Assessment of depth of anesthesia: PRST score versus bispectral index.

UNLABELLED: Assessment of depth of anesthesia is the basis in anesthesiologists work because the occurrence of awareness during general anesthesia is important due to stress, which is caused in the patient at that moment, and due to complications that may arise later. There are subjective and objective methods used to estimate the depth of anesthesia. The aim of this study was to assess the depth of anesthesia based on clinical parameters and on the basis bispectral index, and determine the part of bispectral monitoring in support to clinical assessment. MATERIAL AND METHODS: Sixty patients divided into two groups were analyzed in a prospective study. In first group (group 1), the depth of anesthesia was assessed by PRST score, and in the second group (group 2) was assessed by bispectral monitoring with determination PRST score concurrently. In both groups PRST score was assessed in four periods, while bispectral monitoring is used continuously. For analysis were used the BIS index values from the equivalent periods as PRST scores. PRST score value 0-3, and BIS index 40-60 were considered as adequate depth of anesthesia. The results showed that in our study were not waking patients during the surgery. In the group where the depth of anesthesia assessed clinically, we had a few of respondents (13%) for whom at some point were present indicators of light anesthesia. Postoperative interview excluded the possibility of intraoperative awareness. In the second group of patients and objective and clinical assessment indicated at all times to adequate depth of anesthesia. CONCLUSION: The use of BIS monitoring with clinical assessment allows anesthesiologists precise decision-making in balancing and dosage of anesthetics and other drugs, as well as treatment in certain situations.

[Characteristics of broncho-obstruction in childhood]. / Karakteristike bronhoopstrukcije u djecijoj dobi.

INTRODUCTION: The prevalence of broncho-obstruction in children is in permanent increase at any age and in global. According to many studies, about 50% of children have at least one episode of broncho-obstruction in the first six years of life. Risk factors for broncho-obstruction in children include not only intrinsic, but a lot of extrinsic factors which could accelerate beginning of early symptoms. Globally, there is increase in first hospitalization with broncho-obstruction and many authors described decrease in rehospitalizations, thanks to therapy improvements. There is evidence of seasonal distribution of children treated for broncho-obstruction. Depending on country and author, different periods of year are related to increased number of patients, which could be explained by seasonal agents. Many studies described geographic variation in incidence and prevalence of respiratory diseases, which could also be explained by seasonal agents. PURPOSE: The aim of this paper is to establish frequency of broncho-obstructive syndrome, comparing the age, gender, place of inhabitance and seasonal agents in children treated at the Department of Intensive care at the Pediatrics Clinic in Tuzla trough analysis of their personal histories, clinical, radiography and laboratory findings. METHODS: Analysis was based on population of patients treated at the Department for Intensive care of Pediatrics Clinic in Tuzla with broncho-obstructive syndrome, from January 1st to 31st December 2006. All selected patients were from Tuzla Canton. Source of the data for research were Admission protocol for Pediatric Clinics, Intensive care unit protocol and personal histories of children treated. Method of work was retrospective study which analyzed anamnesis' data, clinical, radiography and laboratory findings, therapeutic procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. RESULTS AND DISCUSSION: Total number of 767 children were treated during the investigated period at the Intensive care unit. Out of this number 332 children (43,3%) were treated for syndrome of broncho-obstruction. The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was most common at nursing age (40,0%) and 76,5% patients were under age of five. Boys dominated at all age groups except for repeated admissions of school age where this relation was equal. Spatial distribution demonstrated that the highest number of children treated for broncho-obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Season distribution demonstrated that the highest numbers of children were treated in December, and lowest in July and August. Number of treated children was statistically significant higher during winter months. Broncho-obstructive syndrome in 67,5% patients was with radiography confirmed pneumonia and in 13,8% with lung athelectasis. The most common isolated agents were Staphylococcus, Klebsiella and Pseudomonas. CONCLUSION: The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was found in 67,5% patients with radiography confirmed pneumonia.

[Operative treatment of acute pancreatitis]. / Operativno lijecenje akutnog pankreatitisa.

Most attacks of acute pancreatitis are self limiting, and the patients recover completely within days or weeks. In a few cases, however, the course is severe, with development of organ failure (single or multiple) and local complications such as necrosis, abscesses, and pseudocist. Between 01.01.2001-01.06.2004, 286 cases of acute pancreatitis were treated in our clinic. The purpose of this study is to represent indication for operative treatment of acute pancreatitis and its complications, according to the Atlanta classification. According to our date, the most frequent cause are changes on biliary tract. Of these 286 patients, 247 suffered from a mild or moderate type of acute pancreatitis and responded fully to medical treatment (215 patients) or to biliary tract surgery (32 patients). The hospital mortality of this group of patients was 2.4%. Surgery was indicated when the patients developed signs of an acute abdomen (9 patients), pancreatic pseudocyst (7 patients), progressiv icterus (2 patients), infection of pancreatic necrosis (10 patients), and pancreatic abscess (7 patients). Four patients with pancreatic necrosis were stable, and they had conservative treatment. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. The hospital mortality of patients with severe acute pancreatitis was 28.2%. Multiple organ failure was the predominant cause of death.

[Arrhythmia and left ventricle remodeling in acute myocardial infarct: recommendations for drug therapy]. / Aritmije i remodeliranje lijevog ventrikula u akutnom infarktu miokarda: preporuke za medikamentozni tretman.

Occurrences of arrhythmias during the acute myocardial infarction is explained with local ischaemia, but mechanism of later occurrences is unclear. Our study had for the aim to examine relationship between postinfarction left ventricle dilatation and appearance of arrhythhmias, and to show drug effects on remodelling. Patients who developed progressive left ventricle dilatation had higher mortality then patients without changes of left ventricle volume, and mortality is due of sudden cardiac death. Drugs who had preventive effects or reverse remodelling can help in prevention of malignant arrhythhmias and sudden cardiac death. It is showed that ACE inhibitors, beta-blockers and aldosterone antagonists had preventive effects on left ventricle remodelling. The combined therapy with ACE inhibitors, beta-blockers and aldosterone antagonists is showed as the most-effective in prevention of remodelling, appearaance of arrhythhmias and sudden cardiac death.

[Incidence of ARDS in patients with multiple injuries]. / Ucestalost ARDS-a u politraumatizovanih bolesnika.

Adult respiratory distress syndrome (ARDS) is common complication and cause of death in some patients with polytrauma. Twenty patients with polytrauma were in test group and have had revised trauma score (RTS) nine or less. The aim of this study is to establish an incidence of ARDS, mortality rate and significance of Lung injury score (LIS) in assessment of damage of the lung function. In test group, 20% (4 patients) tested have developed ARDS with mortality rate of 25% (one patient dead). LIS is important for quantification and qualification of damage of the lung function. In patients who survived, value of LIS has been decreasing within three days. In patient who deceased, LIS has been continuously more than 2.5 within three days. LIS does not have significance as mortality predictor in cases of non-pulmonary complications such as renal, hepatic and cardiac dysfunction.