Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have immediate access ...to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management.
An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021.
Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use.
Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.
Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and ...neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients.
We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1β, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups.
Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.
The Quality of Recovery-40 (QoR-40) questionnaire is a psychometric instrument designed to quantify postoperative recovery. It has been translated and validated in several countries but not in ...Croatia. The aim was to translate, cross-culturally adapt, and validate Croatian version of the QoR-40. The QoR-40 was translated from English by two independent translators, back-translated by a native speaker, and approved by an expert committee. The questionnaire was administered to 106 patients who underwent general anesthesia before elective spinal surgery, post-surgery in the operating room, and 30 days after surgery. Internal consistency was assessed using the Cronbach's alpha coefficient. Construct validity was assessed by evaluating correlation between the QoR-40 and hand grip strength. The mean preoperative global QoR-40 score was 177.6 (95% CI 174.9-180.3) and postoperative 168.9 (95% CI 165.8-171.9); the mean change was -8.8 (95% CI -11.9 to -5.6). Internal consistency was good for global QoR-40 score (Cronbach alpha=0.896), acceptable across all domains (8>alpha>7). There was a significant correlation between grip strength and total QoR-40 score, pain, and physical independence, but not with other domains. In conclusion, the Croatian version of the QoR-40 has acceptable properties and can be used in the assessment of postoperative recovery in Croatian patients. Key words: Anesthesia; Croatian; QoR-40 questionnaire; Validation
Aim To compare the effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on pro-inflammatory cytokine concentrations in patients with ...non-ruptured brain aneurysms undergoing elective open surgery. Methods This parallel, randomized, controlled, open-label trial was conducted at Clinical Hospital Center Zagreb between March 2019 and March 2020. At the beginning of anesthesia, lidocaine group received 40 mg of 2% lidocaine for laryngotracheal topical anesthesia and 4 mg/kg for the scalp block. Control group underwent general anesthesia only. Plasma concentrations of IL-6, TNF-alpha, and IL-1beta were measured before anesthesia (S0); at the incision (SI); at the end of surgery (S2); 24 hours postoperatively (S3). Cerebrospinal fluid (CSF) cytokine concentrations were measured at the incision (L1) and the end of surgery (L2). Results Forty patients (each group, 20) were randomized; 37 were left in the final analysis. IL-6 plasma concentrations increased significantly compared with baseline at S3 in lidocaine group, and at S2 and S3 in control group. In both groups, changes in TNF-alpha and IL-1beta were not significant. CSF cytokine concentrations in lidocaine group did not change significantly; in control group IL-6 and IL-1beta were significantly higher at L2 than at L1. CSF IL-6 in control group significantly increased at L2, but TNF-alpha and IL-1beta did not. No differences in clinical outcome and complication rates were observed. Conclusion Adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia might attenuate CSF IL-6 concentration increase in patients with brain aneurysm. Trial registration Clinical Trials NCT03823482
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 characteristics of 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.
U ovoj studiji autor pokušava sistematizirati arhivsku građu o pavlinima u Rimu, Beču, Budimpešti, Zagrebu i Ljubljani. Tek dio te građe koristili su prije neki autori, pa je većina dokumenata ostala ...do danas nepoznata. U popisu literatura navedene su sve knjige i studije koje autor smatra neophodnima za proučavanje povijesti i djelatnosti pavlina u Hrvata tokom pet stoljeća od 13. do kraja 18. stoljeća.
Introduction Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have ...immediate access to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management. Materials and methods An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021. Results Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use. Conclusion Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.
Termin otežani dišni put odnosi se na teškoće pri intubaciji i ekstubaciji. U ovom radu prikazujemo otežanu ekstubaciju i postupak zbrinjavanja dišnog puta u bolesnice nakon učinjene parotidektomije. ...Iako postoje smjernice za otežani dišni put, ne postoje jasne upute za mehanički uzrokovanu otežanu ekstubaciju kada se endotrahealni tubus ne može izvaditi. Takva stanja rijetko se spominju u literaturi, obično u obliku prikaza bolesnika. Nemogućnost vađenja endotrahealnog tubusa zbog mehaničkih uzroka hitno je stanje, stoga nalaže izradu smjernica i algoritma postupanja. Algoritam koji smo rabili u ovom slučaju protekao je bez komplikacija i bolesnica se dobro oporavila.
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