristup zbrinjavanja dišnog puta je postavljanje jednolumenskog endotrahealnog tubusa pomoću fleksibilnog fiberoptičkog bronhoskopa. Izolacija jednog plućnog krila se u tim slučajevima postiže postavljanjem bronhijalnog blokatora. Alternativna tehnika je izmjena jednolumenskog u dvolumenski endotrahealni tubus pomoću specijalnog katetera, tzv. “izmjenjivača”. Kada je prisutna traheostoma preporuča se postavljanje neovisnog bronhijalnog blokatora

Spin-induced offset stream self-crossing shocks in tidal disruption events

Tidal disruption events occur when a star is disrupted by a supermassive black hole, resulting in an elongated stream of gas that partly falls back to pericenter. Due to apsidal precession, the returning stream may collide with itself, leading to a self-crossing shock that launches an outflow. If the black hole spins, this collision may additionally be affected by Lense-Thirring precession that can cause an offset between the two stream components. We study the impact of this effect on the outflow properties by carrying out local simulations of collisions between offset streams. As the offset increases, we find that the geometry of the outflow becomes less spherical and more collimated along the directions of the incoming streams, with less gas getting unbound by the interaction. However, even the most grazing collisions we consider significantly affect the trajectories of the colliding gas, likely promoting subsequent strong interactions near the black hole and rapid disc formation. We analytically compute the dependence of the offset to stream width ratio, finding that even slowly spinning black holes can cause both strong and grazing collisions. We propose that the deviation from outflow sphericity may enhance the self-crossing shock luminosity due to a reduction of adiabatic losses, and cause significant variations of the efficiency at which X-ray radiation from the disc is reprocessed to the optical band depending on the viewing angle. These potentially observable features hold the promise of constraining the black hole spin from tidal disruption events.Comment: 14 pages, 11 figures, submitted to MNRAS. Movies from the simulations are available at https://github.com/tajjankovic/Spin-induced-offset-stream-self-crossing-shocks-in-TDEs/tree/main/Movies. Comments welcome!

Regionalna anestezija u torakalnoj i abdominalnoj kirurgiji

Surgical procedure causes tissue damage which activates systemic inflammatory response and leads to changes in endocrine and metabolic system. Anaesthesia and pain can further disrupt immune performance. Regional anaesthesia causes afferent nerve blockade and in this way mediates immune protection. Thoracic epidural analgesia is the cornerstone of pain relief in thoracic and abdominal surgery. Alternatively thoracic paravertebral block can be used with less side effects and good analgesic properties. Drugs that interfere with blood coagulation obstruct the use of central regional blocks. Surgery has also changed recently from open to minimally invasive. Also pain treatment for this procedures has changed to less aggressive, systemic or locoregional techniques. It was shown that transversus abdominis plane block and epidural analgesia have the same effect on postoperative pain, but transversus abdominis plane block was better regarding hemodynamic stability and hospital stay. Multimodal approach combining regional and systemic analgesia is currently the most appropriate perioperative pain management strategy. More studies should be done to give recommendations.Kirurški zahvat uzrokuje tkivno oštećenje koje aktivira sistemski upalni odgovor i dovodi do promijena u endokrinom i metaboličkom sustavu pacijenta. Anestezija i bolovi mogu još dodatno utjecati na imunološki sustav. Regionalna anestezija uzrokuje aferentnu blokadu živaca i time dovodi do zaštite imunološkoga sustava. Torakalna epiduralna analgezija je zlatni standard za liječenje bolova u torakoabdominalnoj kirurgiji. Alternativna tehnika je torakalni paravertebralni blok koji ima manje nuspojava i dobar analgetski učinak. Antikoagulantni lijekovi ograničavaju upotrebu centralnih živčanih blokova. Kirurške se tehnike mijenjaju u smjeru minimalno invazivnih kirurških tehnika. Isto tako tehnike liječenja bolova se mijenjaju prema upotrebi manje agresivnih sistemskih i lokoregionalnih tehnika. Studije su pokazale da su “transversus abdominis block” (TAP) i epiduralna analgezija jednako učinkoviti u liječenju postoperativnih bolova, s tim da se kod TAP blokova puno rjeđe pojavljuje pad krvnoga tlaka i da je vrijeme hospitalizacije kraće. Multimodalni pristup s kombinacijom regionalne i sistemske analgezije je trenutno najbolja tehnika za liječenje perioperativnih bolova. Potrebna su dodatna istraživanja da bi se izradile smjernice