Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients

Mechanical ventilation in chronic obstructive pulmonary disease patients, noninvasive vs. invasive method (randomized prospective study) [Usporedba neinvazivne i invazivne umjetne ventilacije kod bolesnika s kroničnom opstruktivnom plućnom bolesti: prospektivna randomizirana studija]

Acute respiratory failure due to chronic obstructive pulmonary disease (COPD) presents an increasing problem throughout the world. The aim of this study was to compare invasive and non-invasive mechanical ventilation (MV) for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit for the period of 36 months and included 156 patients with COPD. MV procedure was performed using standard methods, and was applied as either invasive MV (IMV) or noninvasive MV (NIMV). Patients were randomized in two groups for application of MV using closed, nontransparent envelops. Comparison was made based on patient characteristics, objective parameters on admission and 1h, 4h, 24h, and 48h after admission and based on treatment outcome. We have confirmed that NIMV method is superior to IMV for patients with COPD. MV duration NIMV:IMV was 94:172 hours, p<0.001, time spent in Intensive Care Unit 120:223 hours, p<0.001. Ventilator associated pneumonia 5(6%):29(37%), p<0.001.The advantage of NIMV in COPD patients, especially in the early stages was confirmed

In vitro effect of subinhibitory concentrations of ceftazidime and meropenem on the serum sensitivity of Pseudomonas aeruginosa strains

The aim of this study was to determine the effect of subminimal inhibitory concentrations (subMICs) of ceftazidime, meropenem and gentamicin on the in vitro serum sensitivity of Pseudomonas aeruginosa strains isolated from a variety of isolation sites at two medical wards and an intensive care unit in a government university hospital in Croatia. A total of 20 serum-resistant P aeruginosa strains isolated from different clinical specimens were selected. Bacteria were exposed to 1/2, 1/4, 1/8, 1/16, and 1/32 x MIC of each antibiotic tested. Sensitivity of P. aeruginosa strains to bactericidal activity of normal human serum before and after bacterial exposure to subMICs was determined. Significant difference in serum sensitivity of the strains was observed after the bacteria were exposed to subMICs of ceftazidime and meropenem (p < 0.01), while the exposure to subMICs of gentamicin did not affect significantly the resistance of tested strains to the serum bactericidal activity. Comparing the number of serum-resistant strains before and after exposure to subMICs of antibiotics, statistically significant differences were determined (p < 0.01) after exposure of the strains to 1/2, 1/4, 1/8 and 1/16 x MIC of meropenem, and after exposure to 1/2, 1/4 and 1/8 x MIC of ceftazidime. SubMICs of ceftazidime and meropenem affected not only the resistance to serum bactericidal activity of bacteria, but also their morphology. The alterations in bacterial morphology caused by subMICs of ceftazidime and meropenem could be connected with consecutive bacterial serum sensitivity

Provocative discography and minimally invasive procedures for the treatment of discogenic pain

Diagnosis and treatment of lumbar discogenic pain remains a challenge. It may account for 1/3 of patients with lower back pain. The mechanism of discogenic pain remains unclear, clinical presentation can vary and the MRI may only suggest the presence of internal disc disruption. Provocative discography can provide unique information about the morphology of the disc and remains the only diagnostic test that can relate the changes observed on imaging tests and the patient’s pain. Minimally invasive treatments like intradiscal biacuplasty or intradiscal electrothermal therapy are likely better alternatives to the currently available surgical options. They are cost effective and may cause fewer side effects. However, the value of most of these therapies has yet to be established. More basic science and clinical studies are needed to prove the clinical efficacy of such minimal invasive treatments. One thing that is clear, however, is that the careful patient selection, based on the present data, significantly improves successes of these procedures

Analiza promjena arterijskog tlaka kod ugradnje zglobnih endoproteza u spinalnoj i općoj anesteziji

The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who underwent total hip or knee replacement surgery in the period between July 2010 and February 2011 at Sveti Duh University Hospital were retrospectively evaluated. Seventeen patients underwent the operation in general anesthesia and 63 patients in regional anesthesia. They were allocated into groups of normotensive (n=24) or hypertensive patients (n=56). The anthropologic and hematologic parameters of normotensive and hypertensive patients were compared, as well as their blood pressures immediately before and during the operation. Blood pressure immediately before anesthesia induction, the highest and the lowest intraoperative blood pressures were recorded. Blood pressure immediately before anesthesia induction was significantly higher in hypertensive patients who underwent the operation in regional anesthesia compared to normotensive patients (158.48 mm Hg vs. 144.71 mm Hg, P<0.01). The highest intraoperative systolic blood pressure was also significantly higher in hypertensive patients operated on in regional anesthesia compared to normotensive patients (161.20 mm Hg vs. 146.76 mm Hg, P<0.01). The difference between the highest and the lowest intraoperative systolic blood pressure was significantly greater in hypertensive patients undergoing the operation in regional anesthesia compared to normotensive patients (46.41 mm Hg vs. 35.88 mm Hg, P<0.05). The results presented in this paper indicate that the fluctuations of intraoperative blood pressure were greater and the highest intraoperative systolic blood pressure was higher in hypertensive compared to normotensive patients undergoing the operation in regional anesthesia. In our study, there were no significant differences in intraoperative blood pressure between hypertensive and normotensive patients who underwent the operation in general anesthesia.U ovom radu su analizirane hemodinamske promjene u hipertenzivnih i normotenzivnih bolesnika tijekom operacija ugradnje totalnih endoproteza kuka i koljena u općoj i regionalnoj anesteziji. Retrospektivno su analizirani podatci 80 bolesnika kojima je od srpnja 2010. do veljače 2011. u Kliničkoj bolnici Sveti Duh ugrađena totalna endoproteza kuka ili koljena. Sedamnaest bolesnika operirano je u općoj anesteziji, a 63 u regionalnoj. Njih 24 je svrstano u skupinu normotenzivnih, a 56 u skupinu hipertenzivnih bolesnika. Uspoređivani su njihovi antropološki i hematološki pokazatelji, kao i intraoperacijsko kretanje tlaka. Zabilježen je njihov arterijski tlak neposredno prije uvoda u anesteziju, te najviši i najniži tlak tijekom zahvata. Arterijski tlak neposredno prije uvoda u anesteziju bio je statistički značajno viši u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (158,48 mm Hg prema 144,71 mm Hg, P<0,01). Također najviši intraoperacijski sistolički tlak bio je statistički značajno viši u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (161,20 mm Hg prema 146,76 mm Hg, P<0,01). Razlika između najvišeg i najnižeg intraoperacijskog sistoličkog tlaka bila je statistički značajno viša u hipertenzivnih bolesnika operiranih u regionalnoj anesteziji u odnosu na normotenzivne (46,41 mm Hg prema 35,88 mm Hg, P<0,05). Rezultati izneseni u ovom radu govore u prilog tome da su kolebanja intraoperacijskog tlaka veća, te da je najviši intraoperacijski sistolički tlak viši u hipertenzivnih u odnosu na normotenzivne bolesnike operirane u regionalnoj anesteziji. Nisu pronađene statistički značajne razlike intraoperacijskog tlaka između hipertenzivnih i normotenzivnih bolesnika operiranih u općoj anesteziji

Unilateral spinal anesthesia with low dose bupivacaine and ropivacaine: hypobaric or hyperbaric solutions with fentanyl for one-day surgery?

Background and Objectives: The purpose of this study was to compare the quality of unilateral spinal anesthesia with low dose bupivacaine and ropivacaine deluded in different baric solutions (hyperbaric / hypobaric). In our special interest was to define possibilities to use hypobaric solutions of local anesthetics if they prove to have any advantages. Methods: This prospective study was conduced over a 24-month period, enrolling eighty patients (ASA groups I, II, III) randomly divided into four groups. The study solution [5mg of o.5% bupivacaine or 5 mg 1.0% ropivacaine with 25/mikron/ g fentanyl, prepared in a different baric solution (hyperbaric / hypobaric)] were injected into the subarachnoidal interspaces at the level L2-L3/L3-L4. After the inducing spinal anesthesia, the patients in the hyperbaric groups kept the lateral decubitus position with the operated side facing down; while the patients in the hypobaric groups kept lateral decubitus position facing the operated side up. During the set time intervals we evaluated how rapid was the beginning and the regression of the unilateral block; the extension of the motor and the sensoric block, the haemodinamic changes and the home admition time. Results: All of the patients included in the study tolerated the procedure well. The median time for achieving the unilateral surgical anesthesia was the shortest in hyperbaric ropivacaine group (6.95 minutes). Themaximal degree of themotor block (Bromage 3)was the highest in the hyperbaric bupivacaine group. Themedian recovery time to be able to walk and to the first urine pass was faster achieved in the hyperbaric and hypobaric ropivacaine groups (160 minutes vs.190 minutes), comparing to the hyperbaric and hypobaric bupivacaine groups (230 minutes vs.250 minutes). Side–effects were minor and infrequent in all groups. Conclusions: According to this study the baricity of the anesthetic solution has no influence in achieving successful unilateral spinal block. Ropivacain will be chosen if we want to realize a faster readiness to surgery, and a faster recovery with few side-effects and complications; all particularly appreciable in an outpatient surgery

Quality of the Blood Sampled From Surgical Drainage after Total Hip Arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12 % patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients