Upravljanje dišnim putom tijekom izvođenja laparoskopske kolecistektomije - usporedna analiza

In this study, we aimed to compare supraglottic airway devices (Supreme and i-gel laryngeal mask) with tracheal tube with respect to airway control and efficiency in ventilation and oxygenation. The study included 325 patients of ASA I-II who underwent laparoscopic cholecystectomy. In group 1, the airway was secured using endotracheal intubation (115 patients). In group 2 (103 patients), LMA Supreme was applied, whereas i-gel mask was used for airway management in group 3 (107 patients). Monitoring parameters were recorded and compared using t-test, analysis of variance (ANOVA), Tukey’s test and χ2-test. The following parameters were monitored: insertion time, number of attempts for device placement, oropharyngeal seal pressure, etc. Insertion time was longest in group 1 (14.7±1.65 s) as compared to group 2 (15.5±1.05 s) and group 3 (14.1±1.27 s); ANOVA test yielded a statistically significant difference (p<0.01). Insertion success rate was almost identical in all three groups (p=0.907, χ2-test). Comparison of oropharyngeal seal pressure between group 2 (35.95±2.92 cm H2O) and group 3 (36.47±1.43 cm H2O) yielded no statistical difference (p=0.314, t-test). Endotracheal tube, Supreme and i-gel laryngeal masks were shown to be equally efficient in airway management in laparoscopic cholecystectomy. All three devices enabled efficient ventilation and oxygenation despite certain pathophysiological changes associated with laparoscopy.Ova studija je imala za cilj pružiti usporedbeni prikaz primjene supraglotičnih uređaja (laringealne maske Supreme i i-gel) s endotrahealnom intubacijom u kontroli dišnih putova, učinkovitosti ventilacije i oksigenacije tijekom izvođenja kirurških laparoskopskih operacija. Istraživanje je obuhvatilo 325 bolesnika, ASA klasifikacije I.-II. U prvoj skupini (115 bolesnika) dišni sustav je bio opskrbljen endotrahealnom intubacijom. U drugoj skupini (103 bolesnika) primijenjena je laringealna maska tipa Supreme, dok je maska i-gel korištena za kontrolu dišnih putova u trećoj ispitivanoj skupini (107 bolesnika). Promatrani parametri zabilježeni su i uspoređeni primjenom t-testa, ANOVA testa, Tukeyjeva testa i χ2-testa. Tijekom praćenja zabilježeno je vrijeme postavljanja, broj pokušaja, orofaringealnog tlaka zaptivanja itd. Vrijeme postavljanja bilo je najduže u prvoj (14,7±1,65s), zatim u drugoj (15,5±1,05s) i najkraće u trećoj skupini bolesnika (14,1±1,27s). Usporedba testom ANOVA pokazala je statistički značajnu razliku (p<0,01). Izvedba postavljanja bila je gotovo jednaka u sve tri ispitane skupine (p=0,907, χ2-test). Usporedba orofaringealnog tlaka zaptivanja između druge (35,95±2,92 cm H2O) i treće skupine (36,47±1,43 cm H2O) nije dala statističku značajnost (p=0,314, t-test). Endotrahealna cijev, laringealne maske Supreme i i-gel bile su podjednako učinkoviti uređaji za upravljanje dišnim putovima u laparoskopskim intervencijama. Omogućuju učinkovitu ventilaciju i oksigenaciju bez obzira na bilo kakve specifične patofiziološke promjene koje prate laparoskopsku kolecistektomiju

Is there a doctor on the plane? The distinctive conditions of cardiopulmonary resuscitation on commercial flights

Even today, when over 3.5 billion passengers travel on commercial flights each year, there is confusion about the duties and role of doctors and other licensed medical professionals volunteering to provide assistance to a passenger whose life is in jeopardy, especially when it comes to measures of cardiopulmonary resuscitation in the distinctive conditions of an airborne commercial aircraft. There are still no international, standardized guidelines, rulebooks, or instructions applying to all airlines when it comes to training and organizing the cabin crew, equipping emergency medical kits and covering the role of medical professionals volunteering their services in medical emergency situations. The aim of this work was to attempt to solve a common quandary among medical professionals when it comes to airplane travel. Based on the available literature, national and regional guidelines and rulebooks of airlines, in accordance with the ethical and legal principles binding medical professionals, we have attempted to answer the major questions related to cardiopulmonary resuscitation on commercial flights. All aspects are covered – from a doctor volunteering to provide emergency medical care, through the marshalling of the cabin attendants, the availability of equipment, interaction with the flight captain and the captain’s decision whether to perform an emergency landing, to the possibility of obtaining additional information from medical call centers on the ground and calling medical crews to the nearest airport

Application of ultrasound diagnostics in cardiopulmonary resuscitation

Ultrasound is becoming increasingly available and incorporated into emergency medicine. Focused echocardiographic evaluation in resuscitation (FEER) is a training program available to emergency doctors in order to ensure adequate application of echocardiography in the cardiac arrest setting. The FEER protocol provides an algorithm, whereby a “quick view” can be provided in 10 seconds during minimal interruptions in chest compressions. Performing ultrasound in the cardiac arrest setting is challenging for emergency doctors. The International Liaison Committee on Resuscitation recommend the ‘quick look’ echocardiography view can be obtained during the 10-second pulse check, minimizing the disruption to cardiopulmonary resuscitation

Cardiac arrest and cardiopulmonary resuscitation in the operating room

The occurrence of cardiac arrest during anesthesia and surgery is nowadays associated with many challenges imposed by 21st century medicine. On the one hand, good education of healthcare practitioners, sophisticated anesthetic techniques and equipment, along with safer anesthetics and improved surgical techniques have significantly reduced the risk of cardiac arrest during the perioperative period. Still, the introduction of new, invasive diagnostic and therapeutic procedures in the aging patients and those with comorbidities carries along new risk and challenges. Epidemiological data indicate that intraoperative cardiac arrest is an extremely rare event. Due to variety of moral and ethical prejudices, intraoperative cardiac arrest is frequently presented as if it has happened in the immediate postoperative period, following surgery and anesthesia. The preventive measures, the etiology and diagnosis of cardiac arrest, as well as the specificities regarding organization and performance of cardiopulmonary resuscitation in the operating room, result in a better prognosis compared to other hospital departments. The article also describes the specifics of cardiopulmonary resuscitation in the catheterization laboratory, while a separate section is dedicated to cardiopulmonary resuscitation following systemic toxicity of local anesthetics. Since intraoperative cardiac arrest and death represent very rare complications, European Resuscitation Council has only recently published Guidelines for Resuscitation for performing cardiopulmonary resuscitation in the operating room – in 2015

Application of sepsis-related organ failure assessment score in the intensive care units

Evaluation of the SOFA score during their stay in ICU patients is a good prognostic indicator in assessing treatment outcomes. The aim this study is to determine the importance of SOFA score in the evaluation of complications, duration of mechanical ventilation (MV), length of stay in ICU and outcome of patients with sepsis and / or septic shock in the ICU. This one year prospective study included 60 critically ill patients. After admittance to the ICU were calculated APACHE II score, and during further treatment in the ICU, patients were evaluated SOFA score of 24, 48, 72 hours and seven days after admittance. Were observed the length of stay in ICU, duration of MV and survival. Patients in non survivel group were elderly than in the group of survivors, they spent significantly more days on MV and more frequently had septic shock as a complication (63%). The length of stay in ICU was not statistically significant between the two groups, as opposed to duration of MV, where he recorded a statistically significant difference. The best calibration had SOFA7d (0.85), which means it has had the smallest statistically significant discrepancy between the expected and the observed deaths. Score with the best discrimination between non survivel and survivel groups was SOFA7d; AUROC (0981). Our study showed that a daily evaluation of the SOFA in the ICU to predict the onset of complications, duration of MV and length of stay patients in the ICU. SOFA value calculated for 7 days showed the best discrimination and calibrati on power