Antagonizacija učinka intramuskularne aplikacije sukcinilkolina u štakora primjenom pentadekapeptida BPC 157 [Antagonisation of intramuscular application of succinycholine in rats by pentadecapeptide BPC 157]

Pentadecapeptide BPC 157 improves muscle healing and has neuroprotective properties. We tested BPC 157 counteracting effect on intramuscular application of succinylcholine. Succinylcholine was given into the right quadriceps muscle of the rats, and we assessed local paralytic effect in injected muscle, immediate leg contracture, initial agitation before muscle disability, countless muscle twitches before complete muscle tonus loss, motionless laying, and thereafter, violent screaming upon light touch, and muscle fibers decrease, and edema in injected and non-injected quadriceps muscle and diaphragm. BPC 157 completely eliminated the local succinylcholine effect (leg contracture) and markedly attenuated or eliminated behavioral agitation, muscle twitches, motionless laying. No violent screaming upon light touch appeared in IM succinylcholine-rats. BPC 157 counteracted muscle fibers decrease and edema that otherwise appeared in injected and non-injected quadriceps muscle and diaphragm

Hearing in Children with Otitis Media with Effusion – Clinical Retrospective Study

Hearing loss accompanied with middle ear effusion was analyzed according to audiometric frequencies for different age group. Results for left and right ears were compared in/ and between study and control group. Pure tone audiometry for bone and air conduction and tympanometry was performed in study group of ninety-eight children with conductive hearing loss and otitis media with effusion Control group included fifty-seven children with hearing loss, enlarged adenoids, dysfunction of Eustachian tube and no present middle ear effusion served. Means of hearing loss thresholds for 250 Hz – 4 kHz were established and compared between groups of right vs. left ears of tested vs. control ears according to age subgroups: 1–3 yr, 4–6 yr, 7–9 yr, 10–12 yr, 13–15 yr. At age 1–3 yr otitis media with effusion children showed no ear side difference in hearing loss. Age groups of 4–6 and 7–9 yr otitis media with effusion children showed left ears with higher threshold of hearing loss across all of the tested frequencies than right ears in study and control ears. Right ears showed smaller hearing loss in study and control group and no age group predicted for hearing impairment. Higher hearing loss threshold for 4 kHz in adolescence in otitis media with effusion ears is early sign of sequels after repetitive episodes of middle ear effusion. Control groups showed no ear side or age group dependent difference of hearing loss threshold. Age group of 4–6 and 7–9 y have faster craniofacial structural change in soft tissue than bone base so ear side differences suggest being developmentally determined

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

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

Peripheral Arterial Catheter Related Infections in the Neurosurgical Intensive Care Unit

Intravascular device infections could be serious complications with significant contributable morbidity and mortality. The aim of this prospective clinical study is to demonstrate the infection rate related to peripheral arterial catheters and their clinical significance in neurosurgical intensive care unit (ICU) patients. After removal, all arterial catheter tips were cultivated by semiquantitative method and clinical data were collected. During a period of two years, 186 arterial catheters were placed in 105 neurosugical ICU patients. In 6 cases (3.2%) infection was presumably related to the arterial catheter. The rate of such probable catheter related infections was found to be 5/1000 catheter days. The isolated microorganisms were: Methicillin resistant Staphylococcus epidermidis (MRSE) in 4 cases, Corynebacterium species and Candida albicans each in one case respectively. Thirteen cases (7.0%) were interpreted as contamination and one as colonization. An association was found between the presence of infection from different sources and significant bacterial growth on the catheter. Patients with positive catheter culture had a significantly longer ICU stay, more cumulative catheter days, and a higher mortality rate than those with sterile catheters. We can conclude that the rate of probable peripheral arterial catheter related infection is low. A higher mortality rate in patients who experienced probable catheter related infection does not seem to be a consequence of the aforementioned infection. A more suitable explanation would be that patients with nosocomial infections and higher mortality risk have prolonged ICU stays. There is an increased chance of developing a catheter related infection in those patients who have more cumulative catheter days

Hearing in Children with Otitis Media with Effusion – Clinical Retrospective Study

Hearing loss accompanied with middle ear effusion was analyzed according to audiometric frequencies for different age group. Results for left and right ears were compared in/ and between study and control group. Pure tone audiometry for bone and air conduction and tympanometry was performed in study group of ninety-eight children with conductive hearing loss and otitis media with effusion Control group included fifty-seven children with hearing loss, enlarged adenoids, dysfunction of Eustachian tube and no present middle ear effusion served. Means of hearing loss thresholds for 250 Hz – 4 kHz were established and compared between groups of right vs. left ears of tested vs. control ears according to age subgroups: 1–3 yr, 4–6 yr, 7–9 yr, 10–12 yr, 13–15 yr. At age 1–3 yr otitis media with effusion children showed no ear side difference in hearing loss. Age groups of 4–6 and 7–9 yr otitis media with effusion children showed left ears with higher threshold of hearing loss across all of the tested frequencies than right ears in study and control ears. Right ears showed smaller hearing loss in study and control group and no age group predicted for hearing impairment. Higher hearing loss threshold for 4 kHz in adolescence in otitis media with effusion ears is early sign of sequels after repetitive episodes of middle ear effusion. Control groups showed no ear side or age group dependent difference of hearing loss threshold. Age group of 4–6 and 7–9 y have faster craniofacial structural change in soft tissue than bone base so ear side differences suggest being developmentally determined

Dental Treatment Under General Anesthesia in a Day Care Surgery Setting

Svrha: Analizirati podatke o stomatološkom liječenju u općoj anesteziji (OA-i) provedenom na Klinici za stomatologiju KBC-a Zagreb s naglaskom na osobitosti pacijenata, vrste zahvata i postoperativne komplikacije. Ispitanici i postupci: Retrospektivna analiza kartona 100 pacijenata liječenih u OA-i na jednodnevnoj kirurgiji Klinike za stomatologiju KBC-a Zagreb. Registrirani su demografski (spol, dob) i klinički podatci bolesnika (osnovna bolest, tehnika OA-e, vrsta intubacije, trajanje zahvata, broj karioznih zuba, broj pečatnih ispuna, ispuna, ekstrakcija i endodontskih liječenja, vrijeme do otpusta i postoperativne komplikacije). Rezultati: U OA-i je zbog nesuradnje iz različitih razloga liječeno 80 pacijenata, a 20 zbog teškoga fizičkog stanja ili preopsežnog zahvata za lokalnu anesteziju. Medijan KEP indeksa iznosio je 9 (0 – 21). Sanaciji svih zuba podvrgnuto je 89 pacijenata, a 11 drugim vrstama zahvata. Isti dan otpušteno je 97 pacijenata. Četvero su imali postoperativne komplikacije, pa je troje hospitalizirano zbog daljnjeg praćenja od 24 do 48 sati. Zaključak: Pacijenti s fizičkim i/ili mentalnim oštećenjem imaju veću aktivnost karijesa i povećanu potrebu za stomatološkom skrbi u odnosu prema općoj populaciji. Stomatološko liječenje u OA-i u sustavu jednodnevne kirurgije siguran je i učinkovit način liječenja za pacijente koji ne mogu surađivati sa stomatologom.Objective: To analyze data on full-mouth rehabilitation under general anesthesia (GA) performed at the University Clinical Hospital Zagreb with emphasis on patient characteristics, type of procedure and postoperative complications. Materials and methods: Retrospective chart review of 100 patients treated under GA at the Dental clinic’s day care surgery. Patient’s demographic (sex, age) and clinical data (diagnosis, GA technique, intubation type, procedure duration, number of carious teeth, presence of visible calculus, number of sealed teeth, fillings, extractions and endodontic treatments, discharge time, postoperative complications) were registered. Results: Eighty patients were treatedunder GA because of noncompliance due to different reasons and twenty patients because of either their poor physical condition or extensive dental procedure. Median DMFT per patient was 9(0- 21). Eighty nine patients underwent full-mouth dental restoration and 11 patients underwent other types of procedures. Ninety seven patients were safely discharged the same day. Four patients experienced postoperative complications and three of them were hospitalized for another 24-48 hours for postoperative follow-up. Conclusion: Patients with physical and/or intellectual disabilities have higher caries activity and increased dental treatment needs compared to the general population. Dental treatment under GA in day care service is a safe and effective way of providing dental care for noncompliant patients

Komplikacije stomatološke sanacije u općoj anesteziji nakon otpusta iz sustava jednodnevne kirurgije

Objective: To review the frequency and management of post-discharge complications in patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting and identify the factors that increase the risk for these complications. Material and methods: Anonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA at our institution between 1 st January 2017 and 31 st July 2019. Demographic and clinical data of patients as well as the data about the occurrence and management of complications were collected. Results: Sixty-six parents/caregivers (30.5%) responded to the questionnaire. Most frequent complications were drowsiness and pain in 40(60.6%) patients. Complications were managed by parents or caregivers with conservative measures at home in 57(91.9%) cases. Phone consultation with dentist was required in 5(8.1%) cases. One patient (1.6%) was readmitted. Younger age and diagnosis were associated with increased risk for drowsiness. Conclusion: Post discharge complications of dental treatment in GA in a day-care service are common and they can be managed by parent/caregiver with conservative measures at home. The rate of readmission is low. Dental treatment in GA in a day-care service is a safe procedure that can be performed with acceptable risk in carefully selected patients.Svrha rada: Ispitati učestalost i liječenje komplikacija nakon otpusta pacijenata koji su bili podvrgnuti stomatološkom liječenju u općoj anesteziji (OA) u sustavu jednodnevne kirurgije i identificirati čimbenike koji povećavaju rizik od navedenih komplikacija.Ispitanici i postupci: Anonimni upitnik poslan je roditeljima/skrbnicima pacijenata koji su bili podvrgnuti stomatološkoj sanaciji u OA u našoj ustanovi između 1. siječnja 2017. i 31. srpnja 2019. Prikupljeni su demografski i klinički podatci o pacijentima te podatci o pojavi komplikacija i njihovu liječenju. Rezultati: Na upitnik je odgovorilo 66 roditelja/skrbnika (30,5 %). Najčešće komplikacije bile su ošamućenost i bol koje su se pojavile kod 40 pacijenata (60,6 %). Liječene su konzervativnim mjerama kod kuće u 57 slučajeva (91,9 %). Telefonska konzultacija sa stomatologom bila je potrebna u pet slučajeva (8,1 %). Jedan pacijent (1,6 %) bio je ponovo primljen u bolnicu. Mlađa dob i dijagnoza bile su povezane s povećanim rizikom od ošamućenosti. Zaključak: Komplikacije stomatološkog liječenja u općoj anesteziji poslije otpusta iz jednodnevne kirurgije su česte, no roditelji/skrbnici mogu ih u većini slučajeva liječiti konzervativnim mjerama kod kuće. Postotak ponovnih prijama u bolnicu je nizak. Stomatološko liječenje u OA u sustavu jednodnevne kirurgije siguran je zahvat koji se može obaviti uz prihvatljiv rizik ako se pacijenti pomno odaberu

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

Peripheral Arterial Catheter Related Infections in the Neurosurgical Intensive Care Unit

Intravascular device infections could be serious complications with significant contributable morbidity and mortality. The aim of this prospective clinical study is to demonstrate the infection rate related to peripheral arterial catheters and their clinical significance in neurosurgical intensive care unit (ICU) patients. After removal, all arterial catheter tips were cultivated by semiquantitative method and clinical data were collected. During a period of two years, 186 arterial catheters were placed in 105 neurosugical ICU patients. In 6 cases (3.2%) infection was presumably related to the arterial catheter. The rate of such probable catheter related infections was found to be 5/1000 catheter days. The isolated microorganisms were: Methicillin resistant Staphylococcus epidermidis (MRSE) in 4 cases, Corynebacterium species and Candida albicans each in one case respectively. Thirteen cases (7.0%) were interpreted as contamination and one as colonization. An association was found between the presence of infection from different sources and significant bacterial growth on the catheter. Patients with positive catheter culture had a significantly longer ICU stay, more cumulative catheter days, and a higher mortality rate than those with sterile catheters. We can conclude that the rate of probable peripheral arterial catheter related infection is low. A higher mortality rate in patients who experienced probable catheter related infection does not seem to be a consequence of the aforementioned infection. A more suitable explanation would be that patients with nosocomial infections and higher mortality risk have prolonged ICU stays. There is an increased chance of developing a catheter related infection in those patients who have more cumulative catheter days