Correlation between intra-abdominal hypertension and arterial lactate concentration in severe sepsis patients

Intra-abdominal hypertension (IAH) in severe sepsis patients with consequent multiple organ failure is associated with increased arterial lactate levels. In this nonrandomized, prospective control trial, the correlation between intra-abdominal hypertension and arterial lactate concentration in severe sepsis patients was analysed. Thirty-eight patients undergoing major abdominal surgery with confirmed severe sepsis constituted the severe sepsis patients group. Control group included thirty-eight patients undergoing elective abdominal surgery with at least two risk factors for IAH. Intra-abdominal pressure (IAP) was assessed in both groups every six hours during the first 72 hours, through a Foley catheter placed in the urinary bladder. IAH was diagnosed with two consecutive measurements of IAP >12mmHg. At the same time lactate levels in arterial blood, SvO2 and CVP were assessed. Data were compared using Student’s t test. P <0.05 was considered statistically significant. In the sepsis group, 25 patients (65.8%) had IAP >12mmHg, 10 patients (26.3%) had IAP >16mmHg and three patients (7.9%) had IAP >20mmHg. In the control group, all patients had IAP up to 7mmHg. Arterial blood lactate levels were significantly increased in severe sepsis patients with IAP >16mmHg (4,2mmol/L versus 1,2mmol/L, P<0.05) compared to the control group. Mortality in severe sepsis patients with IAH was 24.5% (10 patients). Arterial blood lactate levels were significantly higher in severe sepsis patients IAH >16mmHg compared to control group. Continuous IAP monitoring in severe sepsis patients is important for early detection of splanchnic hypoperfusion with consequent multi-organ failure, and for timely application of efficacious therapeutic procedures

Regional anesthesia for trauma patients

Trauma patients demands special medical care. Pain is frequently undertreated in the early phase of trauma. Pain is a major symptom of surgical conditions and minimizing pain could lead to misdiagnoses and technical facilities are not appropriate for adequate pain treatment. Consequences of inappropriate pain treatment could aggravate stress response, increases oxygen demand and led to myocardial ischemia Analgesia with parenteral opioids is effective but carries a risk of respiratory depression, nausea and hypotension. Regional anesthesia (RA) is well established method for analgesia in surgical patients for intraoperative and postoperative pain relief. Neuroaxial and peripheral nerve blocks are effective procedures for acute pain treatment. Nerve stimulation and advances in ultrasound guide nerve blocks make those procedures safer and even more desirable. Advantages of RA over systemic analgesia in trauma patients are numerous. Application of local anesthetics produce excellent pain control with decreased stress response and minimal systemic effects is applied properly. Main indications for RA include patients with rib fractures and lower and upper extremities injuries. Anesthesiologist performing RAmust be aware of pathophysiology changes in trauma patients especially addressing compartment syndrome and coagulation abnormalities. Best way is to weighed risk against the benefit of RA in trauma patients individually with increased vigilance and monitoring for eventual side effects

Anesthesia techniques for carotid endarterectomy

Stroke is one of the leading causes of death in the modern countries. Mainstay treatment for stroke prevention is carotid endarterectomy (CEA). Patients scheduled for surgery often have many associate systemic illnesses that pose a risk of perioperative cardiac and neurological complications. Detailed preoperative evaluation of neurological and cardiac function with optimization of the systemic illnesses therapy is obligatory. Ideal anesthesiology technique should provide adequate analgesia, minimal stress response, optimal brain perfusion and oxygenation, optimal hemodynamic and myocardial oxygen balance while assuring calm and relaxed patients with good surgical comfort. Both regional anesthesia and general anesthesia have some advantages and drawbacks. Regarding to cerebral and myocardial ischemia and adverse outcome after CEA, especially in high risk patients, today still it is not clear which anesthesia technique is preferred for CEA. Greatest risk in the early postoperative period is new neurological deficit caused by cerebral ischemia end myocardial infarction caused with hemodynamic instability and therefore CEA patients are placed in the Intensive Care Unit for at least six or more hours where they are monitored for neurological and hemodynamic complications

Scalp block for hemodynamic stability during neurosurgery

Background and Purpose: For elective neurosurgery procedures maintaining perioperative hemodynamic stability and optimal cerebral perfusion is of outmost importance. Beside numerous anesthetics techniques, risk of hemodynamic instability is still very high. Materials and Methods: We retrospectively analyzed perioperative values of heart rate and arterial blood pressure in 39 patients who underwent neurosurgery. We combined general anesthesia with scalp block. We blocked the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with 0,5% chirocaine, including 5 μg/mL of epinephrine that was performed after general anesthesia induction, before pin placement. Heart rate and blood pressure values were measured before anesthesia induction, after induction, after pins placement, after craniotomy and at the end of surgery. Changes of heart rate and blood pressure values less than 20% after painful stimuli was considered as a good hemodynamic stability of applied anesthetic technique. Result: Scalp block was successfully performed in all patients without complications. Measured values of heart rate and blood pressure before and after anesthesia induction compered to values after painful stimuli werewithin the 20% change. Conclusion: Scalp block, combined with general anesthesia provide good hemodynamic stability during neurosurgery

Acute kidney injury in perioperative settings

Acute kidney injury is a clinical syndrome which represents relevant and serious perioperative complication. It is associated with increased patient morbidity, mortality, prolonged hospital stays, and not to mention greater healthcare costs. Yet, the patients who suffered from temporary acute kidney injury in the perioperative period, and regardless of the final outcome, usually complain afterwards about emotional distress, coupled with poor quality of life associated with loss of energy and limited normal physical activity. Therefore, the role of the physician to predict a kidney vulnerable patient in the perioperative period is a task of great importance, albeit not an easy one. The key management is risk stratification of the patient in conjunction with hemodynamic and oxygen optimization, in addition to avoiding nephrotoxic agents during the entire perioperative period

POSTOPERATIVE MENTAL DISORDERS IN CARDIOVASCULAR SURGERY

Poslijeoperacijski poremećaji mentalnih funkcija česta su komplikacija u kardiovaskularnoj kirurgiji s ozbiljnim posljedicama. Glavni poslijeoperacijski poremećaji mentalnih funkcija uključuju poslijeoperacijski delirij i poslijeoperacijsku kognitivnu disfunkciju. Njihova učestalost varira do 15-80%. Poslijeoperacijski poremećaji mentalnih funkcija mogu biti reverzibilni i ireverzibilni,a u većini slučajeva su reverzibilni. Povezani su s povećanim mortalitetom i morbiditetom uz povećane troškove liječenja. Liječenje poslijeoperacijskih poremećaja mentalnih funkcija najčešće je simptomatsko i može biti povezano s opasnim nuspojavama. Sigurnije i učinkovitije je preventivno djelovanje. Preoperacijski je potrebno prepoznati, izbjegavati i optimalizirati čimbenike rizika. Intraoperacijska prevencija uključuje održavanje optimalne oksigenacije mozga tijekom kardiovaskularne kirurgije. Za poslijeoperacijsku prevenciju primjenjuje se multimodalni pristup što uključuje ranu ekstubaciju bolesnika, ranu enteralnu prehranu, ranu mobilizaciju, redovitu evaluaciju kognitivnih funkcija, aktivaciju kognitivnih funkcija i optimalnu analgeziju za što je potreban timski rad medicinskog osoblja koje skrbi za bolesnika. Skupna primjena navedenih metoda pokazuje obećavajuće rezultate u smanjenju učestalosti i komplikacija poslijeoperacijskih poremećaja mentalnih funkcija u kardiovaskularnoj kirurgiji.Postoperative mental disorders are a common complication of cardiovascular surgery, with serious consequences. The main types of postoperative mental disorders include postoperative delirium and postoperative cognitive dysfunction. Their incidence ranges up to 15%-80%. Postoperative mental disorders may be reversible and irreversible. Although reversible in most cases, postoperative mental disorders are associated with increased mortality, morbidity and increasing costs of treatment. The treatment is usually symptomatic and may be associated with dangerous side effects. Safer and more effective is preventive action. Preoperative preventive action need to recognize, avoid and optimize risk factors. Intraoperative prevention involves maintaining optimal oxygenation of the brain during cardiovascular surgery. For postoperative prevention, multimodal approach is applied. It includes early extubation, early enteral nutrition, early mobilization, regular evaluation of cognitive function, activation of cognitive function and optimal analgesia, which requires teamwork of medical staff who care for patients. Combining all these methods can show promising results in reducing the incidence of postoperative mental disorders as a complication in cardiovascular surgery

Ružička days : International conference 19th Ružička Days “Today Science – Tomorrow Industry” : Proceedings

Dear colleagues, we are extremely honoured to present to you the Proceedings of the international conference 19th Ružička Days, which was successfully held on September 21–23, 2022, in Vukovar, Croatia, in the hometown town of our famous Croatian scientist and first Nobel laureate, professor Leopold (Lavoslav) Ružička. The main goals of the Conference were to promote excellence, originality and innovation of interdisciplinary scientific research as well as the practical application of the obtained results through collaboration with industry, emphasizing thus the recognizable slogan of the Ružička Days conference: "Today Science – Tomorrow Industry". In addition, the Conference gave the opportunity for meetings, exchanging the ideas, opinions, experiences and cooperation among participants from different working surroundings. It is also important to point out that since 2008, within the international conference Ružička Days, Meeting of Young Chemists has also been held, where high school students, with the help of their mentors, present papers in the field of chemistry, with the aim to direct students and young people to the technical and natural sciences, especially chemistry. In its seventh issue (2011, 2013, 2015, 2017, 2019, 2021) the Proceedings publishes scientific and professional full papers of high quality in the following sections: Chemical analysis and synthesis (10), Chemical and biochemical engineering (3), Food technology and biotechnology (4), Chemistry in agriculture and forestry (1), Environmental protection (9) and 8th Meeting of Young Chemists (3). Full-length papers were subjected to an international review procedure done by eminent experts from the corresponding fields, to whom we express our gratitude, but they were not subjected to linguistic proofreading. On behalf of the Scientific and Organizing Committee of the 19th Ružička Days we cordially thank all the authors, reviewers, participants, lecturers, organizers, especially the international organizers EuCheMS and EHEDG, auspices and sponsors, and all the others who, in any way, supported the Conference and contributed to the preparation of the Proceedings, especially to our highly skilled and committed associates, who have put a lot of effort in the preparation of these Proceedings. At the very end, special thanks to our young, future scientists and their mentors who are faithful participants of the Meeting of Young Chemists of the Ružička Days conference. Enjoy the extremely interesting scientific and professional papers contained in these Proceedings, until the next 20th jubilee of Ružička Days in 2024! We are looking forward to meeting you again in Vukovar! Yours sincerely, Chief Editors Jurislav Babić Vesna Ocelić Bulatović Dajana Kučić Grgi