EPIDEMIOLOGICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH MORTALITY IN SEVERELY BURNED PATIENTS - CROATIAN NATIONAL BURN CENTER REPORT.

The authors conducted a single-center retrospective study during the last 6.5 years. The study aimed to describe demographic data of burn patients in the Croatian Burn Center and investigate factors affecting mortality for the first time after the Center was established. The study included 109 severely burned patients with a total body surface area (TBSA) burned ≥20%, admitted to the burn intensive care unit. The relationship between the fatal outcome and age, sex, comorbidity, mechanism of injury, TBSA burned, and inhalation injury was investigated. The mean patient age was 54.50±20.21 years and the mean TBSA burned was 42.48±18.64%, with the mortality rate of 50%. The results demonstrated that patients with 2 or more comorbidities compared with those with no comorbidities had a higher chance of lethal outcome (p<0.0001). With an increase of TBSA by 1%, the odds of lethal outcome are expected to increase by 7% (p<0.0001). Other variables included in the analysis did not show statistical significance. TBSA percentage is a well-known predictor of mortality and numerous studies indicate an association between comorbidities and mortality but there are conflicting results about other demographic factors and injury characteristics.

DILEMMAS ABOUT THE SELECTION OF ANESTHESIA FOR ELECTIVE CESAREAN SECTION IN PREGNANT WOMEN WITH MYOTONIC DYSTROPHY TYPE 2 AND SUSPECTED von WILLEBRAND DISEASE: A CASE REPORT.

With advancement of medicine in the field of diagnostics and treatment of women suffering from certain genetic disorders, more and more women have attained reproductive age and desired fertility. Maintaining pregnancy, as well as bringing it to an end poses a real challenge not only for obstetricians, but also for anesthesiologists involved in the procedure. In our case report, we describe anesthetic management of a female patient suffering from myotonic dystrophy type 2 and suspected von Willebrand's disease, and undergoing elective cesarean section. It is acknowledged that both diseases have their own peculiarities and specificities related to anesthesia and require careful consideration when it comes to selecting it. Bearing in mind the advantages and disadvantages of certain types of anesthesia, we believe that in this case, general anesthesia was a better choice compared to the regional techniques of anesthesia.

A multidisciplinary approach to a patient with vulvodynia: a successful treatment and outcome.

Vulvodynia is chronic vulvar pain or a burning sensation lasting for at least 3 months without a cause. We present the case of a 53-year-old postmenopausal woman that experienced vulvar and vaginal burning, and discomfort and pain during sexual intercourse for 3 years, which greatly reduced her quality of life (QOL) despite the absence of itch and genital skin lesions. Her regular gynecological exams showed no pathology, and so she was referred to a dermatologist, who initiated a multidisciplinary treatment approach involving several specialists: an anesthesiologist, gynecologist, urologist, psychiatrist, and dermatologist. Targeted psychiatric treatment (amitriptyline), together with acupuncture treatments and support by a gynecologist, led to a major improvement in symptoms and QOL, as well as a decrease in depression and anxiety measured by the Beck Depression Inventory II (BDI-II) and State-Trait Anxiety Inventory (STAI). A multidisciplinary and integrative approach was crucial for determining a diagnosis and achieving an excellent outcome.

SPINAL ANESTHESIA IN DAY SURGERY - EARLY EXPERIENCES.

Day surgery is a term that refers to performing an operation under anesthesia without needing to stay in the hospital for more than 24 hours. Day surgery has many advantages over surgery that involves a multiple-day hospital stay. Anesthesia for day surgery must have a rapid onset of action, a rapid cessation of action, and be free of, or have minimal side effects. For many years, general anesthesia was believed to be the anesthesia of choice for day surgery due to the delayed onset of local anesthetic after spinal anesthesia, a much longer duration of motor function recovery after surgery with spinal anesthesia compared to general anesthesia, and a more frequent incidence of side effects with spinal anesthesia, such as urinary retention or post-puncture headache. However, with the discovery of new, shorter-acting local anesthetics, and the use of smaller-diameter spinal needles, spinal anesthesia is becoming an equivalent anesthetic option for day surgery, if not a better one. Our early expiriences with spinal anesthesia in day surgery are excellent.

Incidence, Etiology and Outcome of Ventilator-Associated Pneumonia in Patients with Percutaneous Tracheotomy

Although the incidence of ventilator-associated pneumonia (VAP) is very high, there are still many uncertainties about clinical course of VAP among tracheotomized patients. The goal of the present study was to determine the impact of tracheotomy on VAP incidence and etiology, as well as outcome of VAP patients with tracheotomy. The study was conducted in a 15-bed Surgical and Neurosurgical Intensive Care Unit (ICU), Sestre milosrdnice University Hospital Center in Zagreb, Croatia. The study included all patients undergoing only percutaneous tracheotomy during the study period. According to our data, the incidence of VAP among percutaneous tracheotomized patients was 42%, not considering the time between tracheotomy and VAP onset. However, when only patients developing VAP after tracheotomy were taken into account, the incidence of VAP among tracheotomized patients dropped to 8% only. The most commonly isolated bacterium was Staphylococcus aureus, accounting for 17 (37%) isolates, followed by Haemophilus influenzae, accounting for another 10 (22%) isolates. The development of VAP among percutaneously tracheotomized patients was associated with longer total ICU stay (regardless of whether VAP developed before or after tracheotomy), while total duration of mechanical ventilation and mortality rate remained unaffected.