Remimazolam je novi intravenski anestetik iz skupine benzodiazepina. Molekularna struktura remimazolama omogućuje mu poseban farmakokinetički profil te ga izdvaja od drugih lijekova u istoj skupini. ...Zbog bočnoga esterskog lanca u strukturi remimazolam metaboliziraju nespecifične esteraze na inaktivne metabolite, što rezultira njegovim ultrakratkim djelovanjem i brzim oporavkom koji nije ovisan o funkciji niti jednog organskog sustava. S mehanizmom djelovanja nalik klasičnim benzodiazepinima, prvenstveno midazolamu, i jedinstvenom farmakokinetikom u ovoj skupini lijekova, remimazolam se čini kao idealan sedativ za proceduralnu sedaciju za vrijeme kratkih zahvata. Učinkovitost remimazolama za proceduralne sedacije ispitivana je u tri multicentrična klinička istraživanja. Sva tri ispitivanja pokazala su učinkovitost remimazolama u proceduralnoj sedaciji, s visokim stopama uspjeha, brzim početkom i kratkim vremenom oporavka uočenim u skupinama s remimazolamom. U našoj ustanovi ispitivali smo djelovanje remimazolama za proceduralnu sedaciju za dijagnostičke gastroskopije i kolonoskopije. Cilj istraživanja bio je ustanoviti djelotvornost i sigurnost remimazolama kao sedativa za proceduralnu sedaciju. Iako na manjem uzorku, naši rezultati su u skladu s rezultatima velikih kliničkih studija.
Objective:Dural puncture epidural technique is refinement of standard epidural technique. Its goal is to overcome drawbacks of standard epidural. We assessed whether dural puncture epidural technique ...performed by 27-gauge spinal needle would provide higher quality of labour epidural analgesia by using 10 mL epidural bolus of 0.125% bupivacaine. Additionally, the impact of dural puncture epidural on epidural analgesia onset, course of labour and occurrence of maternal side effects was examined.Methods:We designed prospective, randomized, single-blind study. A total of 76 healthy nulliparous parturients were randomly allocated to dural puncture or standard epidural group. After identification of epidural space, spinal Whitacre needle was used for dural puncture. Intrathecal drug administration was omitted at that point. Both groups received a bolus of local anaesthetic mixture, followed by a continuous infusion of diluted local anaesthetic via epidural catheter. Pain was assessed by numeric pain rating scale. The number of top-ups and mode of delivery were recorded in both groups.Results:After 10 minutes, there was a statistically significant difference in numeric pain rating scale ≤3 reported (P=0.028), with 97.4% subjects in dural puncture epidural group achieving adequate analgesia after 10 minutes. There was no statistically significant difference in the number of additional boluses, time to delivery, Bromage scale achieved or maternal outcomes between groups.Conclusion:Dural puncture epidural technique appears to be effective in providing faster onset of epidural analgesia. However, the need for additional boluses remains unchanged. It can be safely used in obstetrics, without deleterious effect on the course of labour.
Antimicrobial resistance (AMR) poses a global threat, leading to increased mortality and necessitating urgent action-however, its impact on athletes and the world of sports has hitherto been ...neglected. Sports environments (including athletic and aquatic) exhibit high levels of microbial contamination, potentially contributing to the spread of resistant microorganisms during physical activities. Moreover, the literature suggests that travel for sports events may lead to changes in athletes' gut microbiomes and potentially impact their antibiotic resistance profiles, raising questions about the broader implications for individual and public/global health. The prevalence of
(
) among athletes (particularly those engaged in contact or collision sports) ranges between 22.4% and 68.6%, with MRSA strains being isolated in up to 34.9% of tested individuals. Factors such as training frequency, equipment sharing, delayed post-training showers, and a history of certain medical conditions are linked to higher colonization rates. Moreover, MRSA outbreaks have been documented in sports teams previously, highlighting the importance of implementing preventive measures and hygiene protocols in athletic settings. In light of the growing threat of AMR, there is a critical need for evidence-based treatment guidelines tailored to athletes' unique physiological demands to ensure responsible antibiotic use and mitigate potential health risks. While various initiatives-such as incorporating AMR awareness into major sporting events-aim to leverage the broad audience of sports to communicate the importance of addressing AMR, proactive measures (including improved AMR surveillance during large sporting events) will be indispensable for enhancing preparedness and safeguarding both athletes' and the general public's health. This narrative review thoroughly assesses the existing literature on AMR and antibiotic usage in the context of sports, aiming to illuminate areas where information may be lacking and underscoring the significance of promoting global awareness about AMR through sports.
Disfunkcija ošita se javlja kod 60 – 80% bolesnika koji su podvrgnuti mehaničkoj respiracijskoj potpori u jedinicama intenzivnog liječenja. Patofiziološki procesi koji dovode do disfunkcije toga ...najvažnijeg respiracijskog mišića započinju već nakon 24 sata mehaničke ventilacije. Disfunkcija ošita značajno doprinosi otežanom odvajanju bolesnika od ventilatora, produljenju mehaničke ventilacije, povećanju morbiditeta i mortaliteta bolesnika. Etiologija disfunkcije ošita uzrokovane mehaničkom ventilacijom (engl. ventilator induced diaphragm dysfunction – VIDD) složena je i ovisna o više čimbenika, uključuje neusklađenost disanja između bolesnika i ventilatora, višednevnu vazopresornu potporu, ali i metaboličke i upalne promjene u mišićnom tkivu kod kritično oboljelih. Uz liječenje osnovnog uzroka zatajenja disanja, temelj uspješne prevencije i liječenja VIDD-a predstavlja pravilno titriranje sedativa i mišićnih relaksansa, praćenje udjela spontane respiracijske aktivnosti, odabir proporcionalnih modaliteta ventilacije čija potpora spontanom disanju u odnosu na konvencionalne modalitete nije konstantna, već je propocionalna spontanoj respiracijskoj aktivnosti. S ciljem prikaza najnovijih spoznaja iz područja patofiziologije i liječenja VIDD-a stručnoj javnosti, elektronički su pretraživane baze podataka PubMed, Medline i Google Scholar. Naše pretraživanje je bilo ograničeno na randomizirana klinička istraživanja i na pregledne radove na engleskom jeziku koji su uključivali bolesnike starije od 18 godina, a koji su bili publicirani u razdoblju od 2016. do 2021., korištenjem rječnika MeSH (engl. medical subject headings). Zaključak: Pandemija virusa SARS-CoV2 posebno je aktualizirala tematiku mehaničke ventilacije kao „life saving“ metode liječenja koja može uzrokovati i značajne nuspojave poput disfunkcije ošita. Neprestano se razvijaju i usavršavaju nove strategije i modaliteti mehaničke ventilacije s ciljem zaštite pluća, ali i ošita. Provođenjem mehaničke ventilacije s ciljem zaštite ošita smanjuju se vrijeme trajanja mehaničke ventilacije, incidencija komplikacija poput višestrukoga organskog zatajenja te posljedično i mortalitet.
D-blade is a relatively new device in the field of videolaryngoscopy, designed for
airway management by enabling indirectoscopic glottic view. In our study, we investigated efficiency
of D-blade in ...comparison with direct Macintosh laryngoscope (gold standard). Fifty-two adult
patients with normal airway scheduled for elective surgery in general anesthesia were randomly assigned
in D-blade video or direct Macintosh group. In the first video group, patients were laryngo-scoped
and intubated by D-blade, and in the second group laryngoscopy and intubation were performed
by Macintosh laryngoscope. Glottic view was evaluated according to Cormack Lehane grading
system (C-L), while duration of intubation and easiness of intubation were evaluated according to
the intubation difficulty score (IDS). Additionally, hemodynamic parameters were recorded before
and after induction. There were no statistically significant between-group differences in time to intubation,
easiness of endotracheal tube insertion, C-L, and IDS. In comparison with direct Macintosh
laryngoscope, D-blade showed similar but still favorable characteristics. In our opinion, D-blade is a
useful device in airway management and should be used in daily anesthesiologist work.
Ventilator-associated pneumonia (VAP) is the most common infection among intensive care unit (ICU) patients. The aim of the present study was to evaluate the impact of tracheotomy on VAP clinical ...course. The study was conducted in a 15-bed Surgical and Neurosurgical ICU, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients developing VAP during ICU stay were eligible for the study. In VAP patients not tracheotomized during ICU stay, the mortality rate was approximately two times higher as compared with patients tracheotomized either before or after VAP onset (crude risk ratio 1.83, 95% confidence interval (95% CI) 1.15-2.91, p = 0.01; crude odds ratio 3.47, 95% CI 1.52-7.94; p = 0.003). In the surviving VAP patients, the duration of mechanical ventilation before VAP onset was higher in the "T before VAP" group as compared with the "no T before VAP" group (8, 6-10 vs. 3, 2-5; p < 0.001), but the number of post-VAP days on mechanical ventilation was shorter in "T before VAP" patients than in "no T before VAP" patients (0, 0-1 vs. 4, 3-9; p < 0.001). The duration of mechanical ventilation after VAP onset in the "T after VAP" group was longer as compared with the "T before VAP" group (4, 3-12 vs. 0, 0-1; p < 0.001). The present study indicated tracheotomy to be associated with a reduced duration of mechanical ventilation after VAP onset, but only if patients were tracheotomized at the moment of VAP onset.
D-blade je relativno nov uređaj na području videolaringoskopije koji omogućava isključivo indirektan prikaz glotisa. U našem istraživanju uspoređivali smo učinkovitost D-blade-a s direktnim ...Macintoshevim laringoskopom koji predstavlja zlatni standard. Pedeset dvoje bolesnika s normalnim dišnim putem, predviđeni za elektivnu kiruršku operaciju u općoj anesteziji, randomizirano su dodijeljeni u skupinu video D-blade ili direktnog Macintosha. U prvoj skupini bolesnici su bili
laringoskopirani i intubirani video D-blade-om, a u drugoj skupini su bili laringoskopirani i intubirani Macintoshevim laringoskopom. Za procjenu prikaza glotisa koristili smo klasifikaciju Cormack Lehane (C-L), dok smo trajanje intubacije i lakoću intubacije procjenjivali koristeći ljestvicu bodovanja težine intubacije (engl. intubation difficulty score, IDS). Hemodinamske parametre smo bilježili prije i nakon indukcije. Između dviju skupina nije bilo statistički značajne razlike u vremenu intubacije, lakoći uvođenja tubusa, klasifikaciji C-L i IDS-u. Prema rezultatima našega istraživanja zaključujemo da u usporedbi s Macintoshevim laringoskopom D-blade pokazuje povoljne karakteristike te bi mogao biti uveden u svakodnevni rad anesteziologa.
Ventilacijska pneumonija (ventilator-associated pneumonia, VAP) je jedna od najčešćih infekcija među bolesnicima u jedinicama intenzivnog liječenja (JIL). Cilj ovoga istraživanja je bio utvrditi ...utjecaj traheotomije na klinički tijek VAP-a. Istraživanje je provedeno u 15-krevetnoj Jedinici intenzivnog liječenja Odjela za anesteziologiju, reanimatologiju i intenzivno liječenje u Kliničkom bolničkom centru “Sestre milosrdnice”, Zagreb, Hrvatska. Svi bolesnici u kojih se razvila VAP tijekom navedenog razdoblja bili su uključeni u istraživanje. U bolesnika s VAP koji nisu traheotomirani (T) tijekom
njihovog boravka u JIL-u smrtnost je bila otprilike dva puta veća u usporedbi s bolesnicima koji su traheotomirani prije ili nakon razvoja VAP (crude risk ratio 1,83, 95% confidence interval (CI) 1,15-2,91, p=0,01; crude odds ratio 3,47, 95% CI 1,52-7,94; p=0,003). Među preživjelim bolesnicima trajanje mehaničke ventilacije prije razvoja VAP je bilo duže u skupini “T prije VAP” u usporedbi sa skupinom “bez T prije VAP” (8, 6-10 prema 3, 2-5; p<0,001), ali je broj dana mehaničke ventilacije nakon razvoja VAP bio kraći u bolesnika skupine “T prije VAP” u usporedbi s onima skupine “bez T prije VAP”
(0, 0-1 prema 4, 3-9; p<0,001). Trajanje mehaničke ventilacije nakon razvoja VAP u skupini “T nakon VAP” je bilo duže u usporedbi sa skupinom “T prije VAP” (4, 3-12 prema 0, 0-1; p<0,001). Ovo istraživanje je ukazalo na to da je traheotomija povezana s kraćim trajanjem mehaničke ventilacije nakon pojave VAP, ali samo ako su bolesnici u trenutku pojave VAP traheotomirani.
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