Coblation tonsilloadenoidectomy - treatment of choice for very small children

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children. We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight

"Blind" interlaminar epidural steroid injections in lumbar spinal stenosis; effective and safe technique in elderly patients

Background and purpose: Blind interlaminar epidural steroid injection (BESI) is one of the treatment modalities for lumbar spinal stenosis (LSS). There are a growing number of elderly patients with LSS. The optimal timing and outcome of BESIs in this population are not well defined, which is the aim of this study. Patients and methods: Thirty patients aged 67±1.5 yrs, with diagnosis of LSS and refractory painwere recruited during year 2010 and followed up for 12months. “Blind” epidural in corresponding interspace was performed with 18G Tuohy needle, using loss of resistance. The epidural mixture (10ml) consisted of 80 mg of triamcinolone acetonide and 40mg of lidocaine. Each patient received in total 3 BESIs every 3 weeks (BESI1, BESI2, BESI3). The pain was evaluated with visual analogue scale (VAS) before first BESI (VAS0) and after each treatment (VAS1, VAS2, VAS3). Subjective quality of performing the same physical activity (PA) was evaluated with simple 3-points scale (0 = no change, 1 = slight improvement, 2 = significant improvement). Results: BESI resulted in significant reduction of VAS (VAS0 8.1±0.3, VAS1 5.8±0.2, VAS2 4.9±0.2, VAS3 4.4±0.3; F=87.57, P< 0.001) – all pair-wise comparisons were significantly different in post-hoc analysis (P<0.001), except VAS2 vs VAS3 having borderline significance (P=0.06). Subjective quality of physical activity significantly improved regarding baseline conditions (BESI1 PA score: 0=1/30,1=7/30, 2=22/30 patients; BESI2 PA score:0=1/30,1=5/30,2=24/30 patients; BESI 3 PA score: 0=4/30, 1=6/30, 2=20/30 patients; c2=3.7, p=0.45). The average duration of successful BESI treatmentwas 6.3±0.8months (range 1–12). There were no reported complications. Conclusions: Blind interlaminar epidural steroid injections (in total 3 injections every 3 weeks) resulted in significant reduction of pain and improvement of physical activity in elderly patients with LSS. It could be regarded as effective and safe procedure in this population

"Blind" interlaminar epidural steroid injections in lumbar spinal stenosis; effective and safe technique in elderly patients

Background and purpose: Blind interlaminar epidural steroid injection (BESI) is one of the treatment modalities for lumbar spinal stenosis (LSS). There are a growing number of elderly patients with LSS. The optimal timing and outcome of BESIs in this population are not well defined, which is the aim of this study. Patients and methods: Thirty patients aged 67±1.5 yrs, with diagnosis of LSS and refractory painwere recruited during year 2010 and followed up for 12months. “Blind” epidural in corresponding interspace was performed with 18G Tuohy needle, using loss of resistance. The epidural mixture (10ml) consisted of 80 mg of triamcinolone acetonide and 40mg of lidocaine. Each patient received in total 3 BESIs every 3 weeks (BESI1, BESI2, BESI3). The pain was evaluated with visual analogue scale (VAS) before first BESI (VAS0) and after each treatment (VAS1, VAS2, VAS3). Subjective quality of performing the same physical activity (PA) was evaluated with simple 3-points scale (0 = no change, 1 = slight improvement, 2 = significant improvement). Results: BESI resulted in significant reduction of VAS (VAS0 8.1±0.3, VAS1 5.8±0.2, VAS2 4.9±0.2, VAS3 4.4±0.3; F=87.57, P< 0.001) – all pair-wise comparisons were significantly different in post-hoc analysis (P<0.001), except VAS2 vs VAS3 having borderline significance (P=0.06). Subjective quality of physical activity significantly improved regarding baseline conditions (BESI1 PA score: 0=1/30,1=7/30, 2=22/30 patients; BESI2 PA score:0=1/30,1=5/30,2=24/30 patients; BESI 3 PA score: 0=4/30, 1=6/30, 2=20/30 patients; c2=3.7, p=0.45). The average duration of successful BESI treatmentwas 6.3±0.8months (range 1–12). There were no reported complications. Conclusions: Blind interlaminar epidural steroid injections (in total 3 injections every 3 weeks) resulted in significant reduction of pain and improvement of physical activity in elderly patients with LSS. It could be regarded as effective and safe procedure in this population

Personalized medicine – parenteral ketogenic diet in pyruvate dehydrogenase deficiency in the ICU; what do we need to know about it?

Manjak kompleksa piruvat dehidrogenaze (engl. Pyruvate Dehydrogenase Complex Deficiency, PDCD) rijedak je genetski neurometabolički poremećaj. Pripada u skupinu mitohondrijskih bolesti. Kliničke manifestacije se kreću od često smrtonosne, teške, novorođenačke laktacidoze do ozbiljnih neuroloških poremećaja kasnije tijekom života. Većina bolesnika ne doživi odraslu dob i rijetko je ova problematika nazočna u jedinicama intenzivnog liječenja odraslih bolesnika. Jedan od važnijih terapijskih postupaka kod ovih bolesnika je ketogena prehrana s visokim udjelom masti kojom se proizvode ketoni kao alternativno gorivo za tijelo i mozak. Ponekad može biti potrebna parenteralna ketogena prehrana koja još uvijek nije precizno definirana u postojećim smjernicama za prehranu bolesnika u jedinicama intenzivnog liječenja. Prikazano je provođenje parenteralne ketogene prehrane, te laboratorijski i klinički nadzor u 18-godišnje bolesnice s mitohondrijskom bolesti (PCDC) i to nakon abdominalnoga zahvata povezanog s upalnim komplikacijama, kada enteralna prehrana nije bila moguća. Prehrana je zahtijevala detaljni izračun osnovnih sastojaka kako bi se osigurala adekvatna opskrba energijom, volumenom i mikronutirijentima, a da bi se pri tome proizvela ketoza. Zajedno s ostalim metodama intenzivnoga liječenja, ovakav način prehrane pomogao je rješavanju komplikacija i ishodu liječenja ove epizode. U zaključku, pravilno propisana parenteralna ketogena prehrana kod bolesnika s PCDC smanjuje laktacidozu i učestalost neuroloških komplikacija. Treba je provoditi isključivo u jedinicama intenzivnoga liječenja, poglavito zbog nužnosti trajnog laboratorijskog i kliničkog nadzora. Kad god je moguće, treba ponovo što prije prijeći na enteralnu prehranu. Poželjno bi bilo imati i točno definirane smjernice za parenteralnu ketogenu prehranu.The pyruvate dehydrogenase complex deficiency (PDCD) is a rare genetic neurometabolic disorder. It belongs to the group of mitochondrial diseases. Clinical manifestations range from often fatal, severe, neonatal lactic acidosis to serious neurological disorders later in life. Most patients do not reach adulthood and are rarely present in intensive care units for adult patients. One of the most important therapeutic procedures in these patients is a ketogenic high-fat diet that produces ketones as an alternative fuel for the body and brain. Sometimes a parenteral ketogenic diet may be required; however, it has not been yet precisely defined in existing nutrition guidelines for intensive care patients. Here we described the implementation of parenteral ketogenic diet, along with the basics of laboratory and clinical monitoring in the 18-year old patient with mitochondrial disease (PCDC) after abdominal surgery associated with inflammatory complications, while enteral intake was not possible. It required a detailed calculation of the basic ingredients of the diet to ensure an adequate supply of energy, volume and micronutrients, while producing ketosis. Together with other intensive care methods, it helped resolve the complications and treatment outcome of this episode. In conclusion, properly prescribed and implemented parenteral ketogenic diet in patients with PCDC reduces the incidence of lactic acidosis and neurological complications. It should be performed exclusively in intensive care units, mainly due to continuous laboratory and clinical monitoring. Whenever possible, enteral nutrition should be resumed as soon as possible. It would also be desirable to have well-defined guidelines for parenteral ketogenic nutrition

OBSTRUCTIVE SLEEP APNEA, ANESTHESIA AND AIRWAY – CLINICAL DILEMMAS AND REVIEW OF THE LATEST GUIDELINES

Cilj ovoga preglednog članka je objasniti anesteziološki pristup bolesnicima s opstrukcijskom apnejom tijekom spavanja (engl. Obstructive Sleep Apnea, OSA), prikazati rezultate najnovijih istraživanja i osvrnuti se na nedavno objavljene smjernice i preporuke. OSA je najčešći poremećaj disanja vezan uz spavanje. Smatra se da je OSA sustavna bolest s više raznih fenotipova i patofi zioloških mehanizama. Dokazano je da bolesnici s OSA-om imaju znakovito povećanu incidenciju perioperacijskih komplikacija, a osobito onih vezanih za održavanje dišnoga puta. Bolesnici s OSA-om osjetljivi su na konvencionalne anestetike i sedative, osobito na opioide. Stoga, u ovih bolesnika kad god je moguće treba primijeniti lokoregionalne tehnike. Među kirurškim bolesnicima izrazito je visoka prevalencija OSA-e, a veliki broj bolesnika je prijeoperacijski nedijagnosticiran. Defi nitivna dijagnoza OSA-e moguća je jedino polisomnografi jom, koja nije uvijek dostupna. Stoga se danas sve više preporuča uporaba raznih validiranih prijeoperacijskih testova i upitnika (STOP, STOP-BANG, Berlin, ASA, P-SAP) koji zadovoljavajuće koreliraju s poslijeoperacijskim ishodima i pomažu u prijeoperacijskoj stratifi kaciji rizika. Veliki napredak su i smjernice Američkog udruženja anesteziologa iz 2014. godine, te preporuke Američkog udruženja za anesteziju i medicinu spavanja iz 2016. godine. Novije smjernice doimaju se praktične, jer svrstavaju bolesnike u tri skupine: 1) bolesnici s dijagnosticiranom OSA-om, koji se pridržavaju liječenja pozitivnim tlakom (engl. Continuous Positive Airways Pressure, CPAP), 2) bolesnici s dijagnosticiranom OSA-om, koji odbijaju ili se slabo pridržavaju liječenja CPAP-om, te 3) bolesnici pod sumnjom na OSA-u. Te smjernice po prvi puta navode i defi niraju termin nekontrolirane sustavne bolesti. Nadalje, taj novi strukturirani pristup daje jasne preporuke uz već nazočne smjernice ASA iz 2014. godine.The aim of this review article is to explain the anesthetic approach to patients with obstructive sleep apnea (OSA), to show results of the most recent research, and to review the recently published guidelines and recommendations. OSA is the most common sleep-related breathing disorder. It is considered that OSA is a systemic disease with many different phenotypes and pathophysiological mechanisms. It has been shown that patients with OSA have an increased incidence of perioperative adverse events, especially those associated with maintaining the airway. Patients with OSA are sensitive to conventional anesthetics and sedatives, particularly opioids. Therefore, in these patients, local and regional techniques should be applied whenever possible. Among surgical patients, there is a high prevalence of OSA, and a large number of patients are not diagnosed preoperatively. Defi nitive OSA diagnosis is only possible with polysomnography, which is not always easily available. Therefore, the use of various validated preoperative tests and questionnaires (STOP BANG, Berlin, ASA, P-SAP) is increasingly recommended today, as these correlate satisfactorily with postoperative outcomes and help in preoperative risk stratification. In the last years, two new important documents have appeared. The practice guidelines for the perioperative management of patients with obstructive sleep apnea were published by the American Society of Anesthesiologists (ASA) in 2014, and the Recommendations of the American Association for Anesthesiology and Sleep Medicine two years later. The latter are practical because they classify patients into 3 groups: 1) surgical patients with OSA, adherent to positive airway pressure (PAP) therapy, 2) surgical patients with OSA, who decline or are poorly adherent to PAP therapy, and 3) surgical patients who have a high probability of OSA. These recommendations defi ne the term of uncontrolled systemic disease for the fi rst time. Furthermore, this new structured approach gives clear recommendations in addition to the current ASA guidelines from 2014

Clostridial gas gangrene after laparoscopic cholecystectomy: the role of SARS-CoV-2 virus – a case report and review of literature

Klostridijska plinska gangrena je brzo šireća nekrotična infekcija mekog tkiva s visokim smrtnim ishodom. Rijetka je komplikacija laparoskopske kolecistektomije. Predstavljamo 68-godišnju bolesnicu koja je razvila klostridijsku plinsku gangrenu nakon laparoskopske kolecistektomije. Bolesnica je prethodno bila bez komorbiditeta osim što je 14 dana ranije imala SARS CoV-2 infekciju s blagim respiratornim simptomima. Klostridijska infekcija je nastala neposredno nakon operacije uzrokujući gangrenu trbušne stijenke, septički šok i multiorgansko zatajenje. Unatoč pravovaljanoj i pravodobnoj antibiotskoj terapiji, kirurškom debridementu i ostalim mjerama intenzivnog liječenja, ishod bolesti bio je letalan. Postavljamo si dva pitanja: je li virus SARS CoV-2 mogao biti inicijator letalne kaskade u ove bolesnice i bismo li promijenili ishod da smo odgodili operaciju?Clostridium gas gangrene is fast-spreading necrotic infection of soft tissue relevant to high mortality rates. It is a rare complication after laparoscopic cholecystectomy. We present a case of a 68-year old woman who developed clostridial gas gangrene after laparoscopic cholecystectomy. The patient didn’t have have any comorbidity except SARS CoV-2 infection with mild respiratory symptoms 14 days ago. The infection developed immediately after the operation causing gangrene of the abdominal wall, septic shock and multi-organ failure. Although the patient was treated with appropriate and prompt antibiotic therapy and thorough surgical debridement and with other supportive measures, outcome was lethal. Based on this case we ask ourselves: Could the SARS CoV-2 virus initiate lethal cascade and should we change the outcome if we postponed the operation

Compassionate mesenchymal stem cell treatment in a severe COVID-19 patient: a case report

COVID-19 presentations range from cold-like symptoms to severe symptoms with the development of acute respiratory distress syndrome (ARDS). We report on a severe COVID-19 patient who was mechanically ventilated and who developed ARDS and bacterial infection. Because of rapid clinical deterioration and the exhaustion of other treatment options, the family and attending physicians requested a compassionate use of adult allogeneic bone marrow-derived mesenchymal stem cells (MSC) in addition to commonly used immunosuppressive, antiviral, and supportive therapy. The clinical course is discussed thoroughly, with a special emphasis on the safety and effect of MSC therapy. Compassionate MSC treatment, given in three rounds, affected ARDS regression. The patient was discharged from the intensive care unit after 31 days and from hospital after 49 days in a good general condition. MSC treatment was not associated with any side effects and was well tolerated in a three-week period; therefore, it should be studied in larger trials and considered for compassionate us

The correlation among the type of anesthesia, cognitive dysfunction, postoperative behavioural changes and S100B levels after adenotonsillectomy in children

Cilj istraživanja bio je utvrditi povezanost između vrste anestezije, kognitivne funkcije, negativnih poslijeoperacijskih promjena ponašanja i razine neurološkog biomarkera proteina S100B. Prospektivna studija provedena je u KBC Split u 64 djece (dob 6-13, ASA I-II) nakon elektivne adenotozilektomije. Djeca su bila randomizirana u dvije skupine: intravenska (n = 32) i inhalacijska (n = 32). U intravenskoj skupini indukcija u anesteziju je učinjena propofolom, fentanilom i vekuronijumom i održavana kontinuiranom infuzijom propofola. U inhalacijskoj skupini indukcija je učinjena fentanilom, sevofluranom i vekuronijumom, te održavana sevofluranom. Anesteziolog koji je anestezirao djecu i otorinolaringolog koji ih je operirao, bio je isti za svu djecu. Kognitivnu funkciju procijenili smo primjenom dvaju testova različite složenosti (PsychE test): jednostavno vrijeme reakcije i paralelno vrijeme reakcije. Svako dijete je prošlo testiranje prije operacije, 2 sata i 24 sata nakon operacije. Procjena negativnih poslijeoperacijskih promjena ponašanja je učinjena upitnikom Post Hospitalization Behavior Questionnaire (PHBQ - 27 pitanja u 6 podljestvica). Protein S100B smo odredili u serumu djece koristeći imunokemijsku metodu “ECLIA“. U kognitivnom funkcioniranju prije anestezije, te 2 h i 24 sata nakon anestezije nije bilo jednoznačnih i jednosmjernih razlika između inhalacijske i intravenske anestezije. Djeca su postizala lošije rezultate u jednostavnom vremenu reakcije nakon inhalacijske anestezije, a nakon intravenske anestezije, lošiji rezultati su bili u paralelnom vremenu reakcije. Broj negativnih poslijeoperacijskih promjena ponašanja, u svih 6 podljestvica PHBQ upitnika, bio je u svim točkama mjerenja statistički značajno manji u intravenskoj skupini u odnosu na inhalacijsku skupinu u ; separacijskoj anksioznosti, općoj anksioznosti, apatija/povlačenje, poremećaju hranjenja i agresiji prema autoritetu. Vrijednosti neurološkog biomarkera S100B značajno su bile povećane nakon opće anestezije u odnosu na prijeoperacijske vrijednosti, no nije bilo razlike između dvije vrste anestezije. Na temelju rezultata našeg istraživanja, prednost ima korištenje totalne intravenske tehnike u odnosu na inhalacijsku, za operacije adenotonzilektomije u djece.The aim of the investigation was to determine the relationship among types of anesthesia, cognitive assessment, negative postoperative behavior changes and the level of neurological biomarkers protein S100B. Prospective study was conducted at the University Hospital Split on 64 children (aged 6-13, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups: TIVA (n = 32) and sevoflurane (n = 32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In sevoflurane group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. In all patients, surgery was performed by the same surgeon and anaesthesia was administered by the same anaesthesiologist. Cognitive assessment was conducted with two psychomotor evaluation tests (PsychE): simple reaction time and dual task. Each subject was examined preoperatively, 2 h and 24h after surgery. Evaluation of negative postoperative behavioral changes were performed with the Post Hospitalization Behavior Questionnaire (PHBQ:- 27 items describing six subscales). The PHBQ was filled out by parents at postoperative days 1, 3, 7 and 14, and 6 months after surgery. S100B assays were performed using the electrochemiluminiscence immunoassay “ECLIA”. There were no unambiguous one-way differences between TIVA and sevoflurane group in cognitive function before anaesthesia, 2 hours and 24 hours after anaesthesia. Children had poorer results in simple reaction time after inhalation anaesthesia, while after TIVA, worse results were in dual task. The number of NPOBCs in all six PHBQ subscales at all follow-up time points was statistically significantly smaller in the TIVA group than in group S. The greatest difference was noticed in the separation anxiety subscale, general anxiety, apathy/withdrawal, eating disturbances, aggression towards authority and sleep anxiety. The values of neurological biomarker S100B were significantly increased after general anesthesia with regard to preoperative values, but there were no differences regarding the 2 types of anaesthesia. Based on the results of our research, we preferthe use of total intravenous techniques over inhalation, for adenotonsillectomy in children

The correlation among the type of anesthesia, cognitive dysfunction, postoperative behavioural changes and S100B levels after adenotonsillectomy in children

Cilj istraživanja bio je utvrditi povezanost između vrste anestezije, kognitivne funkcije, negativnih poslijeoperacijskih promjena ponašanja i razine neurološkog biomarkera proteina S100B. Prospektivna studija provedena je u KBC Split u 64 djece (dob 6-13, ASA I-II) nakon elektivne adenotozilektomije. Djeca su bila randomizirana u dvije skupine: intravenska (n = 32) i inhalacijska (n = 32). U intravenskoj skupini indukcija u anesteziju je učinjena propofolom, fentanilom i vekuronijumom i održavana kontinuiranom infuzijom propofola. U inhalacijskoj skupini indukcija je učinjena fentanilom, sevofluranom i vekuronijumom, te održavana sevofluranom. Anesteziolog koji je anestezirao djecu i otorinolaringolog koji ih je operirao, bio je isti za svu djecu. Kognitivnu funkciju procijenili smo primjenom dvaju testova različite složenosti (PsychE test): jednostavno vrijeme reakcije i paralelno vrijeme reakcije. Svako dijete je prošlo testiranje prije operacije, 2 sata i 24 sata nakon operacije. Procjena negativnih poslijeoperacijskih promjena ponašanja je učinjena upitnikom Post Hospitalization Behavior Questionnaire (PHBQ - 27 pitanja u 6 podljestvica). Protein S100B smo odredili u serumu djece koristeći imunokemijsku metodu “ECLIA“. U kognitivnom funkcioniranju prije anestezije, te 2 h i 24 sata nakon anestezije nije bilo jednoznačnih i jednosmjernih razlika između inhalacijske i intravenske anestezije. Djeca su postizala lošije rezultate u jednostavnom vremenu reakcije nakon inhalacijske anestezije, a nakon intravenske anestezije, lošiji rezultati su bili u paralelnom vremenu reakcije. Broj negativnih poslijeoperacijskih promjena ponašanja, u svih 6 podljestvica PHBQ upitnika, bio je u svim točkama mjerenja statistički značajno manji u intravenskoj skupini u odnosu na inhalacijsku skupinu u ; separacijskoj anksioznosti, općoj anksioznosti, apatija/povlačenje, poremećaju hranjenja i agresiji prema autoritetu. Vrijednosti neurološkog biomarkera S100B značajno su bile povećane nakon opće anestezije u odnosu na prijeoperacijske vrijednosti, no nije bilo razlike između dvije vrste anestezije. Na temelju rezultata našeg istraživanja, prednost ima korištenje totalne intravenske tehnike u odnosu na inhalacijsku, za operacije adenotonzilektomije u djece.The aim of the investigation was to determine the relationship among types of anesthesia, cognitive assessment, negative postoperative behavior changes and the level of neurological biomarkers protein S100B. Prospective study was conducted at the University Hospital Split on 64 children (aged 6-13, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups: TIVA (n = 32) and sevoflurane (n = 32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In sevoflurane group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. In all patients, surgery was performed by the same surgeon and anaesthesia was administered by the same anaesthesiologist. Cognitive assessment was conducted with two psychomotor evaluation tests (PsychE): simple reaction time and dual task. Each subject was examined preoperatively, 2 h and 24h after surgery. Evaluation of negative postoperative behavioral changes were performed with the Post Hospitalization Behavior Questionnaire (PHBQ:- 27 items describing six subscales). The PHBQ was filled out by parents at postoperative days 1, 3, 7 and 14, and 6 months after surgery. S100B assays were performed using the electrochemiluminiscence immunoassay “ECLIA”. There were no unambiguous one-way differences between TIVA and sevoflurane group in cognitive function before anaesthesia, 2 hours and 24 hours after anaesthesia. Children had poorer results in simple reaction time after inhalation anaesthesia, while after TIVA, worse results were in dual task. The number of NPOBCs in all six PHBQ subscales at all follow-up time points was statistically significantly smaller in the TIVA group than in group S. The greatest difference was noticed in the separation anxiety subscale, general anxiety, apathy/withdrawal, eating disturbances, aggression towards authority and sleep anxiety. The values of neurological biomarker S100B were significantly increased after general anesthesia with regard to preoperative values, but there were no differences regarding the 2 types of anaesthesia. Based on the results of our research, we preferthe use of total intravenous techniques over inhalation, for adenotonsillectomy in children

The correlation among the type of anesthesia, cognitive dysfunction, postoperative behavioural changes and S100B levels after adenotonsillectomy in children

Cilj istraživanja bio je utvrditi povezanost između vrste anestezije, kognitivne funkcije, negativnih poslijeoperacijskih promjena ponašanja i razine neurološkog biomarkera proteina S100B. Prospektivna studija provedena je u KBC Split u 64 djece (dob 6-13, ASA I-II) nakon elektivne adenotozilektomije. Djeca su bila randomizirana u dvije skupine: intravenska (n = 32) i inhalacijska (n = 32). U intravenskoj skupini indukcija u anesteziju je učinjena propofolom, fentanilom i vekuronijumom i održavana kontinuiranom infuzijom propofola. U inhalacijskoj skupini indukcija je učinjena fentanilom, sevofluranom i vekuronijumom, te održavana sevofluranom. Anesteziolog koji je anestezirao djecu i otorinolaringolog koji ih je operirao, bio je isti za svu djecu. Kognitivnu funkciju procijenili smo primjenom dvaju testova različite složenosti (PsychE test): jednostavno vrijeme reakcije i paralelno vrijeme reakcije. Svako dijete je prošlo testiranje prije operacije, 2 sata i 24 sata nakon operacije. Procjena negativnih poslijeoperacijskih promjena ponašanja je učinjena upitnikom Post Hospitalization Behavior Questionnaire (PHBQ - 27 pitanja u 6 podljestvica). Protein S100B smo odredili u serumu djece koristeći imunokemijsku metodu “ECLIA“. U kognitivnom funkcioniranju prije anestezije, te 2 h i 24 sata nakon anestezije nije bilo jednoznačnih i jednosmjernih razlika između inhalacijske i intravenske anestezije. Djeca su postizala lošije rezultate u jednostavnom vremenu reakcije nakon inhalacijske anestezije, a nakon intravenske anestezije, lošiji rezultati su bili u paralelnom vremenu reakcije. Broj negativnih poslijeoperacijskih promjena ponašanja, u svih 6 podljestvica PHBQ upitnika, bio je u svim točkama mjerenja statistički značajno manji u intravenskoj skupini u odnosu na inhalacijsku skupinu u ; separacijskoj anksioznosti, općoj anksioznosti, apatija/povlačenje, poremećaju hranjenja i agresiji prema autoritetu. Vrijednosti neurološkog biomarkera S100B značajno su bile povećane nakon opće anestezije u odnosu na prijeoperacijske vrijednosti, no nije bilo razlike između dvije vrste anestezije. Na temelju rezultata našeg istraživanja, prednost ima korištenje totalne intravenske tehnike u odnosu na inhalacijsku, za operacije adenotonzilektomije u djece.The aim of the investigation was to determine the relationship among types of anesthesia, cognitive assessment, negative postoperative behavior changes and the level of neurological biomarkers protein S100B. Prospective study was conducted at the University Hospital Split on 64 children (aged 6-13, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups: TIVA (n = 32) and sevoflurane (n = 32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In sevoflurane group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. In all patients, surgery was performed by the same surgeon and anaesthesia was administered by the same anaesthesiologist. Cognitive assessment was conducted with two psychomotor evaluation tests (PsychE): simple reaction time and dual task. Each subject was examined preoperatively, 2 h and 24h after surgery. Evaluation of negative postoperative behavioral changes were performed with the Post Hospitalization Behavior Questionnaire (PHBQ:- 27 items describing six subscales). The PHBQ was filled out by parents at postoperative days 1, 3, 7 and 14, and 6 months after surgery. S100B assays were performed using the electrochemiluminiscence immunoassay “ECLIA”. There were no unambiguous one-way differences between TIVA and sevoflurane group in cognitive function before anaesthesia, 2 hours and 24 hours after anaesthesia. Children had poorer results in simple reaction time after inhalation anaesthesia, while after TIVA, worse results were in dual task. The number of NPOBCs in all six PHBQ subscales at all follow-up time points was statistically significantly smaller in the TIVA group than in group S. The greatest difference was noticed in the separation anxiety subscale, general anxiety, apathy/withdrawal, eating disturbances, aggression towards authority and sleep anxiety. The values of neurological biomarker S100B were significantly increased after general anesthesia with regard to preoperative values, but there were no differences regarding the 2 types of anaesthesia. Based on the results of our research, we preferthe use of total intravenous techniques over inhalation, for adenotonsillectomy in children