55 research outputs found
Low-dose spinal versus epidural anaesthesia for delivery and expected caesarean section
No full textRegional anaesthesia is associated with significantlly lower mortality
among obstetric patients, but the optimal technique for delivery and cesarean section remains to be determined. Conventional epidural analgesia has disadvantage of slow onset and higher rate of instrumental delivery while spinal anaesthesia in standard doses causes hypotension and bradycardia which might further compromise critical foetal condition. Combined spinal-epidural (CSE) analgesia with low dose of intrathecal local anaesthetic or/and opioid offers theoretical advantages of faster onset and lower incidence
of side effect associated with standard spinal anaesthesia. The optimal
intrathecal dose which balances effective analgesia and haemodynamic stability varies in literature. CSE anaesthesia seems to be particularly suitable for caeserean section in parturiens with significant cardiac comorbidites like aortic stenosis or Eisemenger syndrome due to less haemodynamic compromise.
Therefore, although in the latest Cochrane database research of
clinical trials, CSE technique was not found superior to standard epidural analgesia, it might have advantages in some subgroups of obstetric patients. The definitive role of low-spinal anaesthesia as a part of CSE in clinical practice remains to be clarified
BOL , DELIRIJ I SEDACIJA U JEDINICI INTENZIVNOG LIJEČENJA
No full textDelirium is a complication of intensive care treatment associated with permanent cognitive decline and increased mortality after hospital discharge. In several studies, postoperative pain was found as a possible precipitating factor. Aggressive pain treatment is part of current multicompartment protocols for delirium prevention after hip fracture. Protocol based sedation, pain and delirium management in intensive care units have been shown to have clinical and economic advantages.Delirij je komplikacija intenzivnog liječenja koja je povezana s trajnim kognitivnim deficitom i povećanim mortalitetom nakon hospitalizacije. Nekoliko studija ukazalo je na postoperacijsku bol kao na potencijalni precipitirajući čimbenik nastanka delirija. Agresivno liječenje boli dio je aktualnog multikomponentnog protokola za prevenciju delirija nakon operacije kuka. Strukturirani protokoli u jedinicama intenzivnog liječenja koji objedinjuju sedaciju, liječenje boli i delirija pokazali su se klinički i ekonomski opravdanima
SPAVA LI ANESTEZIOLOG ČVRSTO?
No full textWorking in night shifts influences human health, mood, and cognitive functions. Anesthesia residents and consultants work in long shifts that include the night. Changes of cognitive functions may diminish the quality of anesthesiologist’s work, increase the number of errors, and endanger the patient. Changes of biological rhythms can influence health of the anesthesiologist himself. The alterations in circulation, metabolism, memory, fine motor control, mood and attention have been recorded. After night work, the possibility of car accident for an anesthesiologist is higher. Attempts have been made to reduce negative influences of night work by shortening the number of working hours during the week. The debate about this step is vivid and still present. From this viewpoint, the most interesting aspects are the quality of educational process, the number of errors in practical work, and the quality of health care. After shortening of working hours, there are no clear indicators of the positive effects in any of these fields. Shortening of the working week is part of ‘the culture of safety’ in anesthesiology.Rad u smjenama i noćni rad utječu na zdravlje, raspoloženje i kognitivne funkcije. Specijalizanti i specijalisti anesteziologije rade u dugim smjenama i noću. Promjena kognitivnih funkcija može smanjiti kvalitetu rada anesteziologa, povećati broj grešaka u radu i ugroziti bolesnika. Promjena bioloških ritmova može ugroziti i zdravlje anesteziologa. Zabilježene su promjene cirkulacije, metabolizma, memorije, fine motorike, raspoloženja i pažnje. Nakon noćnog rada raste vjerojatnost prometnih nezgoda. Negativne učinke noćnog rada se pokušalo smanjiti tako da je skraćena ukupna dužina radnog tjedna. Rasprave o učinkovitnosti toga poteza živahne su i trajne. Osobito su zanimljive u tom smislu sljedeće sastavnice: kvaliteta izobrazbe liječnika na specijalizaciji, učestalost grešaka u radu i kvaliteta skrbi o bolesniku. Nakon skraćenja radnog tjedna nema jasnih pokazatelja u navedenim smjerovima koji bi sa sigurnošću potvrdili učinkovitost takve odluke. Skraćenje radnog tjedna uklapa se u “kulturu sigurnosti” u anesteziologiji
Clinical significance of intraabdominal pressure and abdominal perfusion pressure in patients with acute abdominal syndrome
No full textElevated intraabdominal pressure (IAP) has been claimed to play a role in abdominal compartment syndrome. We assessed the correlation between the values of IAP, abdominal perfusion pressure (APP) and clinical scoring systems including SIRS, MODS and APACHE II and the patients' survival rate in patients admitted to the ICU with acute abdomen due to ileus, intestinal perforation, peritonitis and trauma.
We measured IAP and APP in 50 surgical patients. In this study the IAP was measured in a non-invasive manner via urinary bladder pressure. The APP was calculated as the difference between mean arterial pressure and IAP values.
A significantly higher IAP was found in the non-survivors' group in comparison with the survivors' group. On the other hand, the APP inversely correlated with disease severity scores including SIRS, MODS and APACHE II, whereas IAP values did not show any correlation to these clinical parameters. These findings suggest that IAP and APP may be useful tools in the clinical evaluation of patients with acute abdomen
NEUROLOŠKI POREMEĆAJI U TRUDNOĆI
No full textPreeclampsia is characterized by hypertension, peripheral edema and proteinuria, but very often also includes neurologic complications. Neurologic complications of severe preeclampsia are indentical to those of hypertensive encephalopathy. The most common neurologic symptoms are headache, vomiting, mental disorders, visual disturbances, sensorimotor deficits and seizures. Endothelial cell dysfunction is the main cause of multiorgan failure. It is of utmost importance to recognize these symptoms and initiate apropriate therapy. Systemic blood presure must not exceed the cerebrovascular autoregulatory capacity. Serum magnesium level is significantly decreased in pregnant women with severe preeclampsia and cerebral edema. Magnesium has been shown to be effective in reducing the occurrence of seizures in preeclampsia by decreasing neuronal excitability, protecting the endothelium against free radicals and reducing cerebral perfusion.Preeklampsija u trudnica je bolest koja uz povišeni arterijski tlak, periferne edeme i proteinuiriju često uključuje i neurološke poremećaje. Neurološke manifestacije teške preeklampsije ili eklampsije identične su simptomima hipertenzivne encefalopatije. Najčešći neurološki simptomi su glavobolja, povraćanje, mentalni poremećaji, poremećaji vida, gubitak osjeta i motorike te konvulzije. Endotelna disfunkcija krvnih žila osnovni je uzrok multiorganskog zatajenja. Važno je rano uočiti simptome i započeti adekvatnu terapiju. Arterijski tlak treba održavati u granicama koje će spriječiti gubitak moždane autoregulacije. Razina serumskog magnezija značajno je niža u trudnica s izraženim edemom mozga. Magnezij se pokazao učinkovit u smanjivanju eklamptičkih napada jer direktno smanjuje neuralnu podražljivost, štiti endotel od slobodnih radikala i smanjuje tlak cerebralne perfuzije
Quasiperiodic oscillations of electroencephalgram during induction of general anesthesia with thiopental
No full textPretty European law and policy: missing women? Problem of gender-balanced boards and their regulation
No full textU ovom znanstvenom istraživanju i analizi, raspravit će se četiri hipoteze: 1. Žene su nedovoljno zastupljene u pozicijama gospodarskog odlučivanja (u upravnim odborima), 2. Postojeća regulacija neprikladna je i nepostojeća za ovaj problem, 3 . Direktiva o povećanju ravnoteže spolova među savjetodavnim članovima uprava trgovačkih društava uvrštenih na burzama te o drugim povezanim mjerama iznimno je potrebna, te 4. Zastupljenost žena u odborima trebala bi se povećati jer odbori trebaju žene. Prvo, autor će uhvatiti u koštac s općim problemom podzastupljenosti žena u odborima na razini EU i država članica. Ovaj dio većinski je povezan s istraživanjem u vezi zastupljenosti žena u upravnim odborima u državama članicama, odakle su korišteni podaci kako bi se usporedila i kontrastirala zastupljenost žena u svim članicama. Autorica smatra da je važno pokazati raznolikost između članica koji nije povezan s vrstom samog odbora, nego sa regulacijom koja se primjenjuje. Drugo, budući da je trenutna regulativa neprikladan i nepostojeća u području podzastupljenosti žena u odborima, autorica će dati pregled izvora europskog prava koji se bave ravnopravnošću spolova. Prema tome, razvidno je da ne postoji izvor koji regulira ravnopravnost spolova u okviru ekonomskog odlučivanja. Ergo, države članice nemaju izvore za implementaciu i problem ravnopravnosti spolova ostaje na nacionalnom zakonodavstvu. Istraživanje je pokazalo da su države članice koje su donjele obvezujuća pravila za regulaciju ostvarile najbolje rezultate u postizanju ravnopravnosti u odborima. Treće, Direktiva o povećanju ravnoteže spolova među savjetodavnim članovima uprava trgovačkih društava uvrštenih na burzama te o drugim povezanim mjerama nužna je za postizanje ravnopravnosti spolova u upravnim odborima. Autorica analizira put donošenja Direktive, zajedno sa njenom svrhom i ciljevima. Uspoređivanjem i detaljnom analizom, Direktiva se preispituje kritički i sa objektivnog gledišta. Zatim, autorica govori o potrebi žena u odborima i povećanju spolne raznolikosti u njima. U sklopu znanstvenog istraživanja, pruža brojne dokaze i druge studije koje pokazuju da su žene zaista vrijedni čimbenik u svakom odboru. Nadalje, autorica uspoređuje sve različite pristupe koji se mogu poduzeti da se zaustavi podzastupljenosti žena u odborima, s posebnim naglaskom na rješenja koja nudi Europska komisija. Na kraju, autorica daje vlastite smjernice za postizanje rodne ravnoteže u odborima, na temelju vlastitog neovisnog istraživanja.In this scientific research and discussion paper, four hypotheses will be introduced: 1. Women are under-represented in positions of economic decision-making (boards), 2. Current legislation is unsuitable and non-existing for the regulation of this problem, 3. Directive on improving the gender balance among non-executive directors of companies listed on stock exchanges and related measures is highly needed and 4. Gender diversity should be increased because boards need women. Firstly, author will tackle with the general problem of board underrepresentation on the level of EU and Member States. This part is deeply connected with the research regarding the representation of women on boards in Member States, from where data was used in order to compare and contrast the representation of women in all of the MS. Author believes it is important to show the diversity between the MS which is not connected to the type of board itself, but to the legislative measures applied. Secondly, as the current legislation is unsuitable and non-existing for the regulation of underrepresentation of women on boards, author will provide an overview of the legislation dealing with gender equality. Consequently, it is to conclude that there is no legislation to regulate the gender equality within the economic decision-making. Thus, Member States have no legislation to implement and the problem of gender equality is left on numerous national provisions. The research proved that the MS with the legislation measures had the best result in achieving gender equal boards, as shown in the numbers. Thirdly, Directive on improving the gender balance among non-executive directors of companies listed on stock exchanges and related measures is highly needed to provide a proper and unique binding regulation for this matter. Author analyses the Directive and the path of its making alongside with its purpose and targets. By comparing and contrasting, Directive is reviewed critically and from an objective point of view. Finally, author speaks of the need of women on boards and increasing gender diversity. Within her scientific research, author provides numerous evidence and other studies to prove that women truly are a valuable asset in every board. Furthermore, author compares all the different approaches that can be taken to stop the underrepresentation of women on boards, with a special focus on the solution provided by the European Commission. In the end, author concludes this study with providing guidance for achieving gender balance on boards, based on her own independent research she carried out
Age and Individual Sleep Characteristics Affect Cognitive Performance in Anesthesiology Residents after a 24-Hour Shift
No full textIstraživanja su pokazala da i rad u smjenama i deprivacija spavanja nepovoljno utječu na različite aspekte kognitivnog funkcioniranja. Cilj ovoga istraživanja bio je ispitati promjene u kognitivnom funkcioniranju i subjektivnoj pospanosti specijalizanata anesteziologije nakon 24-satnog dežurstva. Dvadeset i šestoro specijalizanata anesteziologije ispunilo je bateriju psihologijskih instrumenata na početku i na kraju dežurstva te upitnik s pitanjima o proteklom dežurstvu, Stanfordsku ljestvicu pospanosti i Upitnik cirkadijarnih tipova. Nakon dežurstva došlo je do značajnog pada kognitivnog uratka izmjerenog Auditivno-verbalnim testom učenja, koji je bio izraženiji kod starijih sudionika te onih s visokim rezultatom na ljestvici rigidnosti spavanja i niskim rezultatom na ljestvici prevladavanja pospanosti. Nisu utvrđene razlike u pamćenju brojeva unaprijed (koncentracija pažnje), dok je u pamćenju brojeva unatrag (radno pamćenje) čak došlo do poboljšanja uratka nakon dežurstva. Iako su na kraju dežurstva sudionici procjenjivali da su značajno pospaniji nego na početku dežurstva, ova subjektivna procjena pospanosti nije bila u korelaciji ni s jednom objektivnom mjerom kognitivnog uratka. Zaključno, uradak u kratkim zadacima koji zahtijevaju koncentraciju pažnje i radno pamćenje nije se pogoršao nakon dežurstva, dok je uradak u zadacima koji su dugotrajniji i monotoni bio značajno niži nakon deprivacije spavanja, pričem je to pogoršanje ovisilo o specifičnim individualnim značajkama spavanja te o dobi. Iznenađujuće je da je dob bila značajan čimbenik u smanjenju kognitivnog uratka nakon dežurstva čak i u relativno dobno homogenom uzorku mladih specijalizanata anesteziologije.Previous research has shown that both shift work and sleep deprivation have an adverse influence on various aspects of human cognitive performance. The aim of this study was to explore changes in cognitive functioning and subjective sleepiness of anesthesiology residents after a 24-hour shift. Twenty-six anesthesiology residents completed a set of psychological instruments at the beginning and at the end of the shift, as well as a questionnaire regarding information about the shift, Stanford Sleepiness Scale, and Circadian Type Questionnaire. There was a significant decline in cognitive performance measured by the Auditory Verbal Learning Test after the shift. The effect was stronger in older participants and in those with high scores on rigidity of sleep scale and low scores on the ability to overcome sleepiness scale. There were no differences in the digits forward test (a measure of concentration), while digits backward test (a measure of working memory) even showed an improved performance after the shift. Although participants reported being significantly sleepier after the shift, the subjective sleepiness did not correlate with any of the objective measures of cognitive performance. In conclusion, the performance in short tasks involving concentration and working memory was not impaired, while performance in long-term and monotone tasks declined after sleep deprivation, and the magnitude of this decline depended on the specific individual characteristicsof sleep and on age. Surprisingly, age seemed to have an important impact on cognitive functions after shift work even in the relatively age-homogeneous population of young anesthesiology residents
Combined Sleeve Gastrectomy and Mini-Gastric Bypass in a New Bariatric Procedure of Mini-Gastric Bypass and Proximal Sleeve Gastrectomy
No full textKirurške su metode najučinkovitije u liječenju patološke pretilosti. Povoljni učinci barijatrijske kirurgije posljedica su anatomskih promjena, ali i promjena do kojih dolazi u metaboličkom i endokrinom statusu. Na temelju iskustva s dosadašnjim standardnim barijatrijskim postupcima proizišla je zamisao o novom, kombiniranom barijatrijskom zahvatu koji bi mogao omogućiti bolju poslijeoperacijsku kontrolu razine glukoze u krvi, kao i bolju kontrolu gubitka tjelesne težine. Zahvat se sastoji od hibridne sleeve gastrektomije i mini-gastric bypassa i kao takav ujedinjuje prednosti obaju postupaka: jedna anastomoza, postignut učinak restrikcije i malapsorpcije te porast razine inkretina i pad razine grelina kao rezultat djelovanja na dva dominantna endokrina sustava. S obzirom na to da je metoda još neispitana ove će hipoteze biti predmet ispitivanja već najavljenog istraživačkog projekta.Surgery is the most effective method for the treatment of morbid obesity. Beneficial effects of bariatric surgery are due to both changed anatomy and consequential alterations in hormonal and metabolic status. Based on the experience with former standard bariatric procedures, the idea came out of a new combined bariatric procedure that could provide better control of glucose level and weight loss. The procedure is a hybrid of sleeve gastrectomy and mini-gastric bypass, therefore uniting advantages of both procedures: one anastomosis, achieved effects of restriction and malabsorption and affection of both dominant endocrine systems that result in an increase in incretin level and a decrease in ghrelin level. However, the procedure is yet a novel one and these hypotheses are about to be examined in the already announced research project
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