Utjecaj intraabdominalnog tlaka na osnovne vitalne funkcije i ishod liječenja

The purpose of the study was to point to the importance of measuring intra-abdominal pressure (IAP) and of early recognition of the consequences of increased IAP on basic vital functions. Measurement of IAP via urinary bladder was conducted every 12 hours in 70 surgical patients with acute abdominal syndromes not previously operated on. Based on the measured IAP values, all patients were divided into groups of patients with normal IAP values (n=20) and patients with increased IAP values (n=50) . Vital functions and basic laboratory analysis were monitored and the values obtained were compared with IAP in both patient groups. A statistically significant difference was found in body weight, body mass index, urine output, creatinine, urea, heart rate, partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) between patients with normal and increased IAP values. The increase in IAP values was found to be associated with an increase in PaCO2, respiratory rate, peak inspiratory pressure, central venous pressure, heart rate, Acute Physiology, Age and Chronic Health Evaluation II score, mortality rate, creatinine and urea values, and number of days of treatment in the intensive care unit. At the same time, the values of PaO2, blood oxygen saturation, diuresis and abdominal perfusion pressure were declining. IAP measurement is an old, cost-effective, reliable technique that is easy to perform and should be applied in all high risk patients.Cilj studije bio je ukazati na značenje mjerenja intraabdominalnog tlaka (intra-abdominal pressure, IAP) i ranog prepoznavanja promjena osnovnih vitalnih funkcija, koje su posljedica povećanja IAP. Mjerenje IAP je provedeno kroz mokraćni mjehur svakih 12 sati kod 70 bolesnika s akutnim abdominalnim sindromom koji nisu prethodno operirani. Na osnovi izmjerenih vrijednosti IAP bolesnici su podijeljeni u skupinu s normalnim vrijednostima IAP (n=20) i skupinu s povećanim vrijednostima (n=50). Praćenjem osnovnih vitalnih funkcija i laboratorijskih analiza dobivene vrijednosti uspoređivane su u odnosu na IAP u objema skupinama bolesnika. Statistički značajna razlika između bolesnika s normalnim i onih s povišenim IAP utvrđena je za tjelesnu težinu, indeks tjelesne mase, diurezu, vrijednosti kreatinina, ureju, srčanu frekvenciju, parcijalni tlak kisika (PaO2) i parcijalni tlak ugljičnog dioksida (PaCO2). Također je zapaženo da su s porastom IAP rasle i vrijednosti PaCO2, broja respiracija, vršnog inspiracijskog tlaka, centralnog venskog tlaka, srčane frekvencije, akutna fi zio loška, starosna i kronična evaluacija zdravlja II (Acute Physiology, Age and Chronic Health Evaluation, APACHE), stopa smrtnosti, vrijednosti ureje i kreatinina te broj dana liječenja u jedinici intenzivnog liječenja, dok su vrijednosti PaO2, zasićenje hemoglobina kisikom, diureza i abdominalni perfuzijski tlak bili u opadanju. Mjerenje intraabdominalnog tlaka je stara, jeftina, pouzdana metoda, jednostavna za izvođenje kod svih visoko rizičnih bolesnika

Chronic Postoperative Pain

Chronic postoperative pain (CPOP) is a serious health issue that affects millions of patients every year. The incidence of CPOP is the highest after amputations, inguinal hernioplasty, thoracotomies, cardiac surgery and breast surgery. In addition to surgical factors, the other risk factors are: female gender, younger age, preoperative pain, psychological state and acute postoperative pain. The most common expression of CPOP is neuropathic pain after surgical trauma. The treatment of chronic postoperative neuropathic pain (CPNP) is difficult. Various methods have been recommended for its prevention, the most important being techniques that avoid nerve damage and adequate perioperative analgesia. The goal of this review was to discuss data from published studies examining the incidence, risk factors and mechanisms of CPOP, with a focus on surgery, the unique opportunity to implement pharmacological strategies for prevention of CPNP and current pharmacotherapy approaches for treatment of CPNP. Commonly used drugs to prevent and treat CPNP in the current clinical setting are: opioids, α2-adrenergic agonists, cyclooxygenase antagonists, gabapentin, pregabalin, steroids, N-methyl-D-aspartate receptor antagonists and local anesthetics