THERAPEUTIC MECHANISMS OF KETAMINE

Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it\u27s use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it\u27s ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit

Impact of intravenous oxytocin on lung haemodynamics and gas exchange during caesarean section under general and spinal anaesthesia

Numerous studies have proven haemodynamic effects of oxytocin, yet there is not much knowledge about the impact of oxytocin on lung haemodynamics and gas exchange. Our goal was to determine the potential impact of intravenous oxytocin on lung haemodynamics and arterial oxygen saturation in patients undergoing Caesarean delivery and to determine the possible difference in arterial oxygen saturation between general and spinal anaesthesia after intravenous administration of oxytocin. Methods. Total of 215 patients scheduled for elective Caesarean delivery were included in the study and randomised into two groups: Caesarean section under spinal anaesthesia and Caesarean section under general anaesthesia. After excluding the patients with severe intraoperative blood loss and those given the standard doses of oxytocin, 70 patients (35 per group) were left for statistical analysis. Patients in both groups were given 10 international units (IU) of oxytocin as a bolus dose plus 10 IU of oxytocin in infusion through 3 minutes, after clamping and cutting of the umbilical cord. Oxygen saturation values throughout the whole procedure were compared between the two groups. Results. Oxygen saturation values decreased more often and to a greater degree in general anaesthesia group than in the spinal anaesthesia group after intravenous administration of oxytocin (all P < 0.05). Conclusion. Drop in arterial oxygen saturation after intravenous oxytocin is inside the safety range among full-term healthy partiurents undergoing spinal or general anaesthesia for Caesarean section. Larger studies on patients with risk factors are needed to conclude the safety of oxytocin in those patients

Intralezijska injekcija triamcinolon acetonida u liječenju halaziona

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of15.27±6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.Cilj studije bio je procijeniti učinkovitost intralezijskog injektiranja triamcinolon acetonida kod primarnog i recidivirajućeg halaziona. U ispitivanje je bilo uključeno 30 bolesnika s primarnim i recidivirajućim halazionom (37 slučajeva) i 24 bolesnika kao kontrolna skupina. Bolesnici s primarnim i recidivirajućim halazionom primili su intralezijsku injekciju 0,1 do 0,2 mL triamcinolon acetonida (40 mg/mL), dok su bolesnici kontrolne skupine primili intralezijsku injekciju 0,1 do 0,2 mL 0,9%-tne NaCl. Podatci o veličini lezije, uključujući digitalnu fotografiju u boji, regresiji ili recidivu lezije te o cjelokupnom oftalmološkom pregledu bilježili su se u vrijeme injektiranja te nakon jednog ili dva tjedna do povlačenja ili kirurškog odstranjenja lezije. Uspješnost je definirana kao najmanje 80%-tno smanjenje veličine lezije bez recidiva. Povlačenje lezije utvrđeno je u 35 slučajeva nakon jedne ili dvije injekcije, srednje vrijeme do povlačenja od 15,27±6,12 dana. Potkožno injektiranje steroida triamcinolon acetonida kod primarnog i recidivirajućeg halaziona pokazalo se jednostavnom i učinkovitom terapijom za halazion

CAESAREAN SECTION AND THE RISK OF POSTPARTAL DEPRESSION: IS THERE A POSSIBLE ROLE OF HEAT SHOCK PROTEINS?

Data on the potential connection between surgical stress during caesarean section and the role of heat shock proteins in development of postpartal depression is lacking in the literature. This is a narrative review with a goal to establish the potential role of heat shock proteins during caesarean section and development of postpartal depression. Systemic hyperinflammatory state, such as the one that occurs during surgery, may trigger protective cell reaction, which is usually called the heat shock response. Results of several researches bring strong evidence of correlation between expression of genes coding for family of heat shock proteins with the onset of depressive symptoms. Also, a recent meta-analysis established caesarean section as a risk factor for development of postpartal depression. It is obvious that heat shock proteins play a certain role in development of psychiatric disorders. However, a role of heat shock proteins in development of postpartal depression remains open for debate. We emphasise the need for a randomised control trial which would enable an answer to the mentioned issue

ANAPHYLAXIS DURING PREGNANCY

Anaphylaxis occuring during pregnancy has a potential to cause devastating damage to the unborn baby and the mother. However, majority of adverse outcomes of anaphylaxis during pregnancy frequently affect the neonates rather than the mothers. The negative neurologic outcomes of the fetus are mostly due to delayed caesarean delivery or inadequate doses of adrenaline during anaphylaxis. Most of the current knowledge on this clinical scenario is based on case reports and very few review articles. This is a mini review of the causes, diagnosis and management of anaphylaxis occuring during pregnancy

ANAPHYLAXIS DURING PREGNANCY

Anaphylaxis occuring during pregnancy has a potential to cause devastating damage to the unborn baby and the mother. However, majority of adverse outcomes of anaphylaxis during pregnancy frequently affect the neonates rather than the mothers. The negative neurologic outcomes of the fetus are mostly due to delayed caesarean delivery or inadequate doses of adrenaline during anaphylaxis. Most of the current knowledge on this clinical scenario is based on case reports and very few review articles. This is a mini review of the causes, diagnosis and management of anaphylaxis occuring during pregnancy

SPECIFICS OF COAGULATION AND REGIONAL ANESTHESIA IN PARTURIENTS

U nemalom broju trudnica mogu biti prisutni poremećaji koagulacijskog sustava koje je nužno poznavati s obzirom da su centralna neuroaksijalna analgezija i anestezija glavne anesteziološke tehnike u zbrinjavanju porođajne boli te boli tijekom carskog reza. Epiduralni i spinalni hematom su rijetke, ali kobne komplikacije spomenutih postupaka. U trudnica s poremećajima koagulacije potrebno je na individualnoj razini procijeniti korist te potencijalne komplikacije centralnih neuroaksijalnih blokova.Coagulation abnormalities are not uncommon during pregnancy and it is necessary to be familiar with such abnormalities because the central neuraxial blocks represent the most common technique for analgesia and anesthesia during delivery or cesarean section because epidural and spinal hematomas are severe complications of the mentioned procedures. In a parturient with coagulation abnormality, it is necessary to estimate, on individual basis, the benefi ts and risks of central neuraxial blocks

SPECIFICS OF COAGULATION AND REGIONAL ANESTHESIA IN PARTURIENTS

U nemalom broju trudnica mogu biti prisutni poremećaji koagulacijskog sustava koje je nužno poznavati s obzirom da su centralna neuroaksijalna analgezija i anestezija glavne anesteziološke tehnike u zbrinjavanju porođajne boli te boli tijekom carskog reza. Epiduralni i spinalni hematom su rijetke, ali kobne komplikacije spomenutih postupaka. U trudnica s poremećajima koagulacije potrebno je na individualnoj razini procijeniti korist te potencijalne komplikacije centralnih neuroaksijalnih blokova.Coagulation abnormalities are not uncommon during pregnancy and it is necessary to be familiar with such abnormalities because the central neuraxial blocks represent the most common technique for analgesia and anesthesia during delivery or cesarean section because epidural and spinal hematomas are severe complications of the mentioned procedures. In a parturient with coagulation abnormality, it is necessary to estimate, on individual basis, the benefi ts and risks of central neuraxial blocks

Obesity and Anaesthesia

Prekomjerna tjelesna težina i pretilost globalni su epidemiološki problem. Osim povećane učestalosti brojnih bolesti (dijabetes tipa 2, hipertenzija, koronarna srčana bolest, opstruktivna apneja, osteoartritis, kolelitijaza), prekomjerna tjelesna težina i pretilost same po sebi otvaraju mogućnost za komplikacije prilikom anestezioloških postupaka. Perioperativna anesteziološka skrb za pretile pacijente uključuje detaljnu preoperativnu evaluaciju te intraoperativno i postoperativno praćenje. Uzevši u obzir trenutačnu epidemiološku situaciju, u budućnosti se može očekivati sve više pretilih pacijenata koji nalažu kirurški postupak i anesteziju.Overweight and obesity have become global health issues of epidemic proportions. In addition to the increased incidence of numerous diseases (type 2 diabetes, hypertension, coronary artery disease, obstructive sleep apnoea, osteoarthritis, cholelithiasis), overweight and obesity inherently increase the risk of complications during anaesthesiology procedures. Perioperative anaesthetic management of obese patients includes detailed preoperative evaluation, as well as the intraoperative and postoperative management. Given the current epidemiologic situation, the number of obese patients requiring surgery and anaesthesia is expected to rise in the future

Intralezijska injekcija triamcinolon acetonida u liječenju halaziona

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of15.27±6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.Cilj studije bio je procijeniti učinkovitost intralezijskog injektiranja triamcinolon acetonida kod primarnog i recidivirajućeg halaziona. U ispitivanje je bilo uključeno 30 bolesnika s primarnim i recidivirajućim halazionom (37 slučajeva) i 24 bolesnika kao kontrolna skupina. Bolesnici s primarnim i recidivirajućim halazionom primili su intralezijsku injekciju 0,1 do 0,2 mL triamcinolon acetonida (40 mg/mL), dok su bolesnici kontrolne skupine primili intralezijsku injekciju 0,1 do 0,2 mL 0,9%-tne NaCl. Podatci o veličini lezije, uključujući digitalnu fotografiju u boji, regresiji ili recidivu lezije te o cjelokupnom oftalmološkom pregledu bilježili su se u vrijeme injektiranja te nakon jednog ili dva tjedna do povlačenja ili kirurškog odstranjenja lezije. Uspješnost je definirana kao najmanje 80%-tno smanjenje veličine lezije bez recidiva. Povlačenje lezije utvrđeno je u 35 slučajeva nakon jedne ili dvije injekcije, srednje vrijeme do povlačenja od 15,27±6,12 dana. Potkožno injektiranje steroida triamcinolon acetonida kod primarnog i recidivirajućeg halaziona pokazalo se jednostavnom i učinkovitom terapijom za halazion