20 research outputs found
Leukociti i drugi hematoloÅ”ki pokazatelji u hrvatskih ratnih veterana s posttraumatskim stresnim poremeÄajem
The aim of the study was to assess differences in white blood cell (WBC), neutrophil, monocyte, basophil, eosinophil and lymphocyte counts between Croatian veterans with combat-related posttraumatic stress disorder (PTSD) and those with combat-related PTSD comorbid with major depressive disorder (MDD). PTSD and/or MDD were diagnosed according to a structured clinical interview based on DSM-IV criteria. Additional criteria were Clinician Administered PTSD Scale (CAPS) for PTSD and Montgomery-Asberg Depression Rating Scale (MADRAS) for MDD. WBC was measured on an automatic blood counter. Results showed no statistically significant difference in WBC, neutrophil, lymphocyte, monocyte, eosinophil, basophil and red blood cell counts (RBC), hemoglobin, hematocrit, MCV, MCH, MCHC and platelet count between the veterans with combat-related PTSD, veterans with combat-related PTSD + MDD comorbidity, and patients with MDD only. In conclusion, there were no differences in WBC, neutrophil, lymphocyte, monocyte, eosinophil, basophil and RBC counts, hemoglobin, hematocrit, MCV, MCH, MCHC and platelet count among veterans with combat-related PTSD, veterans with combat-related PTSD comorbid with MDD, and patients with MDD only.Cilj ove studije bio je ispitati razlike u broju leukocita, neutrofila, monocita, bazofila, eozinofila i limfocita u hrvatskih ratnih veterana s post-traumatskim stresnim poremeÄajem (PTSP) uzrokovanog ratnim traumama u usporedbi s istim poremeÄajem uz istodobno prisutan velik depresivni poremeÄaj (VDP). Dijagnoza PTSP i/ili VDP postavljena je pomoÄu strukturiranog kliniÄkog upitnika prema kriterijima DSM-IV. Kao dopunski kriteriji primijenjena je Clinician Administered PTSD ljestvica (CAPS) za PTSP te Montgomery-Asberg Depression Rating Scale (MADRAS) za VDP. Broj leukocita izmjeren je na automatskom hemaoloÅ”kom brojaÄu. Rezultati nisu pokazali nikakvu statistiÄki znaÄajnu razliku u broju leukocita, neutrofila, limfocita, monocita, eozinofila, bazofila, eritrocita, trombocita, kao ni u razini hemoglobina, hematokrita, MCV, MCH i MCHC izmeÄu veterana s PTSP uzrokovanog ratnim traumama, veterana s PTSP uzrokovanog ratnim traumama i istodobnim VDP i bolesnika koji boluju samo od VDP. ZakljuÄuje se kako ne postoje razlike u broju leukocita, neutrofila, limfocita, monocita, eozinofila, bazofila, eritrocita, trombocita, kao ni u razini hemoglobina, hematokrita, MCV, MCH i MCHC izmeÄu veterana s PTSP uzrokovanog ratnim traumama, veterana s PTSP uzrokovanog ratnim traumama i istodobnim VDP i bolesnika koji boluju samo od VDP
NORMOBARIC HYPEROXIA IN NEUROANESTHESIA
NormobariÄna hiperoksija se sporadiÄno opisuje u literaturi o neurokirurÅ”koj anesteziji. MiÅ”ljenja o toj temi su razliÄita. Dugi niz godina hiperoksiju se povezivalo s moguÄim Å”tetnim uÄincima slobodnih kisikovih radikala, koji se tijekom hiperoksije stvaraju u koliÄini veÄoj nego Å”to je kapacitet antioksidansa, uzrokujuÄi hiperoksiÄnu akutnu ozljedu pluÄa. Nedavna istraživanja pokazuju da normobariÄna hiperoksija može biti korisna u lijeÄenju traumatske ozljede mozga. Glavni ciljevi u neuroanesteziji su održavanje intrakranijskog tlaka, cerebralnog perfuzijskog tlaka te sprjeÄavanje sekundarne ozljede mozga. Hiperoksija poboljÅ”ava oksigenaciju moždanog tkiva i aerobni metabolizam u mozgu zbog Äega može biti neuroprotektivna. Dodatna korist hiperoksije je u lijeÄenju poslijeoperacijskog pneumocefalusa, u smanjenju poslijeoperacijske muÄnine i povraÄanja, uÄestalosti infekcija kirurÅ”kih rana te njihovom bržem cijeljenju, Å”to omoguÄuje bolju kvalitetu oporavka bolesnika. UzevÅ”i u obzir moguÄe dobrobiti normobariÄne hiperoksije te njenih neželjenih uÄinaka potrebna su daljnja istraživanja kako bi se jasno izdvojile skupine bolesnika u kojih hiperoksija može poboljÅ”ati ishod lijeÄenja.Normobaric hyperoxia is occasionally mentioned in the literature concerning neurosurgical anesthesia. Opinions vary on this subject. Hyperoxia was long related to the potentially harmful influence of reactive oxygen species that are produced during hyperoxia in the amounts greater than the antioxidant capacity, thus causing hyperoxic acute lung injury. Recent research shows that hyperoxia may be benefi cial in treating traumatic brain injury. The main goals in neuroanesthesia are maintaining intracranial pressure and cerebral perfusion pressure while preventing secondary brain injury. Hyperoxia enhances brain tissue oxygenation and brain aerobic metabolism, thus being neuroprotective. Additional benefi t of hyperoxia may be found in the treatment of postoperative pneumocephalus by diminishing postoperative nausea and vomiting, and reducing the incidence of surgical site infections and facilitating their healing, thus providing better patient recovery. Considering the potential benefi ts of normobaric hyperoxia and its possible detrimental effect, additional investigation is needed to clearly defi ne the patient category where hyperoxia may have positive effect on patient outcome
UÄinak inhalacijskih anestetika na akutno oÅ”teÄenje bubrega
Acute kidney injury (AKI) is a serious complication associated with increased morbidity and mortality. Total incidence of AKI in hospitalized patients is 1%-5%. As many as 30% of these patients develop AKI in the perioperative period, which is associated with anesthesia and surgery. Despite scientific advances and improved surgery techniques, as well as treatment in intensive care units, no significant decrease in AKI incidence has been achieved. To change this outcome, it is important to identify patients at risk of AKI and prevent its occurrence. Correct selection of anesthetic drugs during general anesthesia, adjusted to the individual needs of patients, also influences the overall outcome of treatment. Nowadays, inhalational anesthetics are not considered nephrotoxic. The more so, inhalational anesthetics have a strong and direct protective effect on many organs through preconditioning and postconditioning. New studies have shown that sevoflurane diminishes ischemia/reperfusion kidney injury and has an anti-inflammatory effect, thus having the potential to reduce the occurrence of AKI. Given the incidence of AKI in the perioperative period, as well as new findings about anesthetics, the issue of anesthetic selection during general anesthesia might be of crucial importance for the final outcome of treatment.Akutno oÅ”teÄenje bubrega (AOB) je ozbiljna komplikacija povezana s poviÅ”enim pobolom i smrtnoÅ”Äu. Ukupna incidencija AOB u bolniÄkih bolesnika iznosi 1%-5%. Äak 30% tih bolesnika su razvili AOB u perioperacijskom razdoblju kao posljedicu anestezije i operacije. UnatoÄ novim znanstvenim spoznajama i unaprjeÄenju kirurÅ”kih tehnika te lijeÄenja u jedinicama intenzivne njege, nije postignut znaÄajniji pomak u smanjenju incidencije AOB. Za promjenu tog ishoda važno je prepoznavanje riziÄne skupine bolesnika te prevencija. Na ukupni ishod lijeÄenja utjeÄe i pravilan odabir anestetiÄkih sredstava tijekom opÄe anestezije, koji je najbolje prilagoÄen individualnim potrebama bolesnika. Danas se smatra da inhalacijski anestetici nisu nefrotoksiÄni. DapaÄe, inhalacijski anestetici imaju snažan izravan zaÅ”titni uÄinak na mnoge organe kroz
predkondicioniranje i postkondicioniranje. Nova istraživanja pokazuju da sevofluran smanjuje ishemijsko-reperfuzijsku ozljedu bubrega i djeluje protuupalno, zbog Äega ima potencijal smanjiti pojavu AOB. S obzirom na incidenciju AOB u perioperacijskom razdoblju i nove spoznaje o anesteticima, pitanje odabira anestetika tijekom opÄe anestezije moglo bi biti od kljuÄnog znaÄenja za sveukupni ishod lijeÄenja
Regionalna anestezija u neurokirurgiji
During neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery
procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent
postoperative pain relief, especially after spinal surgery.Tijekom neurokirurÅ”ih zahvata u bolesnika je vrlo bitno osigurati optimalnu cerebralnu perfuziju i oksigenaciju. UnatoÄ fizioloÅ”koj autoregulaciji perfuzije mozga, održavanje hemodinamske stabilnosti i dobre oksigenacije tijekom anestezije od vitalnog je znaÄaja za uspjeh. OpÄa anestezija s mehaniÄkom ventilacijom i suvremenim anesteticima omoguÄuje zadovoljavajuÄu hemodinamsku stabilnost i prvi je izbor za veÄinu neurokirurÅ”kih zahvata. MeÄutim, ponekad je vrlo teÅ”ko izbjeÄi
kratke varijacije krvnog tlaka tijekom jakih i slabih bolnih podražaja koji se izmjenjuju tijekom zahvata. Promjene sistemnog arterijskog tlaka mogu biti Å”tetne za bolesnike s visokim intrakranijskim tlakom i edemom mozga. LijeÄenje se sastoji u prilagodbi dubine anestezije ili primjene vazoaktivnih lijekova. S druge strane bolesnika je važno brzo probuditi nakon anestezije za neuroloÅ”ki pregled. Regionalna anestezija glave i kralježnice može pokazati povoljan uÄinak smanjenja bolnog
podražaja i hemodinamske varijabilnosti uz uÅ”tedu doza anestetika. TakoÄer regionalne tehnike pružaju odliÄano ublažavanje postoperativne boli
Etomidate in neuroanesthesia for aneurysmal clipping in child with confirmed allergies to general anesthetics
BACKGROUND:
Etomidate may be given in continuous infusion for maintenance of general anesthesia, although that practice is rarely seen due to beliefs that it has possibility of interfering with cortisol synthesis. However, etomidate is sometimes preferable choice as it has least influence on hemodynamics and rarely causes allergic reactions. ----- CASE DESCRIPTION:
We describe a case of 13-year-old boy with aneurysm of left middle cerebral artery, planned for aneurysmal clipping, and previously treated for ruptured aneurysm of right middle cerebral artery. As he was tested and proved allergic to most of the anesthetic drugs, and stable hemodynamic conditions were of most importance during planned neurosurgery, general anesthesia was maintained with etomidate infusion. He was prepared with metilprednisolon, antihistaminic, and ranitidine before the surgery. Cortisol and adrenocorticotropic hormone levels were measured on three consecutive postoperative days. Only cortisol value, in the morning the day after the surgery, was below reference range, with the values back to normal until that evening. He was dismissed from the intensive care unit with Glasgow Coma Score 15. ----- CONCLUSION:
Etomidate may be a choice for neuroanesthesia in specific group of people. We have good experience with our algorithm for continuous infusion of etomidate, with serum cortisol values in the reference range, if corticosteroids were not given before the surgery. Administration of metilprednisolon may diminish influence of perioperative stress on cortisol synthesis inhibition
Lokalno potencirana anestezija i kontrolirana hipotenzija deksmedetomidinom kod plastiÄno-rekonstruktivnih zahvata glave i vrata ā naÅ”a iskustva i preliminarni rezultati
Cilj rada: Zahvati u kirurgiji glave i vrata mogu se odraditi u lokalnoj anesteziji lidokainom s adrenalinom, uz
potenciranje deksmedetomidinom koji dovodi do sniženja tlaka i pulsa bez respiratorne depresije.
Deksmedetomidin je alfa adrenergiÄki agonist koji se rutinski koristi u jedinicama intenzivnog lijeÄenja za
sedaciju. Primjenjuje se se kod razliÄitih dijagnostiÄko-terapijskih procedura odraslih i djece. Kontraindiciran
je kod AV bloka 1. i 2. stupnja. PoÄetak djelovanja kod davanja na perfuzor je 20 minuta. Materijal i metode:
Deksmedetomidin je davan u kontinuiranoj infuziji na perfuzor 0.5-1mcg/kg/h. Doza je ordinirana prema
vrijednosti tlaka - ukoliko je sistoliÄki tlak bio ispod 120 davana je doza 0.5mcg/kg/h, a pri viÅ”im vrijednostima
tlaka 1 mcg/kg/h. Sva Äetiri bolesnika dodatno su dobila metamizol 2.5g u 500 ml kristaloidne otopine. PraÄeni
su vitalni parametri tijekom zahvata, te 20 minuta nakon zahvata u sobi za buÄenje. Stupanj sedacije je
provjeravan kroz komunikaciju s bolesnikom. Rezultati: Äetiri bolesnika ASA statusa 2 ili 3, imalo je eksciziju
i rekonstrukciju lokalnim reženjem radi lipoma lica, tumora vlasiŔta, tumora frontalne regije, te tumora uŔke
uz tumor frontalne regije, te uz razliÄite komorbiditete. Nitko od bolesnika nije imao respiratornu depresiju ili
znaÄajnu hipotenziju. Kontrolirana hipotenzija je bila poželjna kao i kontrolirani pad pulsa. ZakljuÄak:
PlastiÄno- rekonstruktivni zahvati mogu se sigurno obaviti u lokalno potenciranoj anesteziji, uz poželjnu
kontroliranu hipotenziju i sedaciju deksmedetomidinom, bez suplementacije kisikom. Glavne prednosti
sedacije deksmedetomidinom su manje krvarenja u operativnom polju, suradljivi bolesnik, te izbjegnute
respiratorne komplikacije, uz klasiÄne anestetike
UÄinak regionalne vs. opÄe anestezije na imuni odgovor u kirurgiji karcinoma dojke; pregled literature
For breast cancer patients, surgery remains the cornerstone in treatment. Perioperative
and postoperative period is associated with impaired immune function that can have profound
implications for cancer patients in terms of tumor recurrence and metastases. The three main factors
include surgery and related neuroendocrine stress response, anesthetic drugs, including opioid analgesics
and postoperative pain. The most investigated immune cells are natural killer (NK) cells that are
affected by both anesthesia and surgery. It has been demonstrated that ketamine, thiopental, volatile
anesthetics, fentanyl and morphine, but not propofol, remifentanil or tramadol reduce the number
of circulating NK cells and depress their toxicity. The level of NK cellsā cytotoxicity is inversely proportional
to the stage and spread of cancer. Regional anesthesia and its potential beneficial effects on
the perioperative immune response and long-term outcome after surgery has been investigated as an
alternative to general anesthesia in patients undergoing breast cancer surgery. In this paper, we present
a review of literature aimed to assess the impact of regional anesthesia techniques on the immune
response in patients undergoing breast cancer surgery and how it compares to general anesthesia.Za pacijente s rakom dojke operacija je neizostavni dio terapijskog postupka. Predoperativno i postoperativno razdoblje je
povezano s oslabljenom imunoloÅ”kom funkcijom koja može imati znaÄajne posljedice za bolesnike s karcinomom u smislu recidiva
tumora i metastaza. Tri su glavna Äimbenika odgovorna za takve promjene i ukljuÄuju operaciju i s njom povezan neuroendokrini
stresni odgovor, anestetike ukljuÄujuÄi opioidne analgetike i postoperativnu bol. NajÄeÅ”Äe istraživane imunoloÅ”ke stanice
su prirodne stanice ubojice (NK) na koje utjeÄu i anestezioloÅ”ki i kirurÅ”ki postupak. Pokazano je da ketamin, tiopental, hlapljivi
anestetici, fentanilimorfin, ali ne i propofol, remifentanil i tramadol, smanjuju broj cirkulirajuÄih NK stanica i njihovu citotoksiÄnost.
Razina citotoksiÄnosti NK stanica obrnuto je proporcionalna stadiju i proÅ”irenosti karcinoma. Regionalna anestezija
i njezin moguÄi povoljan uÄinak na predoperativni imunoloÅ”ki odgovor i dugoroÄni ishod nakon operacije istraživani su kao
alternativa opÄoj anesteziji u bolesnica koje su podvrgnute operaciji karcinoma dojke. Cilj ovog pregleda literature je procjena
utjecaja regionalne anestezije na imunoloŔki odgovor u pacijentica podvrgnutih operaciji karcinoma dojke te njezina usporedba
s opÄom anestezijom
PREOPERATIVE NUTRITION IN SURGICAL PATIENTS
Preoperacijsko gladovanje, ānihil per osā (niÅ”ta na usta) od ponoÄi na dan operacije je nepotrebno i može dovesti do razliÄitih komplikacija te se smatra opsoletnim. Smjernice preporuÄuju uzimanje tekuÄine do 2 sata prije uvoda u anesteziju bez straha od aspiracije ili drugih neželjenih uÄinaka. Gladovanje zajedno s operacijom, koja je stres za organizam, dovodi do kataboliÄkog stanja organizma, produžuje oporavak bolesnika te uzrokuje brojne druge postoperacijske komplikacije. Ciljevi preoperacijske prehrane su izbjegavanje gladovanja kako bi se održao proteinski status, održavanje imunoloÅ”ke, miÅ”iÄne i endokrinoloÅ”ke funkcije, te ubrzanje oporavka nakon operacije. Velik broj bolesnika je pri dolasku u bolnicu pothranjen. Nadalje, pothranjenost je nezavisni rizik za poveÄani mortalitet, morbiditet te dužinu boravka u bolnici. Stoga preoperacijski probir i procjena nutritivnog stanja te adekvatna preoperacijska prehrana trebaju postati obvezni kod kirurÅ”kih bolesnika. Smjernice Europskog druÅ”tva za kliniÄku prehranu i metabolizam (ESPEN) nalažu primjenu preoperacijske prehrane kod teÅ”ko pothranjenih bolesnika Äak i ako se operacija zbog toga mora odgoditi. Brojna istraživanja su dokazala dobrobit reoperacijske prehrane za bolesnikovo opÄe stanje, smanjenje postoperacijskih komplikacija te sigurnu upotrebu bez straha od aspiracije i drugih komplikacija. ESPEN smjernice preporuÄuju preoperacijsku primjenu ugljikohidratnih pripravaka te daju prednost imunonutriciji nad obiÄnim enteralnim pripravcima. U zakljuÄku možemo reÄi da bi preoperacijska prehrana kirurÅ”kih bolesnika trebala postati standardni dio protokola kod pripreme bolesnika za operaciju.Preoperative fasting, nihil per os after midnight on the day of surgery is considered unnecessary and obsolete. Guidelines encourage taking clear fl uid up to 2 hours before surgery, without fear of aspiration and other complications. Fasting together with surgery, which represents stress for the body, leads to catabolic state, prolongs patient recovery, and causes postoperative complications. The aim of preoperative nutrition and avoiding fasting is to maintain protein balance, muscle and immune function, and to facilitate postoperative recovery. On admission to the hospital, most patients are malnourished, including even 40% of patients undergoing gastrointestinal surgery. Preoperative malnutrition is an independent risk factor for postoperative complications and prolonged length of stay in the hospital. Preoperative screening, assessment of nutritional status, and appropriate preoperative nutrition are mandatory in surgical patients. According to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines, in severely malnourished surgical patients, preoperative
nutritional support should be used even if the operation must be delayed. Numerous studies have demonstrated favorable impact of preoperative nutrition, posing no risk of aspiration and other complications. ESPEN guidelines recommend preoperative use of carbohydrate and immunonutrients. Preoperative nutrition should become standard part of the care protocol for surgical patients