Experiences and attitudes of medical professionals on treatment of end-of-life patients in intensive care units in the Republic of Croatia: a cross-sectional study.

BACKGROUND: Decisions about limitations of life sustaining treatments (LST) are made for end-of-life patients in intensive care units (ICUs). The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia. METHODS: A cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor analysis was conducted to reduce data to a smaller set of summary variables. Mann-Whitney U test was used to analyse the differences between two groups and Kruskal-Wallis tests were used to analyse the differences between more than two groups. RESULTS: Less than third of participants (29.2%) stated they were included in the decision-making process, and physicians are much more included than nurses (p < 0.001). Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that 'do-not-attempt cardiopulmonary resuscitations' orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient's wishes then nurses with high school education (p = 0.038). Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs (p < 0.001, p = 0.005, p = 0.023 respectively). Male participants in comparison to female (p = 0.002), and physicians in comparison to nurses with high school and college education (p < 0.001) displayed more liberal attitudes about LST limitation. CONCLUSIONS: DNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia's geographical location in Southern Europe.

The effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy.

As an N-methyl-D-aspartate antagonist, magnesium sulfate has analgesic properties and reduces noxious input during surgery. The aim of the study was to determine the effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. In this prospective, randomized study, 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were assigned to three groups (n = 20 each). After anesthesia induction, prior to surgical incision, patients received magnesium sulfate 5.0 mg/kg (group A), magnesium sulfate 7.5 mg/kg (group B) or saline intravenously (group C). General anesthesia was performed with the same drugs in all three groups. Postoperative pain intensities at rest, according to the visual analog scale (VAS 0-10), were evaluated at 1, 3, 6, 9 and 24 hours after surgery. According to the VAS scores, patients intravenously received metamizol 2.5 g (VAS 3-4), diclofenac 75 mg (VAS 5-7) or tramadol 1 mg/kg (VAS 8-10). VAS scores at 1 hour postoperatively were significantly lower in groups A (4.7 +/- 1.7; p < 0.05) and B (3.2 +/- 1.8; p < 0.01) than in group C (5.2 +/- 2.0). At 3 hours postoperatively, VAS score was significantly lower in group B (2.4 +/- 1.5) than in group A (3.7 +/- 1.8) or group C (3.8 +/- 2.3) (p < 0.05). After 6, 9 and 24 hours postoperatively, there were no differences in VAS scores among the groups. In conclusion, preemptive intravenous administration of both 5.0 mg/kg and 7.5 mg/kg of magnesium sulfate significantly reduced early postoperative pain after laparoscopic cholecystectomy, but 7.5 mg/kg was found to be more effective. There was no effect on pain reduction at 6, 9 and 24 hours after surgery and no adverse effects were recorded.