Quality of recovery after anesthesia is an important indicator of patient postoperative outcomes. Quality of Recovery-40 (QoR-40) is a validated and widely used multidimensional 40-item questionnaire ...that measures postoperative quality of recovery. The aim of this study was to perform translation and psychometric validation of the Croatian version of QoR-40, which included validity, reliability, responsiveness, and clinical acceptability. The QoR-40 and Short Form-36 (SF-36) questionnaires were administered to patients undergoing general anesthesia for elective surgery on the day before surgery and on postoperative day 3. The quality of recovery was also assessed with visual analog scale (VAS) 0-100. Of 192 enrolled patients, 162 completed the study protocol. Convergent validity assessed by Pearson correlation (r) between the QoR-40 and VAS scores was 0.68 (p<0.001). There were moderate correlations of QoR-40 with SF-36 Physical component scale (r=0.521; p<0.001) and with SF-36 Mental component scale (r=0.580; p<0.001). Construct validity was supported by negative correlation with the length of hospital stay (r=-0.21; p=0.007) and significant difference in total postoperative QoR-40 scores between patients with and without postoperative complications (p<0.001). Internal consistency of the global QoR-40 was high (Cronbach’s α=0.93) and of the QoR-40 dimensions it was moderate to high (≥0.714). Split-half coefficient was 0.87, Cohen’s effect size was 0.81, and standardized response mean was 0.762. Our translated QoR-40 is a valid, reliable and comprehensive questionnaire for measuring quality of postoperative recovery across surgery spectrum in Croatian population with psychometric properties similar to the original version.
One of the most common surgeries in elderly patients is eye surgery. An increasing number of patients undergoing ambulatory eye surgery are on antithrombotic therapy. These drugs may increase the ...risk of perioperative bleeding associated with ophthalmic needle blocks and/or eye surgery. Intraoperative bleeding and postoperative hemorrhagic complications may lead to the loss of vision or even eyes. On the other hand, stopping anticoagulants and antiplatelets before the surgery may increase the risk of thrombotic events with potentially life-threatening complications. The aim of this narrative review is to provide a systematic review of the published evidence for the perioperative antithrombotic management of patients undergoing different types of eye surgery in ambulatory settings. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from January 2015 to December 2018 was performed. The database searches included studies providing evidence relevant to ambulatory eye surgery and perioperative antiplatelet medications and anticoagulants. Updated recommendations will be given for continuation, discontinuation, and modification of antithrombotic agents in order to optimize the management of antithrombotic therapies in outpatients scheduled for eye surgery.
The objective of this clinical update, based on recently published literature, was to discuss incidence and characteristics of the most relevant clinical adverse effects associated with local ...anesthetic and steroid use in regional anesthesia and treatment of acute or chronic pain. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from 2015 to 2018 was performed. This narrative review provides anesthesia practitioners with updated evidences on complications and contraindications of local anesthetic and steroid use with emphasis on current points of view regarding prevention, early diagnosis and treatment of adverse events.
Mediterranean spotted fever (MSF) is usually a mild endemic rickettsial disease occurring in southern Croatia. We have reported the clinical and epidemiological characteristics of an acute MSF case ...associated with severe respiratory distress syndrome and hemodynamical instability. The patient recovered completely after antimicrobial treatment. Indirect immunofluorescence assay (FOCUS Diagnostics Inc.) was performed to detect IgM and IgG antibodies to Rickettsia conorii. A significant increase of both IgM and IgG antibody titres found in paired acute- and convalescent-phase serum confirmed the diagnosis of acute MSF.
The aims of this prospective, observational study were to evaluate the changes of the regional cerebral saturation (rSO2) measured by near-infrared spectroscopy during elective laparoscopic ...cholecystectomy under total intravenous anesthesia and the association between patient's characteristics and critical decline of rSO2. Hemodynamics, rSO2, and oxygen saturation were recorded in different time points: before the anesthesia (Tbas), 2 minutes after the induction (supine position) (Tind), 2 minutes after CO2 insufflation (supine) (TCO2), 10 minutes after CO2 insufflation (reverse Trendelenburg) (TrevT), and 2 minutes after deflation (supine) (Tpost). Average age was 53±13 (range: 22 to 79 y). In 12 of a total of 62 patients (19.4%) the rSO2 decreased >20% (20.5% to 28.4%) in TCO2 or TrevT times. Significantly higher decrease of the rSO2 was found in patients older than 65 years and those with body mass index >30 kg/m (P<0.05). Noninvasive monitoring of cerebral oxygenation could be an important part of perioperative care in obese and older patients.
Background:
One of the most serious complications after major orthopedic surgery is deep wound or periprosthetic joint infection. Various risk factors for infection after hip and knee replacement ...surgery have been reported, including patients' comorbidities and surgical technique factors. We investigated whether hyperglycemia and diabetes mellitus (DM) are associated with infection that requires surgical intervention after total hip and knee arthroplasty.
Methods:
We reviewed our computerized database for elective primary total hip and knee arthroplasty from 2000 to 2008. Demographic information, past medical history of patients, perioperative biochemistry, and postoperative complications were reviewed.
Patients were divided into two groups: Infected group (101 patients who had surgical intervention for infection at our institution within 2 years after primary surgery) and noninfected group (1847 patients with no intervention with a minimum of one year follow-up. The data were analyzed using t, chi-squared, and Fisher's exact tests.
Results:
There were significantly more diabetes patients in the infected group compared with the noninfected group (22% versus 9%, p < .001). Infected patients had significantly higher perioperative blood glucose (BG) values: Preoperative BG (112 ± 36 versus 105 ± 31 mg/dl, p = .043) and postoperative day (POD) 1 BG (154 ± 37 versus 138 ± 31 mg/dl, p < .001). Postoperative morning hyperglycemia (BG >200 mg/dl) increased the risk for the infection more than two-fold. Non-DM patients were three times more likely to develop the infection if their morning BG was >140 mg/dl on POD 1, p = .001. Male gender, higher body mass index, knee arthroplasty, longer operative time and hospital stay, higher comorbidity index, history of myocardial infarction, congestive heart failure, and renal insufficiency were also associated with the infection.
Conclusions:
Diabetes mellitus and morning postoperative hyperglycemia were predictors for postoperative infection following total joint arthroplasty. Even patients without a diagnosis of DM who developed postoperative hyperglycemia had a significantly increased risk for the infection.
Abstract Study Objective To assess the efficacy of intraoperative inspired oxygen fractions (FIO2 ) of 0.8 and 0.5 when compared with standard FIO2 of 0.3 in the prevention of postoperative nausea ...and vomiting (PONV). Design Prospective, randomized, double-blinded, controlled study. Setting General hospital, postanesthesia care unit (PACU), and gynecology floor room. Patients 120 ASA physical status I and II women, aged 21 to 76 years, undergoing elective gynecologic laparoscopic surgery. Interventions Patients were randomized to receive a gas mixture of 30% oxygen in air (FIO2 = 0.3, Group G30), 50% oxygen in air (FIO2 = 0.5, Group G50), or 80% oxygen in air (FIO2 = 0.8, Group G80); there were 36 patients in each group. A standardized sevoflurane general anesthesia, postoperative pain management, and antiemetic regimen were used. Measurements Frequency of nausea, vomiting, and both was assessed for early (0 to two hrs) and late PONV (two to 24 hrs), along with use of rescue antiemetic, degree of nausea, and severity of pain. Main Results There was no overall difference in the frequency of PONV at the early and late assessment periods among the three groups. G80 patients had significantly less vomiting than Group G30 at two hours, 3% (1/36) vs. 22% (8/36), respectively, P = 0.028. Nausea scores, rescue antiemetic use, pain scores, and opioid consumption did not differ among the groups. Conclusion High intraoperative FIO2 of 0.8 and FIO2 of 0.5 do not prevent PONV in patients without antiemetic prophylaxis. An intraoperative FIO2 of 0.8 has a beneficial effect on early vomiting only.
U populaciji bolesnika starije dobi očni kirurški zahvati su jedni od najčešćih kirurških zahvata. Sve više bolesnika kojima
je potreban kirurški zahvat na očima su starije dobi i većinom su na ...kroničnoj terapiji lijekovima uključujući antitrombocitne
lijekove. Ti lijekovi mogu povećati rizik od perioperacijskog krvarenja prilikom izvođenja regionalnih očnih blokova ili
kirurškog zahvata. Krvarenje tijekom operacije oka i hemoragijske komplikacije poslije zahvata mogu dovesti do gubitka
vidne funkcije ili čak samog oka. S druge strane, prekidanje uzimanja antitrombocitnih i antikoagulacijskih lijekova prije
kirurškog zahvata dovodi do povećanog rizika za nastanak ozbiljnih i za život opasnih tromboembolijskih komplikacija. Cilj
ovoga narativnog preglednog članka je sustavni pregled objavljenih dokaza o perioperacijskom antitrombotskom liječenju
očnih bolesnika planiranih za različite zahvate u dnevnoj očnoj kirurgiji. Pretražene su baze medicinskih podataka pomoću
PubMed, Ovid Medline® i Google Scholar za razdoblje od siječnja 2015. godine do prosinca 2018. godine. Obuhvaćene su
studije relevantne za planirane očne operacije u jednodnevnoj kirurgiji i perioperacijsko liječenje antitrombocitnim i antikoagulacijskim
lijekovima s naglaskom na sadašnje stavove u pogledu nastavka, prekida ili modifikacije antitrombotske terapije
kako bi se pospješila priprema bolesnika za očne zahvate.
Opstrukcijska apneja tijekom spavanja, (OSA, engl. obstructive sleep apnea) najčešći je poremećaj disanja pri spavanju, okarakteriziran učestalim kolapsom gornjih dišnih putova uslijed smanjenog ...mišićnog tonusa ždrijela i izraženog negativnog intratorakalnog tlaka prilikom pojačanog respiratornog napora pri udahu, što biva popraćeno epizodama desaturacije arterijske krvi kisikom, hiperkarbijom i kratkotrajnim buđenjima uz pojavu glasnoga hrkanja. Klinički znakovi i anatomska obilježja koja upućuju na sindrom opstrukcijske apneje su glasno hrkanje, zamijećen prestanak disanja tijekom spavanja, abdominalni tip debljine i zadebljali vrat, te poremećena anatomija ždrijela. Klinički simptomi očituju se najčešće u neobjašnjivo pretjeranoj dnevnoj pospanosti, kardiopulmonalnim poremećajima i kognitivnoj disfunkciji. Prije dolaska na anesteziološki pregled većina bolesnika s opstrukcijskom apnejom nije prethodno klinički dijagnosticirana, što ima za posljedicu znatno povećanje rizika perioperativnih komplikacija i iznenadne smrti. Mogu se očekivati komplikacije zbog otežane uspostave i održavanja dišnoga puta, povećanog rizika aspiracije želučanoga soka, povećane osjetljivosti na primjenu anestezijskih lijekova, komplikacije povezane s čestim popratnim kardiovaskularnim i cerebrovaskularnim bolestima, uzročno povezanih s apnejom, te poslijeoperativni delirij. Prepoznavanje simptoma opstrukcijske apneje prije kirurškoga zahvata omogućava anesteziološkom timu planiranje odgovarajuće pripreme i načina vođenja anestezije, te perioperativnog nadzora bolesnika, što je osobito naglašeno u sve više zastupljenoj dnevnoj kirurgiji. Procjena kvalitete spavanja, kao i čimbenika rizika za poremećaje disanja pri spavanju i prekomjerne dnevne pospanosti, pomoću upitnika omogućuje jednostavno, jeftino i pouzdano otkrivanje opstrukcijske apneje tijekom spavanja kod kirurškog bolesnika. Perioperativne komplikacije moguće je smanjiti primjenom anestezioloških protokola i strategija za smanjenje povećanog operacijskoga rizika ovih bolesnika i njihovom daljnjom nadopunom na temelju znanstvenih dokaza.
PDF
