Working 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.
Among other higher brain functions such as consciousness and learning, general anesthesia also affects memory. A number of information retrieval tests are performed to determine the effects of drugs ...on explicit memory. In this study, we investigated the recognition of words before and after general anesthesia in subjects having and not having received anesthesia on one or more occasions before the present one. The study included 51 patients, ASA physical status I or II, median age 50, at least high-school graduates, without head trauma, known psychiatric or memory disorder, and taking no psychoactive medication. A standardized anesthesia technique, a single surgical procedure and a defined study-test interval were used. We designed our own test as a combination of story recall test and brief word learning test, both widely used in psychological and psychiatric examination. There was no significant difference in word recognition before and after general anesthesia in either patient group. Many studies indicate that anesthesia and surgery are associated with cognitive impairment lasting for 33 months in 10%-14% of elderly patients. We hypothesized that general anesthetics can cause prolonged cognitive alterations. Study results showed that previous anesthesia in addition to the current one had no significant influence on the word recognition test.
Because of complex pathophysiology and severe consequences, traumatic brain injuries (TBI) are an important medical problem. Pathophysiology of TBI includes local and systemic stress response, in ...which interleukin-8 (IL-8) is considered as a key mediator of neuroinflammation. However, prognostic relevance of IL-8 measurement in adult patients with severe TBI is not certain. Therefore, IL-8 was determined in blood samples from central venous and jugular bulb catheter and in cerebrospinal fluid of twenty patients with isolated TBI at admission to Intensive Care Unit. None of the patients had history of stroke, dementia, autoimmune diseases, acute infection or medication with anti-inflammatory drugs. Ten patients died due to traumatic brain injury, while the other ten recovered well. While there was no significant difference of IL-8 levels in cerebrospinal fluid between survivors and nonsurvivors, central venous plasma level of IL-8 was significantly lower in survivors (71.00 ± 14.17 pg/ml), than in nonsurvivors (111.26 ± 16.9 pg/ml). Receiver Operating Characteristic (ROC) analysis revealed significant prognostic value for IL-8 in the blood as well as for the age of patients, Glasgow Coma Scale (GCS) and Acute Physiologic and Chronic Health Evaluation (APACHE II). These findings suggest that the central venous plasma values of IL-8 at admission might be an early predictive marker in patients with severe TBI, comparative to standard clinical prognostic markers such as APACHE II and GCS.
Background and Purpose: For elective neurosurgery procedures maintaining perioperative hemodynamic stability and optimal cerebral perfusion is of outmost importance. Beside numerous anesthetics ...techniques, risk of hemodynamic instability is still very high.
Materials and Methods: We retrospectively analyzed perioperative
values of heart rate and arterial blood pressure in 39 patients who underwent neurosurgery. We combined general anesthesia with scalp block. We blocked the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with 0,5% chirocaine, including 5 μg/mL of epinephrine that was performed after general anesthesia
induction, before pin placement. Heart rate and blood pressure values
were measured before anesthesia induction, after induction, after pins placement, after craniotomy and at the end of surgery. Changes of heart rate and blood pressure values less than 20% after painful stimuli was considered as a good hemodynamic stability of applied anesthetic technique.
Result: Scalp block was successfully performed in all patients without
complications. Measured values of heart rate and blood pressure before and after anesthesia induction compered to values after painful stimuli werewithin the 20% change.
Conclusion: Scalp block, combined with general anesthesia provide good hemodynamic stability during neurosurgery.
U radu su najprije zabilježeni opći podaci o Srijemu, zatim slijedi prikaz društvenih i crkvenih prilika na tom području do Metodova cloba. Nakon sažetih misli u Metodovoj upravi crkvenom »panonskom« ...pokrajinom slijedi spomen događaja i biskupa srijemskih sve do XV. stoljeća. Povijesnu pozornost zaslužuju redovnici koji su djelovali u Srijemu protiv patarena, husita i Turaka, posebice Jakov Markijski i Ivan Kapistranski.
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 literature 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.
Intravascular device infections could be serious complications with significant contributable morbidity and mortality. The aim of this prospective clinical study is to demonstrate the infection rate ...related to peripheral arterial catheters and their clinical significance in neurosurgical intensive care unit (ICU) patients. After removal, all arterial catheter tips were cultivated by semiquantitative method and clinical data were collected. During a period of two years, 186 arterial catheters were placed in 105 neurosurgical ICU patients. In 6 cases (3.2%) infection was presumably related to the arterial catheter. The rate of such probable catheter related infections was found to be 5/1000 catheter days. The isolated microorganisms were: Methicillin resistant Staphylococcus epidermidis (MRSE) in 4 cases, Corynebacterium species and Candida albicans each in one case respectively. Thirteen cases (7.0%) were interpreted as contamination and one as colonization. An association was found between the presence of infection from different sources and significant bacterial growth on the catheter. Patients with positive catheter culture had a significantly longer ICU stay, more cumulative catheter days, and a higher mortality rate than those with sterile catheters. We can conclude that the rate of probable peripheral arterial catheter related infection is low. A higher mortality rate in patients who experienced probable catheter related infection does not seem to be a consequence of the aforementioned infection. A more suitable explanation would be that patients with nosocomial infections and higher mortality risk have prolonged ICU stays. There is an increased chance of developing a catheter related infection in those patients who have more cumulative catheter days.
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.
Normobarična hiperoksija se sporadično opisuje u literaturi o neurokirurškoj anesteziji. Mišljenja o toj temi su različita. Dugi niz godina hiperoksiju se povezivalo s mogućim štetnim učincima ...slobodnih kisikovih radikala, koji se tijekom hiperoksije stvaraju u količini većoj nego što je kapacitet antioksidansa, uzrokujući hiperoksičnu akutnu ozljedu pluća. Nedavna istraživanja pokazuju da normobarična hiperoksija može biti korisna u liječenju traumatske ozljede mozga. Glavni ciljevi u neuroanesteziji su održavanje intrakranijskog tlaka, cerebralnog perfuzijskog tlaka te sprječavanje sekundarne ozljede mozga. Hiperoksija poboljšava oksigenaciju moždanog tkiva i aerobni metabolizam u mozgu zbog čega može biti neuroprotektivna. Dodatna korist hiperoksije je u liječenju poslijeoperacijskog pneumocefalusa, u smanjenju poslijeoperacijske mučnine i povraćanja, učestalosti infekcija kirurških rana te njihovom bržem cijeljenju, što omogućuje bolju kvalitetu oporavka bolesnika. Uzevši u obzir moguće dobrobiti normobarične hiperoksije te njenih neželjenih učinaka potrebna su daljnja istraživanja kako bi se jasno izdvojile skupine bolesnika u kojih hiperoksija može poboljšati ishod liječenja.
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