Efficacy and safety of general anesthesia with caudal block for inguinal hernioplasty in children: a randomized controlled trial.

OBJECTIVE: Caudal block is a type of regional anesthesia suitable for inguinal hernia surgery in children. Our goal was to determine the effectiveness of caudal block combined with general anesthesia in providing intra- and postoperative analgesia and its effect on hemodynamic stability and drug consumption. PATIENTS AND METHODS: Prospective, randomized controlled study included 78 boys, 3-5 years, with an indication for inguinal herniorrhaphy, divided into groups G (general anesthesia, n=39) and G+C (general anesthesia + caudal block, n=39). We monitored hemodynamic parameters intraoperatively, postoperative pain, and total consumption of all medicaments in the perioperative period. The monitoring of complications and side effects of drugs was also carried out. RESULTS: Boys in group G had statistically significantly higher values of heart rate in the 5th minute (p<0.01), in the 25th minute (p<0.01), and after awakening from anesthesia (p<0.01). We obtained similar results with systolic and diastolic pressure values in the 5th minute (p<0.01), 15th minute (p<0.01), 25th minute (p<0.01), before awakening from anesthesia (p<0.01) and after awakening (p<0.01). They also had significantly statistically higher total consumption of propofol, fentanyl, and acetaminophen (p<0.01). Boys in group G+C had significantly lower postoperative pain scores: initially (p<0.01), after 2 hours (p<0.01), and after 5 hours (p<0.01). No complications occurred in this group. CONCLUSIONS: In children, the combination of general anesthesia with caudal block, compared to general anesthesia only, is more efficient in suppressing visceral pain, leading to better hemodynamic stability, and reducing the consumption of medicines in the perioperative period.

Dexmedetomidine vs. propofol sedation reduces the duration of mechanical ventilation after cardiac surgery - a randomized controlled trial.

OBJECTIVE: The aim of our study was to compare the clinical effects of sedation with dexmedetomidine vs. propofol in patients undergoing cardiac surgery and analyze their effects on the duration of mechanical ventilation (MV), length of stay in the intensive care unit (ICU), and total hospital stay. PATIENTS AND METHODS: The study included 120 patients who were randomized in a 1:1 ratio into two groups of 60 patients. The first group was sedated with continuous dexmedetomidine in doses 0.2-0.7 mcg/kg/h. The second group was sedated with propofol in doses 1-2 mg/kg/h. RESULTS: Patients sedated with dexmedetomidine required 2.2 hours less time on MV (p<0.001). There was a positive correlation between the duration of MV and the ICU length of stay (r=0.368; p<0.001), as well as between the duration of MV and the total hospital stay (r=0.204; p=0.025). Delirium occurred in the postoperative period in 25% of patients sedated with propofol, while in the dexmedetomidine group it was only 11.7% (p=0.059). Patients who developed delirium had a significantly longer duration of MV (12.6±5.4 vs. 9.3±2.5 hours, p=0.010). CONCLUSIONS: Postoperative sedation with dexmedetomidine, compared to propofol, reduces the duration of MV, but does not influence the length of stay in the ICU and length of hospitalization after open heart surgery.

[Scoring systems for evaluating injury severity]. / Bodovni sistemi za procenu tezine traume.

INTRODUCTION: Various trauma scoring systems were developed in order to assess injury severity and aid in decision making regarding further therapy and probable outcome. ANATOMIC INJURY SEVERITY SCALES: AIS--Abbreviated Injury Scale is a summary of all the values (from 1-9) for each organ or body part that is injured. ISS--Injury Severity Scale scores three dominant injuries from AIS scale. The maximum score for ISS is 75. MISS--Modified Injury Severity Score is a square of the AIS value for the three body parts with most severe injuries. PHYSIOLOGIC INJURY SEVERITY SCALES: GCS--Glasgow Coma Score is a numerical scale that assesses the severity of CNS injuries, that is the most appropriate system for numerical assessment of consciousness disturbance. Trauma score is a sum of GCS decreased for 1/3, plus the assessment of cardiopulmonary function. COMBINED ANATOMIC-PHYSIOLOGIC SCORING SYSTEMS: TRISS score (TS-ISS--trauma and injury severity score) TRISS combines ISS, TS, age of the patient and mechanism of injury, in order to determine survival probability. PTS--Pediatric Trauma Score takes into consideration all of the peculiarities of pediatric patients in response to trauma. Score values are from -6 to +12. APACHE--Acute Physiology And Chronic Health Evaluation Although it is complicated for general use, it still represents the most commonly used scoring system in Intensive Care Units. NEW SCORING SYSTEMS: MPM--Mortality Probability Models. MODS--Multiple Organ Dysfunction Syndrome. LODS--Logistic Organ Dysfunction Syndrome. SAPS--Simplified Acute Physiologic Score.

[The premature infant as an anesthesiology problem--case report]. / Prevremeno rodeno dete kao anestezioloski problem--prikaz slucaja.

INTRODUCTION: In pediatric anesthesia, neonatal anesthesia takes a special place because of its specific problems connected to physiological properties of newborns and their adaptation after birth. Adaptation itself, represents a line of changes in organ function and organ systems for new circumstances of life. DISCUSSION: Preoperative evaluation means identification of any present disease that might need preoperative treatment or specific course of anesthesia and surgery, in order to determine the most proper anesthesia regimen for the child. The primary aim of anesthesia is analgesia, unconsciousness and muscle relaxation, keeping vital parameters in optimal state. CONCLUSION: Newborns and infants, as specific age groups, demand special preoperative evaluation and approach to surgery. Knowledge of newborn's physiology and pathology either congenital or acquired is necessary for optimal choice of anesthesia regimen and surgical procedure in order to minimise postoperative complications.

[Propofol in general anesthesia in children]. / Propofol u opstoj anesteziji dece.

For a long period of time propofol has been in use for total intravenous anesthesia in adults. In our literature there are no data on the use of propofol in pediatric anesthesia. The aim of the study was to compare effects of propofol for the induction of anesthesia, maintenance and recovery after anesthesia, with barbiturate, that is, inhalation anesthesia during spontaneous breathing. 50 children underwent propofol anesthesia. A control group comprised 50 children who underwent thiopentone and halothane anesthesia. The average propofol dose was 2.38 mg/kg/tt. Monitoring of cardiovascular parameters revealed statistically significant variations in systolic and diastolic pressure in both groups, but a more significant decrease was recorded in the propofol group. The decrease, recorded only during the initiation of anesthesia, stabilized afterwards. Side effects (pain during the initiation, apnea, spontaneous movements) were present in the propofol anesthesia, while in the halothane group they were reduced. In the propofol group period of recovery was short, indicating advantages of this anesthetic in day care centers.

[Serotyping and pyocin typing of Pseudomonas aeruginosa in a study of intrahospital infections]. / Serotipizacija i piocin tipizacija Pseudomonas aeruginosa u ispitivanju intrahospitalnih infekcija.

Typing of Pseudomonas aeruginosa strains is the necessary precondition for the study and control of intrahospital infection caused by this microorganism. Since O-serotype is considered to be the basic epidemiological marker we have studied presence and distribution of some O-serotypes of 235 Pseudomonas aeruginosa strains isolated from 131 patients. The following O-serotypes have been most frequently found: O11 (21%), O6 (18%) and O12 (16%). The combination of sero and pyocin typing proved the presence of epidemic strains at departments of burns and orthopedics.

[Methicillin-resistant staphylococci. Identification and distribution in the hospital environment]. / Meticilin-rezistentni stafilokok. Identifikacija i zastupljenost u bolnickoj sredini.

Occurrence of methicillin resistant staphylococcal strains in hospital environment is more frequently found. These strains are multiresistant so that diseases caused by them require a special therapeutical approach. They are significant causative agents of intrahospital infections which may have epidemic character. Using two methods for detection of methicillin resistant staphylococcus 335 strains were tested. Methicillin resistance was found in 36 (20.6%) of 175 strains of St. aureus and 49 (30.5%) strains of coagulase negative staphylococci. The largest number of methicillin resistant strains is isolated from materials of patients hospitalized at surgical and hematological clinics.

[The incidence of Staphylococcus saprophyticus in urine and its identification]. / Ucestalost Staphylococcus saprophyticus u urinu i njegova identifikacija.

Having in mind the known fact that Staphylococcus saproplyticus is one of the most common causes of acute urinary infections, especially in females in the generative period, we have studied its incidence in 12,556 urine samples (6,374 of females and 6,182 of males) taken at the clinics and polyclinics of the Military Medical Academy. For identification of Staphylococcus saprophyticus we have used disk-diffusion test for sensitivity to novobiocin. In order to check realiability of this test we have studied morphological and biochemical characteristics in 30 novobiocin-resistant and 30 novobiocin-sensitive strains of coagulase-negative staphylococci. Of 12,556 examined urine samples we have isolated 217 strains of coagulase-negative staphylococci (10(4) and more bacteria/ml of urine in pure culture). Of this number 33 strains (15.2%) were resistent to novobiocin and we have regarded them as Staphylococcus saprophyticus. The greatest incidence of novobiocin-resistant strains we have found in the urine of female patients treated at polyclinics (19, e.i. 57.6%). Resistence to novobiocin, formation of light yellowish pigment and absence of beta-hemolysis have shown to be satisfactory criteria in diagnosis of Staphylococcus saprophyticus from urine.