The anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for aortic dissection or aneurysm ...rupture.
We present some aspects of the anesthetic management of two parturients with ascending aortic aneurysm for cesarean sections; amongst, the use of remifentanil with its effects on patient and newborn. We emphasize the importance of a cardio-obstetric team in the context of preoperative planning of such patients. Also, we reviewed some literature on the anesthetic management with its effect on peri-operative hemodynamic stability.
Maintaining hemodynamic stability is paramount in the prevention of the rupture or dissection of ascending aortic aneurysm during labor of parturient.
During November to December 2020, a high rate of COVID-19-associated pneumonia with bacterial superinfections due to multidrug-resistant (MDR) pathogens was recorded in a COVID-19 hospital in Zagreb. ...This study analyzed the causative agents of bacterial superinfections among patients with serious forms of COVID-19. In total, 118 patients were hospitalized in the intensive care unit (ICU) of the COVID-19 hospital. Forty-six out of 118 patients (39%) developed serious bacterial infection (VAP or BSI or both) during their stay in ICU. The total mortality rate was 83/118 (70%). The mortality rate due to bacterial infection or a combination of ARDS with bacterial superinfection was 33% (40/118). Six patients had MDR organisms and 34 had XDR (extensively drug-resistant). The dominant species was
with all isolates (34) being carbapenem-resistant (CRAB) and positive for carbapenem-hydrolyzing oxacillinases (CHDL). One
causing pneumonia harboured the
gene. It appears that the dominant resistance determinants of causative agents depend on the local epidemiology in the particular COVID center.
seems to easily spread in overcrowded ICUs. Croatia belongs to the 15 countries in the world with the highest mortality rate among COVID-19 patients, which could be in part attributable to the high prevalence of bacterial infections in local ICUs.
Anaphylaxis during pregnancy Reiner, Krešimir; Zah Bogović, Tajana; Ćaćić, Marko ...
Psychiatria Danubina
31, Številka:
Suppl 1
Journal Article
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Anaphylaxis occuring during pregnancy has a potential to cause devastating damage to the unborn baby and the mother. However, majority of adverse outcomes of anaphylaxis during pregnancy frequently ...affect the neonates rather than the mothers. The negative neurologic outcomes of the fetus are mostly due to delayed caesarean delivery or inadequate doses of adrenaline during anaphylaxis. Most of the current knowledge on this clinical scenario is based on case reports and very few review articles. This is a mini review of the causes, diagnosis and management of anaphylaxis occuring during pregnancy.
BackgroundThe analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third ...trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block.MethodsThirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic.ResultsThe US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia.ConclusionUS-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT06009302, identification number: NCT06009302, date of registration: 18/08/2023.
Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, ...sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it's use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it's ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit.
Pretilost i anestezija Mihaljević, Slobodan; Reiner, Krešimir; Čačić, Marko
Medicus (Zagreb, Croatia : 1992),
04/2018, Letnik:
27, Številka:
1 Debljina i ...
Journal Article
Recenzirano
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Prekomjerna tjelesna težina i pretilost globalni su epidemiološki problem. Osim povećane učestalosti brojnih bolesti (dijabetes tipa 2, hipertenzija, koronarna srčana bolest, opstruktivna apneja, ...osteoartritis, kolelitijaza), prekomjerna tjelesna težina i pretilost same po sebi otvaraju mogućnost za komplikacije prilikom anestezioloških postupaka. Perioperativna anesteziološka skrb za pretile pacijente uključuje detaljnu preoperativnu evaluaciju te intraoperativno i postoperativno praćenje. Uzevši u obzir trenutačnu epidemiološku situaciju, u budućnosti se može očekivati sve više pretilih pacijenata koji nalažu kirurški postupak i anesteziju.
Background
There are no data on the difference between the impact of ropivacaine and levobupivacaine on sympathetic nerve fibers during central neuraxial blocks. We hypothesized that there is no ...difference in the degree of sympathectomy between the two drugs during lumbar epidural analgesia for labor pain.
Methods
Sixty healthy parturients were randomized to the type of local anesthetic–opiod solution administered in the epidural space: 10 mL of 0.125% ropivacaine + 100 mcg of fentanyl or 10 mL of 0.125% levobupivacaine + 100 mcg of fentanyl. After the baseline measurement, photoplethysmography signal from the first toe of the leg was recorded 5, 10 and 20 minutes after administration of epidural analgesia.
Results
Area under the curve and the pulse transit time of the toe photoplethysmography increased in both groups during the first 20 minutes after administration of epidural analgesia (P < 0.001 for both parameters in both groups). No difference in the degree of sympathectomy was found between the groups for the area under the curve. The difference in the change of the pulse transit time suggests that the two local anesthetics might differ in the degree of sympathectomy (P = 0.024).
Conclusion
0.125% ropivacaine and 0.125% levobupivacaine do not differ in the terms of sympathectomy–mediated side effects of the epidural block for labor analgesia. However, the photoplethysmography findings suggest a certain difference in the degree of sympathectomy between the two local anesthetics.
Objective: To detect changes in finger photoplethysmography after administration of epidural anaesthesia as a surrogate method for evaluating autonomic nervous system activity. Methods: We included a ...total of 46 patients scheduled for elective surgical procedures under lumbar epidural anaesthesia. A Biopac SS4LA pulse plethysmograph transducer was used for photoplethysmography recording, and the device was placed on the first toe of the right leg. The first standard lead of the electrocardiogram was simultaneously measured with the finger photoplethysmography. First measurement was done before the administration of epidural anaesthesia, and second measurement was done 25 minutes post administration of epidural anaesthesia. Results: The area under the curve of the finger photoplethysmography statistically significantly increased 25 minutes after administration of epidural anaesthesia compared with the first measurement (p=0.0001). The amplitude of the finger photoplethysmography as well as the pulse transit time also statistically significantly increased after administration of epidural anaesthesia. Conclusion: The area under the curve reflects the changes in sympathetic activity after epidural anaesthesia below the block level. It can be used for the detection of the degree of sympathetic block and, respectively, for epidural block success. Future prospects include detection of sympathetic block cessation as an indicator for discharge from the awakening room and beginning of patient verticalisation.
U nemalom broju trudnica mogu biti prisutni poremećaji koagulacijskog sustava koje je nužno poznavati s obzirom da su centralna neuroaksijalna analgezija i anestezija glavne anesteziološke tehnike u ...zbrinjavanju porođajne boli te boli tijekom carskog reza. Epiduralni i spinalni hematom su rijetke, ali kobne komplikacije spomenutih postupaka. U trudnica s poremećajima koagulacije potrebno je na individualnoj razini procijeniti korist te potencijalne komplikacije centralnih neuroaksijalnih blokova.
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