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Cattering Offer Customized for Specific Dietary Requirements of the Elderly People
No full textStarenje je prirodan fiziološki proces. Porastom životnog standarda u razvijenim zemljama raste i životni vijek. Udio starijih osoba u cjelokupnoj populaciji se povećava stoga je i za očekivati porast broja turista u dobi iznad 65. godina. Izvor informacija osoba starije životne dobi o destinaciji za odmor je najčešće tisak ili prikupljanje informacija od poznanika, stoga je jako bitno ostaviti dobar dojam. Gastronomija kraja u koji dolaze je jedan od bitnih motiva dolaska.
Povisivanjem životne dobi događaju se brojne promjene različitih organa i organskih sustava. Kad će nastupiti vidljivi znaci starenja ovisi o životnim navikama pojedinca tijekom života. Nepušenje, pravilna i uravnotežena prehrana, redovita umjerena tjelesna aktivnost, te održavanje poželjne tjelesne mase važni su čimbenici u održavanju zdravlja. Starenjem se povećava rizik od pojave kronične nezarazne bolesti, a prehrambeno ponašanje i stil života utječe na njihovu pojavnost.
Planiranje prehrane osoba starije životne dobi je od velikog značaja. Pravilna prehrana uglavnom neće izliječiti od kroničnih bolesti, ali može umanjiti tegobe i utjecati na kvalitetu života. Žele li zadržati goste treće životne dobi u destinaciji, nositelji ugostiteljske ponude trebaju biti upoznati s prehrambenim potrebama osoba starije životne dobi kao i sa smjernicama i preporukama za njihovu prehranu u cilju formiranja dobre ugostiteljske ponude za tu dobnu skupinu.
Mediteranska prehrana preporuča se kao dobar prehrambeni model. Slijedeći taj model prehrane može se umanjiti rizik od pojave kroničnih bolesti kod osoba starije životne dobi te mediteransku prehranu možemo preporučiti ugostiteljima kao dobar model prehrane za osobe starije životne dobi.Aging is a natural physiological process. As the standard of living increases in developed countries, life expectancy also increases. The share of elderly people in the entire population is increasing, so an increase in the number of tourists over the age of 65 is to be expected. The source of information for elderly people about the vacation destination is usually the press or gathering information from acquaintances, so it is very important to leave a good impression. The gastronomy of the region they come to is one of the important reasons for coming. Increasing age causes numerous changes in various organs and organ systems.
When the visible signs of aging will appear depends on the lifestyle habits of the individual during his life. Not smoking, a proper and balanced diet, regular moderate physical activity, and maintaining a desirable body weight are important factors in maintaining health. Aging increases the risk of developing chronic non-communicable diseases, and dietary behavior and lifestyle affect their occurrence.
Diet planning for elderly people is of great importance. Proper nutrition will generally not cure chronic diseases, but it can reduce complaints and affect the quality of life. If they want to keep guests of the third age in the destination, the owners of the catering offer should be familiar with the nutritional needs of the elderly as well as with the guidelines and recommendations for their nutrition in order to create a good catering offer for that age group.
The Mediterranean diet is recommended as a good dietary model. Following this diet model can reduce the risk of chronic diseases in elderly people, and we can recommend the Mediterranean diet to restaurateurs as a good diet model for elderly people
"Organisms settlement on oyster spat collectors in Bistrina Bay"
No full textEkološki uvjeti Malostonskog zaljeva pogodni su za naseljavanje europske plosnate kamenice Ostrea edulis Linnaeus, 1758 koja se na ovom području uzgaja stoljećima, a kao jedno od najproduktivnijih dijelova navodi se uvala Bistrina. Tradicionalni način prikupljanja mlađi temeljio se na potapanju grana tršlje, hrasta crnike ili smrče, a trenutno se u uzgoju koriste plastične kapice nanizane na željezne profile i drugi oblici plastičnih kolektora. S obzirom na to da podloga uronjena u more predstavlja novo stanište, na kolektore se osim mlađi kamenice naseljava niz različitih organizama koji mogu imati pozitivan ili negativan utjecaj na rast i razvoj kamenice.
Cilj ovog istraživanja bio je identificirati organizme koji naseljavaju kolektore za prikupljanje mlađi u uvali Bistrina i njihovu masu. Za potrebe ovog istraživanja, u uvalu Bistrina je postavljeno devet triplikata kolektora (plastične kapice nanizane na željezne profile) u razdoblju od devet tjedana. Prvi triplikat postavljen je 19. travnja 2022. nakon čega je svaki tjedan postavljan po jedan, zaključno sa 6. travnja 2022. Nakon nešto više od četiri mjeseca izloženosti naseljavanju, triplikati kolektora su vađeni, vagani i analizirani, a obraštajni organizmi determinirani. Prvo vađenje i analiza kolektora obavljeno je 30. kolovoza 2022. nakon čega se svaki tjedan analizirao jedan triplikat. Zabilježeno je ukupno 41 različitih vrsta organizama, uz četiri taksona determinirana do razine roda te dva do koljena kojem pripadaju. Među njima su zabilježene i neke alohtone vrste, kao što su Paraleucilla magna, Hydroides elegans i Amathia verticilata. Primijećene su razlike u ukupnoj i prosječnoj masi uzoraka ovisno o strani kapica s kojih su uzeti; proces obraštanja je intenzivniji na donjoj strani kapica. Jedini organizam pronađen u svakom uzorku je morski cjevaš Hydroides elegans Haswell, 1883.The ecological conditions of Mali Ston Bay are suitable for the settlement of the European flat oyster Ostrea edulis Linnaeus, 1758, which has been cultivated in this area for centuries, and the bay of Bistrina is cited as one of the most productive parts. The traditional method of collecting spat was based on submerging the branches of oak or spruce. Currently, plastic caps strung on iron profiles and other forms of plastic collectors are used. Given that the substrate immersed in the sea represents a new habitat, in addition to oyster fry, the collectors are inhabited by a number of different organisms that can have a positive or negative impact on the growth and development of oysters.
The aim of this research was to identify the organisms that inhabit the collectors for the collection of fry in Bistrina bay and their mass. For the purposes of this research, nine triplicates of collectors (plastic caps strung on iron profiles) were installed in the bay of Bistrina for a period of nine weeks. The first triplicate was installed on April 6, 2022. After a little more than four months of exposure to the settlement, triplicates were removed, weighed and analyzed, and the fouling organisms were determined. The first extraction and analysis of the collectors were carried out on August 30, 2022., after which one triplicate was analyzed per week. A total of 41 different types of organisms were recorded, with four taxa determined to the genus level and two to the genera to which they belong. Some non-native species, such as Paraleucilla magna, Hydroides elegans and Amathia verticilata, were recorded among them. Differences were observed in the total and average mass of the samples depending on the side of the caps from which they were taken; the fouling process is more intense on the underside of the caps. The only organism found in each sample was the serpulid tubeworm Hydroides elegans Haswell, 1883
Legends about fairies and some supernatural beings in Žuljana on Pelješac
No full textPostojanost vjerovanja u nadnaravno poznato je od samih početaka ljudskoga postojanja te se prenosilo s generacije na generaciju. Predmet istraživanja rada su vjerovanja u nadnaravna bića te brojne predaje i legende koje postoje u pelješkom mjestu Žuljana. Dočarana su usmenim kazivanjima stanovnika ovoga naselja.
Cilj rada je približiti narodne predaje o vilama i nekim nadnaravnim bićima u Žuljani na Pelješcu te osobama koje bi htjele više znati o predajama koje nitko nije zapisao (što se odnosi na Žuljanu) pružiti širi spektar predaja i kazivanja o nadnaravnim događanjima i bićima. Također proširiti vidike ljudima i povećati svijest o prošlim vremenima te pričama koje su na prijelazu stoljeća kolale Žuljanom. Rečeno će se ostvariti metodom strukturiranog intervjua, opisnom te komparativnom metodom. U radu će se prikazati čovjekovo divljenje prema vilama, a jedan od razloga je bio što su one bile s drugog svijeta, čovjeku nepoznatog i nedostatnog svijeta. Prema navedenom i obrazloženom u radu može se reći da su ljudi imali strah od nepoznatog i drugačijeg, onog što ne pripada njihovom svijetu, a razlog njihovog straha je neznanje. To je bio ključni razlog vjerovanja u nadnaravno tadašnjeg stanovništva.The persistence of belief in the supernatural has been known since the very beginnings of human existence and has been passed down from generation to generation. The subject of research is beliefs in supernatural beings and numerous traditions and legends that exist in the town of Žuljana in Pelješac. They are evoked by the oral stories of the inhabitants of this settlement.
The aim of the work is to bring folk tales about fairies and some supernatural beings in Žuljana on Pelješac closer to people who would like to know more about legends that no one has written down, (which refers to Žuljana) to provide a wider spectrum of traditions and stories about supernatural events and beings. Also to broaden people's horizons and increase awareness of past times and stories that circulated in Žuljana at the turn of the century. Tradition, that is, what will be said will be tried to be realized using the method of structured interview, descriptive and comparative method. The work will show man's admiration for fairies, and one of the reasons was that they were from another world, unknown and insufficient to man. According to the above and explained in the paper, it can be said that people were afraid of the unknown and different, that which does not belong to their world, due to lack of knowledge. This was the key reason for the belief in the supernatural of the population at that time
Prediction of ship fuel consumption
No full textPotrošnja goriva za brodove pokazala se kao jedan od ključnih faktora koji pridonose pogoršanju stanja okoliša i porastu operativnih troškova za pomorsku industriju. Suvremeni veliki brodovi za kružna putovanja imaju velike energetske potrebe. Potrebe za energijom ovise o uvjetima rada i potrebnoj brzini broda, ti visoki energetski zahtjevi obično znače visoke troškove goriva. Uz provedbu međunarodnih propisa u cilju smanjenja onečišćenja okoliša, donesene su razne mjere i postupci za predloženo povećanje energetske učinkovitosti brodova. U praksi, ekonomičnost potrošnje goriva može biti postignuta projektnim ili operativnim pristupima u novosagrađenim ili postojećim plovilima u uporabi. U ovom radu se koristi metoda višestruka linearna regresija (multiple linear regression - MLR) za konstruiranje profila učinkovitosti potrošnje goriva brodova za kružna putovanja. Krivulje performansi su izvedene da bi analizirali i pratili performanse broda u plovidbi. Tradicionalno u praksi, potrebna brzina broda određena je duljinom plovnog puta podijeljenom s vremenom koje je dostupno za putovanje. Analizom izvorno prikupljenih podataka s kruzera zaključeno je da je se može predvidjeti unaprijed potrošnja goriva. Stoga predviđanjem potrošnje goriva može se koristiti za određivanje brzine plovidbe za optimalnu potrošnju goriva prema zahtjevima rute i tako postići značajne uštede goriva, smanjenje troškova putovanja, povećanje energetske učinkovitosti i smanjenje štetne emisije plinova s broda i utjecaja na okoliš.Fuel consumption for ships has proven to be one of the key factors contributing to the deterioration of the environment and the increase in operational costs for the maritime industry. Modern large cruise ships have high energy requirements. Energy requirements depend on operating conditions and required ship speed, and high energy requirements usually mean high fuel costs. Along with the implementation of international regulations aimed at reducing environmental pollution, various measures and procedures were adopted to increase the energy efficiency of ships. In practice, economy of fuel consumption can be achieved by design or operational approaches in newly built or existing vessels in use. In this paper, the multiple linear regression (MLR) method is used to construct the fuel consumption efficiency profile of cruise ships. The performance curves are derived to analyse and monitor the performance of the ship in navigation. Traditionally in practice, the required ship speed is determined by the length of the waterway divided by the time available for the voyage. The analysis of the originally collected data from the cruise ship concluded that fuel consumption can be predicted in advance. Therefore, by predicting fuel consumption, it can be used to determine sailing speed for optimal fuel consumption according to route requirements and thus achieve significant fuel savings, reduction of travel costs, increase of energy efficiency and reduction of harmful ship emissions and environmental impact
The contribution of dubrovnik naturalists to the formation of the modern botanical discipline
No full textHistoriografija dubrovačkog prirodoslovlja nedovoljno je istražena tema, posebice u području botaničkih istraživanja. Duga tradicija poznavanja vrijednih ljekovitih biljaka koja se njegovala tijekom cijelog trajanja Republike, posebice u okrilju ljekarne samostana Male braće, poprimila je formalna obilježja tijekom 18., a posebice 19. stoljeća kada se botanika ustoličuje kao znanstvena disciplina na sveučilištima diljem Europe, na kojima studiraju i istaknuti dubrovački prirodoslovci.
U ovome radu posebice se apostrofira druga polovica 19. i početak 20. stoljeća u Dubrovniku, kada je u ozračju europskih tekovina, i dubrovačko područje bilo predmetom istraživanja ne samo austrijskih nego i istaknutih hrvatskih botaničara. U ovome radu prikazan je kulturni i društveni kontekst zaslužan za popularizaciju botanike kao discipline na području Dubrovnika tijekom predmetnog razdoblja. Temelj istraživanja su prikazi profesionalnih životopisa te znanstvenih i stručnih te općenito društvenih doprinosa petorice istaknutih dubrovačkih prirodoslovaca – Ivan E. Kuzmić, Antun Drobac, Mato Vodopić, Ivan August Kaznačić i Lujo Adamović. Krajnji cilj istraživanja jest doprinijeti snažnijoj reafirmaciji njihovih individualnih doprinosa u razvoju botaničke znanosti Dalmacije, Hrvatske i šireg prostora jugoistočne Europe, a u okviru razmatranja i istraživanja povijesti botanike dubrovačkog kraja.The historiography of Dubrovnik's natural history is an insufficiently researched topic, especially in the field of botanical research. The long tradition of knowledge of valuable medicinal plants, which was nurtured during the entire duration of the Republic, especially under the auspices of the pharmacy of the Little Friars monastery, took on formal characteristics during the 18th, and especially the 19th century when botany became enthroned as a scientific discipline at universities across Europe, where prominent Dubrovnik naturalists studied.
In this paper, the second half of the 19th and the beginning of the 20th century in Dubrovnik is particularly apostrophized, when, in the atmosphere of European heritage, the Dubrovnik area was the subject of research too, not only by Austrian but also prominent Croatian botanists. This paper presents the cultural and social context responsible for the popularization of botany as a discipline in the area of Dubrovnik during the period in question. The basis of the research are presentations of professional biographies and scientific, professional and social contributions of five prominent Dubrovnik naturalists - Ivan E. Kuzmić, Antun Drobac, Mato Vodopić, Ivan August Kaznačić and Lujo Adamović. The final goal of the research is to contribute to a stronger reaffirmation of their individual contributions to the development of the botanical science of Dalmatia, Croatia and the wider Southeast Europe, within the framework of consideration and research of the history of the botany of the Dubrovnik region
APPLICATION OF HOLOGRAPHIC TECHNOLOGY IN EDUCATIONAL GAMES FOR RAISING AWARENESS ABOUT ENVIRONMENT
No full textRad istražuje implementaciju holograma u edukativnu ozbiljnu igru, s naglaskom na suvremenu digitalizaciju učionica i primjenu principa univerzalnog dizajna kako bi se osigurala široka dostupnost i korist za sve učenike. Za potrebe istraživanja za pisanje ovog rada te u sklopu projekta Play2Green razvijena je aplikacija HoloZoo. Ova aplikacija omogućava učenicima da putem holografskih prikaza istraže zaštićene životinje, sudjeluju u kvizovima i uče na interaktivan način. Analizirajući hologramske tehnologije, istraživanje pruža uvid u njihovu prirodu i prednosti u edukaciji te se detaljno razmatra kako hologrami pružaju vizualne, interaktivne i perceptivne prednosti, omogućavajući učenicima dublje razumijevanje složenih koncepata. U radu se istražuje aktualna primjena holograma u edukaciji te se ukazuje na njihovu mogućnost poboljšanja interakcije i angažmana učenika. Razlaže se pojam ozbiljnih igara koje pružaju interaktivno i zabavno iskustvo koje potiče učenike da se angažiraju i aktivno sudjeluju u obrazovnim materijalima. Ozbiljne igre (engl. serious games) predstavljaju inovativan pristup koji kombinira elemente igara s edukativnim i korisnim ciljevima. Ove igre nude niz značajnih koristi koji ih čine moćnim alatom za obrazovanje, trening i rješavanje stvarnih problema. U zaključku, istraživanje potvrđuje važnost holografskih tehnologija u edukaciji i istražuje njihov utjecaj na proces učenja. Naglašava se nužnost prilagodbe učionica digitalnom okruženju kako bi se omogućilo svim učenicima da imaju jednaku priliku za učenje, uz podršku univerzalnog dizajna koji osigurava pristupačnost i inkluzivnost.The paper explores the implementation of holograms in an educational serious game, with an emphasis on contemporary digitization of the classroom and the application of universal design principles to ensure wide accessibility and benefit for all students. The HoloZoo application was developed for the purposes of research for writing this paper and as part of the Play2Green project. This app allows students to explore protected animals, take quizzes and learn interactively through holographic displays. Analyzing hologram technologies, the research provides insight into their nature and benefits in education and examines in detail how holograms provide visual, interactive, and emotional benefits, enabling students to gain a deeper understanding of complex concepts. The paper investigates the current application of holograms in education and points out their possibility of improving interaction and student engagement. It breaks down the notion of serious games that provide an interactive and fun experience that encourages students to engage and actively participate in educational materials. Serious games represent an innovative approach that combines game elements with educational and useful goals. These games offer several significant benefits that make them a powerful tool for education, training and solving real-world problems. In conclusion, the research confirms the importance of holographic technologies in education and explores their impact on the learning process. It emphasizes the need to adapt the classroom to the digital environment to allow all students to have an equal opportunity to learn, supported by universal design that ensures accessibility and inclusiveness
Innovation Commercialization Strategies in Hospitality Sector
No full textU ovom radu razrađuje se svaki aspekt procesa inoviranja te utjecaja inoviranja na hotelijerstvo danas kao i u prošlosti. Počevši od koncepta inovacije i njene uloge u poslovanju poduzeća dolazi se do strateškog inoviranja i temeljnih pitanja koje ono mora postaviti i koje je neophodno za uspjeh poduzeća te se razmatraju faze razvoja inovacija radi postizanja komercijalizacije. Posebno se ističu inoviranje i implementacija inovacija zbog njihovog širokog utjecaja na čovječanstvo.This paper elaborates every aspect of the innovation process and the impact of innovation on the hotel industry today as well as in the past. Starting from the concept of innovation and its role in companies’ operations, we come to strategic innovation and the fundamental questions that it must ask and which are necessary for the success of the company, and the stages of innovation development in order to achieve commercialization are considered. In particular, innovation and the implementation of innovations stand out because of their wide impact on humanity
Exchange Rate Determination: Theory, Evidence and Policy
No full textTečajna politika neke zemlje jedna je od važnih odrednica njezina smjera kretanja u pogledu razvoja i ostvarenja razina stabilnosti gospodarstava. Prema tome, proces odabira deviznog tečaja za svaku zemlju predstavlja potragu za optimalnim rješenjem koje svojim djelovanjem neće ostvariti negativne posljedice, prvenstveno kada je u pitanju stabilnost cijena unutar gospodarstva. Utjecaj na monetarnu politiku, a posljedično tomu i na odabir tečajnog režima ostvaruju i značajna gospodarska kretanja. Stoga je nužan odabir one tečajne politike koja će rezultirati ispunjenjem makroekonomskih ciljeva. U pogledu Republike Hrvatske, zabilježene su značajne promjene od trenutaka njezina nastanka i djelovanja unutar zajednica, pa sve do razdoblja samostalnosti, a potom i ulaska u Europsku uniju te eurozonu. Osnovni cilj empirijskog dijela rada je analiza utjecaja uvođenja eura na stanje hrvatskog gospodarstva u pogledu porasta cijena te komparacije istih sa susjednom Republikom Slovenijom i posljedicama uvođenja eura u njezino gospodarstvo.The exchange rate policy of a country is one of the important determinants of its direction of movement in terms of the development and achievement of levels of economic stability. Therefore, the process of selecting the exchange rate for each country is a search for an optimal solution that will not have negative consequences, primarily when it comes to price stability within the economy. Significant economic developments also have an influence on monetary policy, and consequently on the choice of the exchange rate regime. Therefore, it is necessary to choose the exchange rate policy that will result in the fulfillment of macroeconomic goals. Regarding the Republic of Croatia, significant changes were recorded from the moment of its creation and activity within the communities, until the period of independence, and then the entry into the European Union and the Eurozone. The main goal of the empirical part of the work is to analyze the impact of the introduction of the euro on the state of the Croatian economy in terms of price increases and to compare them with the neighboring Republic of Slovenia and the consequences of the introduction of the euro in its economy
"COVID -19 in Dubrovnik General Hospital - nurse procedures and interventions"
No full textUvod: Postupak smještaja pacijenta, kao i intervencije i postupci medicinske sestre kod pacijenta u okolnostima epidemije značajno je promijenjen. Edukacija i organizacija rada u Općoj bolnici Dubrovnik je zahtijevala reorganizaciju kako prostornu tako i kadrovsku, kako bi se oboljelima pružila sva potrebna skrb. Vrlo visoka razina odgovornosti, rad u novonastaloj situaciji je pred medicinske sestre postavio novu razinu zahtjevnosti pristupa intervencijama i postupcima medicinske sestre.
Cilj istraživanja: U izvanrednim okolnostima epidemije istražili smo mortalitet i morbiditet bolesti COVID-19 u Općoj bolnici Dubrovnik s obzirom na dob, spol te težinu bolesti. Istražili smo koja je dobna skupina bila najzastupljenija i kolika je učestalost pojavnosti komplikacija kod oboljelih u kojoj dobnoj skupini u Općoj bolnici Dubrovnik.
Metode i ispitanici: Za istraživanje smo radili retrospektivnu analizu brojčanih podataka iz informacijskog sustava BIS-a, medicinske i sestrinske dokumentacije na COVID-19 odjelu u OB Dubrovnik. Razdoblje retrospektivnog istraživanja proveli smo od početka pandemije 19.03.2020. do proglašenja kraja pandemije 11.05.2023. sukladno postavljenim ciljevima i hipotezama rada.
Rezultati istraživanja: Za statističku analizu rezultate smo prikazali u tabelarnom i grafičkom prikazu u obliku apsolutnih frekvencija te postotcima. Rezultati su obrađivani Hi kvadrat testom i ANOVA testom.
Rasprava: Provedeno retrospektivno istraživanje polučilo je dijelom očekivane rezultate. Rezultati istraživanja ukazuju na vidljivu razliku s obzirom na odabrane pokazatelje. Pogleda li se razina signifikantnosti kod varijabli spol, opis otpusta, respirator, godina može se uočiti kako vrijednost značajnosti Hi kvadrat testa iznosi p<0,05, što znači da je uočena statistički značajna razlika s obzirom na dob ispitanika u Općoj bolnici Dubrovnik.
Zaključak: Možemo zaključiti da je u Općoj bolnici Dubrovnik bolest učestalija kod osoba starije životni dobi u odnosu na srednju životnu dob. Smrtnost je veća kod osoba koje su bile starije životne dobi u odnosu na srednju životnu dob. Pacijenti starije životne dobi su duže boravili u zdravstvenim ustanovama u odnosu na srednju i mlađu životnu dob.Introduction: The procedure for accommodating the patient, as well as the interventions and procedures of the nurse in the patient in the circumstances of the epidemic, has been significantly changed. Education and organization of work in the Dubrovnik General Hospital required a reorganization of both spatial and personnel, in order to provide patients with all the necessary care. A very high level of responsibility, working in the new situation has set before nurses a new level of complexity of approach to nursing interventions and procedures.
The goal of the research: In the extraordinary circumstances of the epidemic, we investigated the mortality and morbidity of the disease COVID-19 in Dubrovnik General Hospital with regard to age, gender and severity of the disease. We investigated which age group was the most represented and what is the frequency of complications in patients in which age group at Dubrovnik General Hospital.
Methods and subjects: For the research, we performed a retrospective analysis of numerical data from the BIS information system, medical and nursing documentation in Dubrovnik General Hospital. We spent the retrospective research period from the beginning of the pandemic on March 19, 2020. until the declaration of the end of the pandemic on May 11, 2023. in accordance with the set goals and hypotheses of the work.
Research results: for statistical analysis, we presented the results in tabular and graphic form in the form of absolute frequencies and percentages. The results were processed with Chi square test and ANOVA test.
Discussion: The conducted retrospective study obtained some of the expected results. The research results indicate a visible difference with regard to the selected indicators. If you look at the level of significance for the variables gender, description of discharge, ventilator, age, you can see that the significance value of the Chi-square test is p<0.05, which means that a statistically significant difference was observed with regard to the age of the respondents in OB Dubrovnik..
Conclusion: We can conclude that in Dubrovnik General Hospital the disease is more frequent in people of older age compared to middle age. Mortality is higher in people who were older compared to middle-aged people. Elderly patients stayed longer in health care institutions compared to middle-aged and younger patients
"Spinal anesthesia through advantages and disadvantages"
No full textSpinalna anestezija ili spinalni blok je tehnika regionalne anestezije koja uz epiduralnu anesteziju i
kaudalni blok ulazi u skupinu neuroaksijalnih blokova. Spinalna anestezija se koristi kao alternativa
općoj anesteziji, obično u operacijskim zahvatima na donjim ekstremitetima (stopalu, koljenima,
kukovima), zdjelici te operacijama donjeg dijela abdomena kada nije neophodno potpuno
uspavljivanje bolesnika tj. opća anestezija. Osobitost tehnike spinalne anestezije je aplikacija lokalnog
anestetika u spinalni prostor tj. u okolinu leđne moždine ispunjene cerebrospinalnim likvorom. Kod
toga spinalna igla prolazi između kralješka kroz meke česti, ligamente i tvrdu moždanu ovojnicu
(duru mater). Jednu od prvih spinalnih anestezija za operacijski zahvat na čovjeku izveo je August
Bier, 1898. godine. Razvoj preciznosti tehnike spinalne anestezije i upotreba određenih skupina
lokalnih anestetika doprinijeli su značajnom smanjenju komplikacija (glavobolja, nizak krvni tlak, bol
u donjem dijelu leđa) te prolaznih neuroloških simptoma (tresavica nakon zahvata, otežano mokrenje,
alergijska reakcija, produženi privremeni gubitak osjeta, ozljeda struktura u području kralježnice i sl.).
Uspješnost spinalnog bloka ovisi o aktualnoj anatomiji kralježnice, vrsti, dozi i koncentraciji
primijenjenog lokalnog anestetika, suradljivosti bolesnika te vještini i iskustvu anesteziologa.
Nastupom spinalnog bloka, moguće je postići spinalnu anesteziju (bolesnik gubi sve osjete i
motoriku) ili samo spinalnu analgeziju (gubitak samo osjeta boli) i to distalno od segmenta kralježnice
na kojemu je primijenjeni lokalni anestetik. Ovisno o vrsti i dozi lokalnog anestetika, spinalna
anestezija djeluje prosječno oko 2-3 sata, nakon čega se počinju vraćati senzorni osjeti i motorika.
Bolesnik za spinalnu anesteziju prolazi jednaku anesteziološku pripremu kao i za opću anesteziju.
Tijekom spinalne anestezije se kontinuirano i neinvazivno prate vitalne funkcije bolesnika kao i kod
opće anestezije. U poslije operacijskom tijeku bolesnik se također nadzire sve do potpunog oporavka
osjeta i motoričke funkcije.
Sestrinstvo ima aktivnu i važnu ulogu u pripremi bolesnika prije spinalne anestezije (uzimanjem
sestrinske anamneze tj. uvida u aktualnu terapiju bolesnika, kronične bolesti, ranije anestezije i
neželjene reakcije na lokalni anestetik, zatim u uzorkovanju nalaza i kompletiranju medicinske
dokumentacije za anesteziološki pregled, pripremi bolesnika za regionalnu anesteziju te primjeni
premedikacije prema odredbi anesteziologa), tijekom samog izvođenja spinalnog bloka (priprema
sterilnih materijala i lokalnih anestetika te asistiranje kod izvođenje spinalne anestezije), u nadzoru
spinalne anestezije tijekom operacije te u neposrednom poslije operacijskom periodu (neinvazivnom
praćenju vitalnih funkcija bolesnika, praćenju dinamike oporavka senzornog osjeta i motorne
funkcije).
Potrebno je istaknuti važnost dobivanja suglasnosti bolesnika, ali i operatera za primjenu spinalne
anestezije. Naime, potencijalno nemiran i nesuradljiv bolesnik može ne namjerno otežati ili čak i
kompromitirati izvođenje operacijskog zahvata. Zbog toga je od osobitog značenja pravovremena
komunikacija između svih članova kirurško-anesteziološkog tima. Ukoliko se usuglasi odluka za
spinalnu anesteziju, nastoji se primijeniti najoptimalnija tehnika spinalne anestezije kako za sigurno
izvođenje određene operacije (npr. spinalni blok uz primjenu sedacije), tako i za ukupnu dobrobit
bolesnika (bilateralni ili unilateralni spinalni blok). Pri tome se osobito uvažava anesteziološka
procjena bolesnika i konačna odluka specijaliste anesteziologa.
METODE
U ovom preglednom radu je prikazana kratka povijest i tehnika spinalne anestezije koja je uspoređena
sa suvremenom primjenom i izvođenjem klasičnog, bilateralnog i unilateralnog spinalnog bloka.
Osobito je istaknuta prednost spinalne anestezije (manja zbunjenost i pospanost nakon zahvata,
potpuno olakšavanje boli odmah nakon zahvata, smanjena potreba za jakim analgeticima, smanjenje
pojavnosti mučnine i nagona na povraćanje, raniji povratak jelu i piću nakon zahvata, manji utjecaj
anestetika na srce i pluća, te manji rizik za infekcije pluća), nedostatci (neugodan položaj na
operacijskom stolu, promijenjen osjećaj u donjem dijelu tijela tijekom operacija u donjem abdomenu
(hernioplastike, carski rez i sl.), hipotenzija, bradikardija, svrbež kože, mučnina, parestezije u predjelu
donjih ekstremiteta i/ili stražnjice, jaka postpunkcijska glavobolja u 1 od 100 slučajeva) kao i rizici
vezani uz postojeće bolesti samog bolesnika (migrenozne glavobolje, popratne kronične bolesti, već
postojeće ozljede živca, neurološke bolesti, infekcija u području primjene spinalnog bloka). Pregledni
rad je temeljen na uvidu u stručne i znanstvene radove vezane uz spinalnu anesteziju dostupne u bazi
podataka PubMed i Portalu hrvatskih znanstvenih i stručnih časopisa (Hrčak-srce) kroz posljednjih
pet godina.
ZAKLJUČNO
Spinalna anestezija može biti bilateralna (blok oba donja ekstremiteta) ili unilateralna (blok samo
jednog donjeg ekstremiteta). Unilateralnom spinalnom anestezijom se, za razliku od bilateralne,
postiže potpuni blok senzorne, motoričke i simpatičke funkcije vezan samo uz jednu nogu. Doze
lokalnog anestetika i analgetika su, za unilateralni blok manje i prilagođene potrebama anestezije
samo jednog ekstremiteta. Posljedično, unilateralnim blokom se zadržava veća hemodinamska
stabilnost u usporedbi sa bilateralnim. Stoga je indicirana upravo kod rizičnih bolesnika za operacije
na donjem ekstremitetu, osobito ako se tehnikama perifernih živčanih blokova ne može osigurati
anestezija za predviđeno operativno polje. Obje vrste anestezije osiguravaju odličnu anesteziju.
Karakteristično je za bilateralni blok da u potpunosti nastupa unutar 3-5 min dok je za postizanje
unilateralnog potrebno punih 15 min tijekom kojih bolesnik mora ležati bočno. Oporavak
unilateralnog bloka, uključujući senzorni, motorički i autonomni je puno brži i ugodniji, manja je
pojavnost popratnih neželjenih nuspojava, koje su kod unilateralnog bloka i manje vjerojatne.INTRODUCTION Spinal anesthesia, or spinal block, is a regional anesthesia technique that, along
with epidural anesthesia and caudal block, belongs to the group of neuraxial blocks. Spinal anesthesia
is used as an alternative to general anesthesia, usually in surgical procedures on the lower extremities
(foot, knees, hips), pelvis and lower abdominal surgeries when it is not necessary to completely put
the patient to sleep, i.e. general anesthesia. The peculiarity of the spinal anesthesia technique is the
application of local anesthetic in the spinal space, i.e. in the surroundings of the spinal cord filled with
cerebrospinal fluid. In this case, the spinal needle passes between the vertebrae through the soft
tissues, ligaments and the hard meninges (dura mater). August Bier performed one of the first spinal
anesthesias for human surgery in 1898. The development of the precision of the spinal anesthesia
technique and the use of certain groups of local anesthetics contributed to a significantly reduced
complication (headache, low blood pressure, lower back pain) and transient neurological symptoms
(shaking after the procedure, difficulty urinating, allergic reaction, prolonged temporary loss of
sensation, injury structure in the area of the spine, etc.).The success of the spinal block depends on the
current anatomy of the spine, the type, dose and concentration of the applied local anesthetic, the
cooperation of the patient and the skill and experience of the anesthesiologist. With the onset of a
spinal block, it is possible to achieve spinal anesthesia (the patient loses all sensation and movement)
(spinal anesthesia), or only spinal analgesia (loss of pain sensation only) distal to the segment of the
spine on which the local anesthetic was applied. Depending on the type and dose of local anesthetic,
spinal anesthesia works for an average of 2-3 hours, after which sensory sensations and motor skills
begin to return. The patient for spinal anesthesia undergoes the same anesthesiological preparation as
for general anesthesia. During spinal anesthesia, the patient's vital functions are monitored
continuously and non-invasively, just as during general anesthesia. In the postoperative course, the
patient is also monitored until complete recovery of sensation and motor function.
Nursing plays an active and important role in the preparation of the patient before spinal anesthesia
(by taking a nursing history, i.e. insight into the patient's current therapy, chronic diseases, previous
anesthesia and adverse reactions to local anesthetics, then in sampling the findings and completing the
medical documentation for the anesthesia examination, preparing the patient for regional anesthesia
and the application of premedication as prescribed by the anesthesiologist), during the actual
performance of the spinal block (preparation of sterile materials and local anesthetics and assisting in
the performance of spinal anesthesia), in the supervision of spinal anesthesia during surgery and in the
immediate postoperative period (non-invasive monitoring of the patient's vital functions, monitoring
dynamics of recovery of sensory sensation and motor function).
It is necessary to emphasize the importance of obtaining the consent of the patient and the operator for
the application of spinal anesthesia. Namely, a potentially restless and uncooperative patient can
inadvertently make it difficult or even compromise the performance of a surgical procedure. That is
why timely communication between all members of the surgical-anesthesiology team is of particular
importance. If the decision for spinal anesthesia is agreed upon, the most optimal technique of spinal
anesthesia is applied both for the safe performance of a specific operation (eg spinal block with
sedation) and for the overall well-being of the patient (bilateral or unilateral spinal block). In doing so,
the anesthesiological assessment of the patient and the final decision of the anesthesiologist are
particularly respected.
METHODS In this review, a brief history and technique of spinal anesthesia is presented, which is
compared with the modern application and performance of classical, bilateral and unilateral spinal
block. The advantages of spinal anesthesia were particularly highlighted (less confusion and
drowsiness after the procedure, complete relief of pain immediately after the procedure, reduced need
for strong analgesics, reduction in the incidence of nausea and the urge to vomit, earlier return to
eating and drinking after the procedure, less impact of anesthetics on the heart and lungs, and lower
risk of lung infections), disadvantages (uncomfortable position on the operating table, altered
sensation in the lower part of the body during operations in the lower abdomen (hernioplasty,
caesarean section, etc.), hypotension, bradycardia, skin itching, nausea, paresthesias in the area lower
extremities and/or buttocks, severe post-puncture headache in 1 out of 100 cases) as well as risks
related to existing diseases of the patient himself (migraine headaches, concomitant chronic diseases,
pre-existing nerve injury, neurological diseases, infection in the area of application of the spinal
block).The review work is based on an insight into professional and scientific works related to spinal
anesthesia available in the PubMed database and the Portal of Croatian scientific and professional
journals (Hrčak-srce) over the last five years.
CONCLUSIONSpinal anesthesia can be bilateral (block of both lower extremities) or unilateral
(block of only one lower extremity). Unilateral spinal anesthesia, in contrast to bilateral, achieves a
complete block of sensory, motor and sympathetic function related to only one leg. The doses of local
anesthetics and analgesics for unilateral block are smaller and adapted to the needs of anesthesia of
only one limb. Consequently, unilateral block maintains greater hemodynamic stability compared to
bilateral. Therefore, it is indicated precisely in high-risk patients for operations on the lower
extremity, especially if peripheral nerve block techniques cannot provide anesthesia for the intended
operative field. Both types of anesthesia provide excellent anesthesia. It is characteristic of a bilateral
block that it fully occurs within 3-5 minutes, while a unilateral block requires a full 15 minutes,
during which the patient must lie on his side. Recovery from a unilateral block, including sensory,
motor and autonomic, is much faster and more pleasant, the incidence of accompanying unwanted
side effects is lower, which are less likely with a unilateral bloc