Development of post-thoracotomy pain syndrome in patients undergoing lung surgery – comparison of thoracic paravertebral and epidural analgesia

Background and Purpose: Post-thoracotomy pain syndrome is one of the major concerns following the thoracic surgery. Our study was aimed to compare two methods of regional analgesia in development of this syndrome as well as establish the quality of life in both groups. Patients and Methods: 50 patients undergoing thoracotomy were enrolled in the study and were randomized to thoracic paravertebral cathether analgesia group (group TPA; 25 patients) and to thoracic epidural analgesia group (group TEA; 25 patients). Before induction of anaesthesia patients in both groups received 60 μg/kg morphine and local anaesthetic (TEA group: 0.125% bupivacaine, TPA group: 0.5% bupivacaine according to Bromage scheme). After the procedure TEA group recieved a mixture, composed of morphine 10 mg, bupivacaine 125 mg and clonidine 0.15 mg/100 mL saline; the rate of infusion was 0.05 mL/kg/h. TPA group received another mixture, composed of morphine 10 mg, bupivacaine 250 mg and clonidine 0.15 mg/100 mL saline; the rate of infusion was the same as already noted above. PCA infusion system was used in both cases. Postthoracotomy pain was assessed in 3 month’s period after the surgery. The quality of life was evaluated with Brief Pain Inventory. Results and Conlusion: Post-thoracotomy pain was experienced in 52, 25% of all the patients (TPA group 47, 37%, TEA group 57, 14%). No differences in assessment of post-thoracotomy pain were observed in TPA group as compared to TEA group. No differences in the quality of life were observed between two groups

Hyperperfusion and intracranial haemorrhage after carotid angioplasty with stenting – latest review

The number of endovascular procedures is constantly increasing. As far as the carotid artery is concerned, carotid angioplasty with stenting (CAS) is an alternative to surgical treatment (carotid endarterectomy; CEA). Two major devastating complications can occur after both procedures – cerebral hyperperfusion syndrome (CHS) and intracranial haemorrhage (ICH). The incidence of CHS and ICH in CAS is fortunately low but overall morbidity and mortality remains high. This latest review re-evaluates the pathogenesis, clinical features, risk factors and diagnostic procedures as well as management of these two complications

Terminologija klinične prehrane: Motnje prehranjenosti in s prehranjenostjo povezana stanja

Izhodišča: Prehransko stanje posameznika uvrščamo med ključne dejavnike njegovega zdravja. Za učinkovito individualno in multidisciplinarno obravnavo stanj, povezanih s prehranskim stanjem posameznika, moramo dobro poznati terminologijo klinične prehrane. Ker je klinična prehrana kot medicinska stroka razvita tudi pri nas, v tujini pa so tovrstni terminološki dokumenti že na voljo, želimo tudi v Sloveniji na podlagi konsenza oblikovati enotno terminologijo. Metode: Prispevek je osnovan na podlagi eksplicitnega terminološkega dogovora. K sodelovanju smo povabili obsežno skupino relevantnih slovenskih strokovnjakov s kliničnih, predkliničnih in drugih področij, ki so povezana z dejavnostjo klinične prehrane v medicini, pri oblikovanju pa je sodeloval tudi terminolog s področja medicine. Kot izhodišče smo izbrali terminološke smernice Evropskega združenja za klinično prehrano in presnovo ter ob njih upoštevali najnovejša strokovna priporočila za posamezne pojme. Avtorji so bili v stiku prek osebnih srečanj in elektronske pošte. Pri končnem oblikovanju konsenza je sodelovalo 42 avtorjev iz 19 slovenskih ustanov. Rezultati: Predstavljamo temeljne pojme, terminološke definicije in pripadajoče slovenske termine s področja klinične prehrane. Opredelili smo osnovne motnje prehranjenosti – podhranjenost, prekomerno hranjenost, neravnovesje mikrohranil in sindrom ponovnega hranjenja. Poleg tega smo opredelili tudi s prehranjenostjo povezana stanja – sarkopenijo in krhkost. Osnovne pojme smo podprli s kliničnim kontekstom, v katerem nastopajo. Zaključki: Poenoteno razumevanje osnovnih patoloških stanj, ki jih obravnava klinična prehrana, je izhodišče za nadaljnji razvoj stroke, poleg tega pa je podlaga tudi za prehransko obravnavo in učinkovito prehransko oskrbo

Terminologija klinične prehrane: Prehranska obravnava – presejanje prehranske ogroženosti in prehranski pregled

Izhodišča: Pomembno vlogo pri prehranski obravnavi imata tako presejanje prehranske ogroženosti kot prehranski pregled, na podlagi katerega lahko postavimo diagnozo motnje prehranjenosti ali s prehranjenostjo povezane motnje. Ocena posameznikovega prehranskega stanja, ki jo pridobimo s prehransko obravnavo, je namreč ključna za načrtovanje učinkovite prehranske oskrbe. Za razvoj področja je pomembno, da so vsi termini, ki se uporabljajo pri kliničnem delu, usklajeni. Taki terminološki dokumenti v mednarodnem prostoru že obstajajo, smiselni pa so tudi za slovenščino in naše okolje. Metode: Prispevek temelji na eksplicitnem terminološkem dogovoru skupine 42 relevantnih slovenskih strokovnjakov iz 19 slovenskih ustanov. Osnova oblikovanja terminoloških smernic je terminološki dokument Evropskega združenja za klinično prehrano in presnovo, pri čemer so bili upoštevani tudi novejši izsledki klinične prehrane. Rezultati: Predstavljeni so slovenski termini in terminološke definicije s področja klinične prehrane. Opredeljeni so osnovni pojmi s področja prehranske obravnave, ki je praviloma del medicinske obravnave. Predstavljena sta pojma prehranska ogroženost in presejanje prehranske ogroženosti, ob čemer so navedeni tudi različni presejalni testi za presejanje prehranskih motenj in s prehranjenostjo povezanih stanj. Podrobno so opredeljeni tudi prehranski pregled in njegovi sestavni deli. Zaključki: Tako presejanje prehranske ogroženosti kot prehranski pregled sta bistvena za diagnostično obravnavo v okviru klinične prehrane, poenoteno razumevanje terminologije pa omogoča primerno prepoznavo patoloških stanj pri bolnikih in pripravo ustreznega načrta prehranskih ukrepov

Development of postthoracotomy pain syndrome in patients undergoing anterolateral thoracotomy – a comparision of paravertebral and epidural analgesia

IZVLEČEK NAMEN Posttorakomijski bolečinski sindrom (PTBS) je posledica torakalnega kirurškega posega, ki se pojavi in vztraja najmanj dva meseca po njem ter pomembno vpliva na kakovost življenja bolnika. Namen raziskave je bila primerjava dveh metod regionalne analgezije pri razvoju PTBS in ugotoviti kakovost življenja pri bolnikih v obeh skupinah. BOLNIKI in METODE V prospektivno randomizirano raziskavo smo vključili 50 bolnikov, pri katerih je bila indicirana anterolateralna torakotomija. Bolnike smo naključno razporedili v dve skupiniprva skupina je prejemala analgetično mešanico po paravertebralnem katetru (skupina TPA25 bolnikov), druga pa po epiduralnem katetru (skupina TEA25 bolnikov). Pred indukcijo anestezije in kirurškim rezom so bolniki po katetru prejeli 60 mcg/kg morfina in lokalni anestetik (skupina TPA 0.5% bupivakain po modificirani shemi, skupina TEA 0.125% bupivakain po Bromage-jevi shemi). Po opravljenem operativnem posegu so bolniki prejemali analgetično mešanico po katetruv skupini TPA je bila mešanica sestavljena iz 10 mg morfina, 250 mg bupivakaina in 0.15 mg klonidina/100 ml fiziološke raztopinev skupini TEA pa iz 10 mg morfina, 250 mg bupivakaina in 0.15 mg klonidina/100 ml fiziološke raztopine. Hitrost infuzije v obeh skupinah je bila enaka – 0.05 ml/kg/h pri obeh skupinah. Po treh mesecih smo ocenili incidenco PTBS in kakovost življenja po operativnem posegu, za kar smo uporabili Kratek vprašalnik o bolečini. REZULTATI PTBS je opisalo 52,25% bolnikov (skupina TPA 47, 37%skupina TEA 57, 14%). Pri oceni PTBS ni bilo statistično pomembnih razlik v obeh skupinahravno tako ni bilo nobenih statistično pomembnih razlik v obeh skupinah glede kakovosti življenja. ZAKLJUČKI Obe preiskovani metodi – aplikacija analgetične mešanice po paravertebralnem in po epiduralnem katetru sta primerljivi pri razvoju posttorakotomijskega bolečinskega sindromaravno tako sta primerljivi glede kakovosti življenja po operativnem posegu. KLJUČNE BESEDE: Posttorakotomijski bolečinski sindrom, anterolateralna torakotomija, paravertebralni kateter, epiduralni kateter, kakovost življenjaABSTRACT OBJECTIVE Post-thoracotomy pain syndrome (PTPS) is one of the major concerns following the thoracic surgeryit is defined as a persistent pain two months after the procedure and affects quality of life. Our study was aimed to compare two methods of regional analgesia in development of this syndrome as well as establish the quality of life in both groups. PATIENTS and METHODS 50 patients undergoing thoracotomy were enrolled in the prospective randomised study. They were randomized to thoracic paravertebral cathether analgesia group (group TPA25 patients) and to thoracic epidural analgesia group (group TEA25 patients). Before induction of anaesthesia and start of the surgery patients in both groups received 60 mg/kg morphine and local anaesthetic (TEA group: 0.125% bupivacaine, TPA group: 0.5% bupivacaine according to Bromage scheme). After the procedure TEA group received a mixture, composed of morphine 10 mg, bupivacaine 125 mg and clonidine 0.15 mg/100 mL salinethe rate of infusion was 0.05 mL/kg/h. TPA group received another mixture, composed of morphine 10 mg, bupivacaine 250 mg and clonidine 0.15 mg/100 mL salinethe rate of infusion was the same as already noted above. Post-thoracotomy pain was assessed in three-month period after the surgery. The quality of life was evaluated with Brief Pain Inventory.   RESULTS Post-thoracotomy pain was experienced in 52, 25% of all the patients (TPA group 47, 37%, TEA group 57, 14%). No differences in assessment of post-thoracotomy pain were observed in TPA group as compared to TEA group. No differences in the quality of life were observed between two groups. CONCLUSION Both methods – thoracic paravertebral and epidural analgesia - are comparable in development of post-thoracotomy pain syndrome. The quality of life after procedure is comparable in both groups. KEY WORDS post-thoracotomy pain syndrome, anterolateral thoracotomy, paravertebral cathether, epidural cathether, quality of lif

Terminologija klinične prehrane: Načrt prehranskih ukrepov in organizacija prehranske oskrbe v zdravstvenih in negovalnih ustanovah

Izhodišča: Na podlagi prehranske obravnave in postavljene diagnoze motnja prehranjenosti ali s prehranjenostjo povezane motnje lahko oblikujemo posamezniku prilagojeni načrt prehranskih ukrepov. Ta je nujen, da vzdržujemo ali izboljšamo posameznikovo prehranjenost, pripravijo in izvajajo pa ga bolnik, njegovi bližnji in večstrokovna skupina, ki deluje v okviru različnih organizacijskih oblik ukvarjanja s klinično prehrano. Metode: Skupina 42 slovenskih strokovnjakov iz 19 slovenskih zdravstvenih ustanov je oblikovala eksplicitni terminološki dogovor. Osnovnim pojmom s področja prehranske oskrbe in organizacijskih oblik klinične prehrane smo določili slovenski termin in ustrezno terminološko definicijo, pri čemer smo izhajali tako iz strokovne literature področja kot iz jezikoslovne literature. Temelj oblikovanja terminologije so terminološke smernice Evropskega združenja za klinično prehrano in presnovo. Rezultati: V prispevku predstavljamo slovenske termine in terminološke definicije načrta prehranskih ukrepov, prehranske podpore in prehranske terapije. Opredelili smo tudi prehransko okolje, diete, paliativno prehrano in oblike hrane ter hranjenja v klinični prehrani. Opisali smo tudi možnosti za organizacijo prehranske oskrbe v zdravstvenih in negovalnih ustanovah. Zaključek: Poenoteno razumevanje osnovnih pojmov s področja prehranske terapije, prehranske podpore in organizacijskih oblik klinične prehrane je nujno za uspešno sporazumevanje med strokovnjaki, poenoteno poučevanje in razvoj ter vključitev organizacijskih oblik klinične prehrane v zdravstveni sistem

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome