Stroke is one of the leading causes of death in the modern countries. Mainstay treatment for stroke prevention is carotid endarterectomy (CEA). Patients scheduled for surgery often have many ...associate systemic illnesses that pose a risk of perioperative cardiac and neurological complications. Detailed preoperative evaluation of neurological and cardiac function with optimization of the systemic illnesses therapy is obligatory. Ideal anesthesiology technique should provide adequate analgesia, minimal stress response, optimal brain perfusion and oxygenation, optimal hemodynamic and myocardial oxygen balance while assuring calm and relaxed patients with good surgical comfort. Both regional anesthesia and general anesthesia have some advantages and drawbacks. Regarding to cerebral and myocardial ischemia and adverse outcome after CEA, especially in high risk patients, today still it is not clear which anesthesia technique is preferred for CEA. Greatest risk in the early postoperative period is new neurological deficit caused by cerebral ischemia end myocardial infarction caused with hemodynamic instability and therefore CEA patients are placed in the Intensive Care Unit for at least six or more hours where they are monitored for neurological and hemodynamic complications.
In the setting of intensive care units the incidences of multi-drug resistant gram-negative (MDR-GN) pathogens causing
ventilator associated pneumonia (VAP) has increased, leading clinicians to use ...colistin. Our aim was to assess outcomes
associated with the use of inhalation and intravenous colisitn versus only intravenous colistin in patients with MDR-GN VAP.
A retrospective, single centre study at University Hospital Centre, Zagreb. Patients were divided in two groups, according
to their administration of antibiotics – inhalation and intravenous (INH+IV) administration for 8 patients or intravenous only
(IV) administration for 23 patients.
The results showed that demographic and clinical characteristics and the gram negative pathogens isolated were similar
between the two groups, except for K. pneumoniae, which was higher in the IV group. No statistically significant difference
between the two groups were observed regarding intensive care unit mortality (P=0.951), sepsis (P=0.474), acute
respiratory distress syndrome (P=0.548), length of ICU stay (P=0.686) and length of mechanical ventilation (P=0.858). A
statistically significant difference was found regarding the eradication of pathogens in respiratory cultures (P= 0.018).
The addition of inhalation to intravenous colistin in MDR-GN VAP improves microbiologic outcome, but does not improve
ICU mortality in these patients. Larger prospective trials are warranted to confirm the benefit of adjunctive inhalation colistin
as a MDR-GN VAP therapy in the critically ill.
Background and Purpose: Regional anesthesia is the choice for patients undergoing preventive open carotid surgery. Recently intermediate cervical plexus block has been described as a reliable and ...safe anesthesia technique in comparison with superficial and deep cervical plexus block. The aim of our study was to assess the complications of intermediate cervical plexus block in high risk patients.
Materials and Method: The study was performed in 29 ASA III and
ASA IV patients with the intermediate cervical plexus block for carotid
endarterectomy from January 2006 till November 2008 in the University Hospital Zagreb. The following data were collected: age, sex, ASA status and preoperative disease. Furthermore, intraoperative and postoperative complications associated with intermediate cervical plexus block and carotid
endarterectomy were recorded.
Results: Median age was 69 years (range, 46 – 82 years). One patient developed Horner’s syndrome, three patients developed transitory ischemic attack, one developed stroke intraoperatively and died, seven patients developed transitory hemodynamic instability, one was hypotensive in the postoperative period and required vasoactive support.
Conclusion: Intermediate cervical plexus block is safe and effective for carotid endarterectomy in high risk patients.
