Danijela Gulam - Academia.edu (original) (raw)

Papers by Danijela Gulam

Research paper thumbnail of Stjepan Barišin i suradnici: Trodimenzionalna transezofagusna ehokardiografija: nova intraoperacijska perspektiva u praćenju kardijalnih bolesnika

1 Odjel kardiovaskularne anestezije, Klinika za anesteziologiju, reanimatologiju i intenzivno lij... more 1 Odjel kardiovaskularne anestezije, Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KB Dubrava Zagreb; 2 Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KB Sveti Duh Zagreb; 3 Kardiologija-djelatnost za internu medicinu, Poliklinika Medikol Zagreb; 4 Odjel kardijalne anestezije, Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KBC Osijek. Kontakt adresa: Prim. dr. sc. Stjepan Barišin, dr. med. Odjel kardiovaskularne anestezije Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje KB Dubrava, Zagreb, Av. Gojka Šuška 6, 10 000 Zagreb tel: 01/2902938 abarisin@kbd.hr Pregledni članak UDK 616.12-073.7:616-089 Prispjelo: 6. rujna 2011. Povijesni prikaz transezofagusne ehokardiografije Ehokardiografija je u kliničku uporabu ušla 1950-tih godina isključivo za procjenu stenoze mitralne valvule (MV) i efuzije perikarda (5). Intraoperacijski je prvi puta primijenjena 1972. godine kada se epikardijalnom son-dom potvrdila u...

Research paper thumbnail of Mutations that modulate receptor?hormone congruency as a cause of the primate GH receptor species specificity

Theory in Biosciences, 2005

Peptide hormones depend on reliable recognition by their receptors. Any mutation that compromises... more Peptide hormones depend on reliable recognition by their receptors. Any mutation that compromises recognition of hormone and receptor molecules is dangerous, the carrier animal would not procreate and the mutation would be lost. Although, most of the hormones from one mammalian species are active when injected into another, the incompatibility of human GH receptor toward nonprimate GHs is a notable exception. It is reported that the coevolution of GH and GHR in primates includes two crucial steps (Mol. Biol. Evol. 18 (2001) 945). The first was mutation of GH His-->Asp at position 171 that happened before the split of Old world and New world monkeys. The second event was Leu-->Arg change at position 43 in the GH receptor molecule that happened in the ancestor of Old world monkeys. The proposed model is based on the possibility that certain mutations can modify the surface of one of interacting molecules to form a confined empty space, a niche in the otherwise congruent hormone/receptor interface. Altoough affinity between molecules is probably slightly reduced, recognition and function are not compromised in this special case. Further mutations of hormone and receptor molecules are allowed under the condition that they remain confined to the niche space. Mutations that do not compromise hormone function can be passed to offsprings. If the consequent mutation of one molecule change its shape to fill the niche space, further mutations without function loss will become less probable. Without the niche space, the phase of fast evolution is closed and both genes become conserved. In this setting, accumulated mutations before the niche closing mutation are the cause of species specificity. To become a dominant variety, carrier animals must possess survival advantage in comparison to the carriers of other less advantageous mutations.

Research paper thumbnail of Poslijeoperacijske respiracijske komplikacije nakon operacija abdominalnih tumora, randomizirana klinička studija

Research paper thumbnail of Total Intravenous Anesthesia with Ketofol versus Combination of Ketofol and Lidocaine for Short-Term Anesthesia in Pediatric Patients; Double Blind, Randomized Clinical Trial of Effects on Recovery

Children

Background: Ketofol admixture has been proposed to be useful for sedation and general anesthesia.... more Background: Ketofol admixture has been proposed to be useful for sedation and general anesthesia. The beneficial effect of the combination of ketofol with lidocaine may be a shortened time of anesthesia and recovery period. This study aimed to establish the effect of total intravenous anesthesia (TIVA) with ketofol and ketofol with lidocaine on recovery in children. Methods: Two hundred children from the ages of 1–12 years who underwent short surgical procedures were randomly allocated into two groups. Propofol mixtures (ketofol) were prepared for group l. A ratio of 1:4 of ketofol was used for induction and for the maintenance of anesthesia a ratio of was used 1:7. For the induction and maintenance of anesthesia ketofol with lidocaine (lidoketofol) was used in group II. The McFarlan infusion regimen was used with reduction. The extubating time, anesthesia duration and the length of stay in the post-anesthesia care unit (PACU) were recorded. Results: Extubation time showed to be con...

Research paper thumbnail of Cjelovitost sluznice tankog crijeva tijekom anestezije kod velikih kirurških zahvata trbuha

The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent pat... more The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent patients during the major open abdominal surgery which lasted from 2 to 7 hours. Two samples of the intestinal mucosa were removed: at the beginning, and at the end of the surgical procedure in general anaesthesia. A mucosal injury was classified into 4 grades. pH, PCO2 and lactate level were measured in the blood samples from the arterial and mesenteric vein in one hour time intervals. The changes of intestinal mucosa were found in 31 patients (51.7%): in 19 patients (31.7%) grade 1 changes were recorded, in 10 patients (16.7%) grade 2, and in 2 patients (3.3%) grade 3. Grade 4 lesions were not recorded. There was a statistically significant correlation between grades of the mucosal damage and the surgery duration (p=0.001). Analysis during the one hour intervals showed that there was no exact time point when the significant aggravation of the pathohistological changes in intestinal mucosa...

Research paper thumbnail of Why Monitoring Cerebral Desaturation Events During Surgery in the Beach Chair Position?

Moždani oksimetri se koriste u novije vrijeme za nadzor nad regionalnom moždanom oksigenacijom ti... more Moždani oksimetri se koriste u novije vrijeme za nadzor nad regionalnom moždanom oksigenacijom tijekom kirurških zahvata kod kojih se očekuje hemodinamska nestabilnost bolesnika. Jedan od takvih zahvata je operacija ramena u sjedećem položaju, koji se u inozemnoj literaturi naziva “the beach chair position” (engl. BCP). Hipotenzija koja se javlja nakon pozicioniranja bolesnika u sjedeći položaj dovodi do pada perfuzijskog tlaka u mozgu što bi moglo predisponirati potencijalni cerebrovaskularni incident. Cerebralni desaturacijski događaji (engl. cerebral desaturation events, CDE’s) predstavljaju pad vrijednosti zasićenosti kisika u mozgu za 20 % u odnosu na bazalnu vrijednost mjerenu s moždanim oksimetrom INVOS (engl. In Vivo Optical Spectroscopy, INVOS 5100; Somanetics Corp., Troy, Michigan, USA). Zbog tih potencijalnih desaturacijskih događaja koji bi mogli biti štetni za neurološku funkciju istraživači i kliničari stalno nastoje pronaći odgovarajuće metode za nadzor nad moždanom p...

Research paper thumbnail of Patient satisfaction with regional anesthesia in orthopedic surgery

Periodicum Biologorum, 2015

Background and Purpose: The patient satisfaction with perioperative care and anesthesia is import... more Background and Purpose: The patient satisfaction with perioperative care and anesthesia is important indicator of the quality of the health care syste

Research paper thumbnail of Changes in heart rate and blood pressure of anesthesiologists at University Hospital Center Osijek during work on call and free days

Research paper thumbnail of Three-dimensional transoesophageal echocardiography: new intraoperative perspective in follow-up of cardiac patients

Research paper thumbnail of A wound infiltration as a method of postoperative analgesia

Periodicum Biologorum, 2009

A wound infiltration is a method of postoperative analgesia efficient in the various surgical sub... more A wound infiltration is a method of postoperative analgesia efficient in the various surgical subdisciplines. This technique resulted from the observation that patients whose surgical procedures were performed under regional anaesthesia techniques have reduced postoperative analgesic consumption. Owing to the advances in the drug discovery and to the introduction of local anaesthetics with prolonged effects, this technique has less adverse reactions and considerable analgesic effects. New local anaesthetics with long duration of action and low toxicity like levobupivacaine and ropivacaine are currently available at the market. Such drugs with lower potential for systemic toxicity provided additional safety dimension to local infiltration techniques. A variety of methods were developed to achieve painless recovery period, better patient comfort and to improve patient outcome. Probably the most common technique is a field block at the end of the surgery that can be performed both duri...

Research paper thumbnail of Postsurgical respiratory complications folowing abdominal tumors procedures: a randomised clinical trial

Autori prikazuju rezultate prospektivnog klinickog ispitivanja pojavnosti respiracijskih komplika... more Autori prikazuju rezultate prospektivnog klinickog ispitivanja pojavnosti respiracijskih komplikacija nakon kirurgije abdominalnih tumora.

Research paper thumbnail of The use of an ultrasound-guided popliteal block for hallux valgus surgery in a patient with myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disease which affects neuromuscular transmission, causing... more Myasthenia gravis (MG) is an autoimmune disease which affects neuromuscular transmission, causing muscle fatigue and weakness (1). The myasthenic patients are always a challenge to the anesthesiologist, because they demonstrate various responses to the neuromuscular blocking agents. The post-operative risk of respiratory failure has always been a matter of concern (2, 3). We report a successful use of the ultrasound guided popliteal block for elective foot surgery in a 46-year old woman with MG, showing that this regional anesthesia technique, by avoiding the use of neuromuscular blocking agents, provided safe care for this patient.

Research paper thumbnail of Zašto nadzirati moždane desaturacijske događaje tijekom operacija u sjedećem položaju

Takve operacije su operacija srca (1), abdominalne operacije koje zahtijevaju anti-Trendelenburgo... more Takve operacije su operacija srca (1), abdominalne operacije koje zahtijevaju anti-Trendelenburgov položaj (2), torakalni kirurški zahvati s ventilacijom jednog plućnog krila, neurokirurški zahvati u stražnjoj lubanjskoj jami, endarterektomija karotida (3) i operacije ramena u sjedećem položaju, koji se u inozemnoj literaturi često naziva “the beach chair position” (engl. skraćenica BCP) (4). Postavljanje bolesnika u posebne položaje potrebne za određene kirurške zahvate iznimno je važno za kirurga zbog vizualizacije kirurškog polja, ali pokreće različite i ziološke mehanizme regulacije za prilagodbu na novi položaj tijela (5). Tijekom postavljanja bolesnika iz ležećeg u druge položaje tijela, kao što je to sjedeći položaj, zbog gravitacijskog utjecaja dolazi do redistribucije cirkulirajućeg volumena krvi u trbuh i udove (6). Anestezirani bolesnici imaju promijenjeni simpatički odgovor na promjene položaja tijela, koji dovodi do hipotenzije, posebno prigodom postavljanja iz ležećeg ...

Research paper thumbnail of Arterial pressure and heart rate changes in patients during “beach chair position” for shoulder surgery: comparison of the regional and general anesthesia techniques

Background and Purpose: Patients scheduled to shoulder surgery are placed in a sitting position c... more Background and Purpose: Patients scheduled to shoulder surgery are placed in a sitting position called “the beach chair position” during the operation. This type of surgery can be performed with two anesthetic techniques: general anesthesia or regional anesthesia (interscalene block). This patient positioning is characterized by changes in heart rate and systemic blood pressure. The aim of this study is to show whether the type of anesthetic technique influence the changes in systemic pressure and heart rate in this particular patient position. Materials and methods: Retrospective clinical study with reviewed anesthetic charts and medical documentation of the patients scheduled for elective shoulder surgery. Point measurements of systolic and diastolic blood pressure and heart rate were: before surgery, after the positioning of the anesthetized patient, at the end of the operation (lodging of the patient) and then the lowest recorded pressure and heart rate during surgery. Results: ...

Research paper thumbnail of Clinical Anaesthesiology : Reanimatology and Intensive Care Medicine

Knjiga je uvod u anesteziologiju i prvi udžbenik za studente i specijalizante na Medicinskom faku... more Knjiga je uvod u anesteziologiju i prvi udžbenik za studente i specijalizante na Medicinskom fakultetu, Sveucilista Josipa Jurja Srossmayera u Osijeku. Namjera je prikazati fundamentalne ciljeve i koncizne izvore klinicke prakse na pocetku specijalizacije iz anesteziologije. Sažeti opisi klinicke prakse priprema su za kvalifikacijsko ispitivanje ili postupak sa specijalnim bolesnicima. U stivu se naglasava važnost medicinskog postupka i esencijalni temelji znanosti u klinickoj anesteziologiji koji se najbolje uce u klinickom okruženju. Knjiga je uređena tako da su znanstveni principi opisani sa raspravom klinickog postupka.

Research paper thumbnail of Trodimenzionalna transezofagusna ehokardiografija: nova intraoperacijska perspektiva u praćenju kardijalnih bolesnika

Research paper thumbnail of Does the Anesthesia Technique Affect Arterial Pressure and Regional Cerebral Oxygen Saturation During Shoulder Arthroscopy in the Beach Chair Position?

Acta Clinica Croatica

-Th is study aimed to investigate the impact of posture and anesthesia techniques on blood pressu... more -Th is study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefi ned points during perioperative period. Th e GA group patients had signifi cantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). Th ere was a signifi cant diff erence in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10 th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). Th is correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically signifi cantly diff erent. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.

Research paper thumbnail of Premedication with midazolam is equally effective via the sublingual and intravenous route of administration

Signa Vitae - A Journal In Intensive Care And Emergency Medicine

Background. The aim of this study was to investigate the clinical efficacy and potential side eff... more Background. The aim of this study was to investigate the clinical efficacy and potential side effects of sublingual midazolam, used for premedication, in comparison with intravenous midazolam. The second aim was to explore cost-effectiveness of sublingual midazolam administration. Methods. A prospective, randomized, controlled, single-blinded trial was conducted at the Clinical Hospital Centre Osijek, Croatia, during the period 1st of May till 31st of October, 2012. We enrolled 140 patients (American Society of Anesthesiologists (ASA) physical status I-II, age≥18 years) scheduled for some kind of elective surgical procedure. Exclusion criteria were ASA III or higher, psychiatric disorders, allergy to midazolam and use of psychotropic drugs. Patients were randomized into one of two groups. One group received 2.5 mg of midazolam intravenously and the other group received 1/4 of a midazolam tablet (approximately 3.75 mg) sublingually. Sedation was clinically evaluated using the Ramsey sedation scale at 0, 10, 20 and 30 minutes after drug administration. We also noted side effects and degree of amnesia. Results. Ten minutes after administration of premedication, a significantly higher number of patients in the intravenous group had a Ramsey score of 2 (p=0.000). Ten and twenty minutes after drug administration, most of the patients in the sublingual group had a Ramsey score 1-2, and after 30 minutes most of them had a Ramsey score 2-3, which is comparable with the intravenous (p=0.642) group. Conclusion. Sublingual application of midazolam has an equivalent sedative effect as intravenous midazolam 20 minutes after administration but is associated with a bitter taste and weaker amnestic effect.

Research paper thumbnail of Transcranial Cerebral Oxymetric Monitoring Reduces Brain Hypoxia in Obese and Elderly Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy

Surgical laparoscopy, endoscopy & percutaneous techniques, 2017

The aims of this prospective, observational study were to evaluate the changes of the regional ce... more The aims of this prospective, observational study were to evaluate the changes of the regional cerebral saturation (rSO2) measured by near-infrared spectroscopy during elective laparoscopic cholecystectomy under total intravenous anesthesia and the association between patient's characteristics and critical decline of rSO2. Hemodynamics, rSO2, and oxygen saturation were recorded in different time points: before the anesthesia (Tbas), 2 minutes after the induction (supine position) (Tind), 2 minutes after CO2 insufflation (supine) (TCO2), 10 minutes after CO2 insufflation (reverse Trendelenburg) (TrevT), and 2 minutes after deflation (supine) (Tpost). Average age was 53±13 (range: 22 to 79 y). In 12 of a total of 62 patients (19.4%) the rSO2 decreased >20% (20.5% to 28.4%) in TCO2 or TrevT times. Significantly higher decrease of the rSO2 was found in patients older than 65 years and those with body mass index >30 kg/m (P<0.05). Noninvasive monitoring of cerebral oxygenati...

Research paper thumbnail of Klinička anesteziologija: reanimatologija i intenzivno liječenje

… Udžbenici Sveučilišta u …

Research paper thumbnail of Stjepan Barišin i suradnici: Trodimenzionalna transezofagusna ehokardiografija: nova intraoperacijska perspektiva u praćenju kardijalnih bolesnika

1 Odjel kardiovaskularne anestezije, Klinika za anesteziologiju, reanimatologiju i intenzivno lij... more 1 Odjel kardiovaskularne anestezije, Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KB Dubrava Zagreb; 2 Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KB Sveti Duh Zagreb; 3 Kardiologija-djelatnost za internu medicinu, Poliklinika Medikol Zagreb; 4 Odjel kardijalne anestezije, Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KBC Osijek. Kontakt adresa: Prim. dr. sc. Stjepan Barišin, dr. med. Odjel kardiovaskularne anestezije Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje KB Dubrava, Zagreb, Av. Gojka Šuška 6, 10 000 Zagreb tel: 01/2902938 abarisin@kbd.hr Pregledni članak UDK 616.12-073.7:616-089 Prispjelo: 6. rujna 2011. Povijesni prikaz transezofagusne ehokardiografije Ehokardiografija je u kliničku uporabu ušla 1950-tih godina isključivo za procjenu stenoze mitralne valvule (MV) i efuzije perikarda (5). Intraoperacijski je prvi puta primijenjena 1972. godine kada se epikardijalnom son-dom potvrdila u...

Research paper thumbnail of Mutations that modulate receptor?hormone congruency as a cause of the primate GH receptor species specificity

Theory in Biosciences, 2005

Peptide hormones depend on reliable recognition by their receptors. Any mutation that compromises... more Peptide hormones depend on reliable recognition by their receptors. Any mutation that compromises recognition of hormone and receptor molecules is dangerous, the carrier animal would not procreate and the mutation would be lost. Although, most of the hormones from one mammalian species are active when injected into another, the incompatibility of human GH receptor toward nonprimate GHs is a notable exception. It is reported that the coevolution of GH and GHR in primates includes two crucial steps (Mol. Biol. Evol. 18 (2001) 945). The first was mutation of GH His--&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;Asp at position 171 that happened before the split of Old world and New world monkeys. The second event was Leu--&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;Arg change at position 43 in the GH receptor molecule that happened in the ancestor of Old world monkeys. The proposed model is based on the possibility that certain mutations can modify the surface of one of interacting molecules to form a confined empty space, a niche in the otherwise congruent hormone/receptor interface. Altoough affinity between molecules is probably slightly reduced, recognition and function are not compromised in this special case. Further mutations of hormone and receptor molecules are allowed under the condition that they remain confined to the niche space. Mutations that do not compromise hormone function can be passed to offsprings. If the consequent mutation of one molecule change its shape to fill the niche space, further mutations without function loss will become less probable. Without the niche space, the phase of fast evolution is closed and both genes become conserved. In this setting, accumulated mutations before the niche closing mutation are the cause of species specificity. To become a dominant variety, carrier animals must possess survival advantage in comparison to the carriers of other less advantageous mutations.

Research paper thumbnail of Poslijeoperacijske respiracijske komplikacije nakon operacija abdominalnih tumora, randomizirana klinička studija

Research paper thumbnail of Total Intravenous Anesthesia with Ketofol versus Combination of Ketofol and Lidocaine for Short-Term Anesthesia in Pediatric Patients; Double Blind, Randomized Clinical Trial of Effects on Recovery

Children

Background: Ketofol admixture has been proposed to be useful for sedation and general anesthesia.... more Background: Ketofol admixture has been proposed to be useful for sedation and general anesthesia. The beneficial effect of the combination of ketofol with lidocaine may be a shortened time of anesthesia and recovery period. This study aimed to establish the effect of total intravenous anesthesia (TIVA) with ketofol and ketofol with lidocaine on recovery in children. Methods: Two hundred children from the ages of 1–12 years who underwent short surgical procedures were randomly allocated into two groups. Propofol mixtures (ketofol) were prepared for group l. A ratio of 1:4 of ketofol was used for induction and for the maintenance of anesthesia a ratio of was used 1:7. For the induction and maintenance of anesthesia ketofol with lidocaine (lidoketofol) was used in group II. The McFarlan infusion regimen was used with reduction. The extubating time, anesthesia duration and the length of stay in the post-anesthesia care unit (PACU) were recorded. Results: Extubation time showed to be con...

Research paper thumbnail of Cjelovitost sluznice tankog crijeva tijekom anestezije kod velikih kirurških zahvata trbuha

The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent pat... more The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent patients during the major open abdominal surgery which lasted from 2 to 7 hours. Two samples of the intestinal mucosa were removed: at the beginning, and at the end of the surgical procedure in general anaesthesia. A mucosal injury was classified into 4 grades. pH, PCO2 and lactate level were measured in the blood samples from the arterial and mesenteric vein in one hour time intervals. The changes of intestinal mucosa were found in 31 patients (51.7%): in 19 patients (31.7%) grade 1 changes were recorded, in 10 patients (16.7%) grade 2, and in 2 patients (3.3%) grade 3. Grade 4 lesions were not recorded. There was a statistically significant correlation between grades of the mucosal damage and the surgery duration (p=0.001). Analysis during the one hour intervals showed that there was no exact time point when the significant aggravation of the pathohistological changes in intestinal mucosa...

Research paper thumbnail of Why Monitoring Cerebral Desaturation Events During Surgery in the Beach Chair Position?

Moždani oksimetri se koriste u novije vrijeme za nadzor nad regionalnom moždanom oksigenacijom ti... more Moždani oksimetri se koriste u novije vrijeme za nadzor nad regionalnom moždanom oksigenacijom tijekom kirurških zahvata kod kojih se očekuje hemodinamska nestabilnost bolesnika. Jedan od takvih zahvata je operacija ramena u sjedećem položaju, koji se u inozemnoj literaturi naziva “the beach chair position” (engl. BCP). Hipotenzija koja se javlja nakon pozicioniranja bolesnika u sjedeći položaj dovodi do pada perfuzijskog tlaka u mozgu što bi moglo predisponirati potencijalni cerebrovaskularni incident. Cerebralni desaturacijski događaji (engl. cerebral desaturation events, CDE’s) predstavljaju pad vrijednosti zasićenosti kisika u mozgu za 20 % u odnosu na bazalnu vrijednost mjerenu s moždanim oksimetrom INVOS (engl. In Vivo Optical Spectroscopy, INVOS 5100; Somanetics Corp., Troy, Michigan, USA). Zbog tih potencijalnih desaturacijskih događaja koji bi mogli biti štetni za neurološku funkciju istraživači i kliničari stalno nastoje pronaći odgovarajuće metode za nadzor nad moždanom p...

Research paper thumbnail of Patient satisfaction with regional anesthesia in orthopedic surgery

Periodicum Biologorum, 2015

Background and Purpose: The patient satisfaction with perioperative care and anesthesia is import... more Background and Purpose: The patient satisfaction with perioperative care and anesthesia is important indicator of the quality of the health care syste

Research paper thumbnail of Changes in heart rate and blood pressure of anesthesiologists at University Hospital Center Osijek during work on call and free days

Research paper thumbnail of Three-dimensional transoesophageal echocardiography: new intraoperative perspective in follow-up of cardiac patients

Research paper thumbnail of A wound infiltration as a method of postoperative analgesia

Periodicum Biologorum, 2009

A wound infiltration is a method of postoperative analgesia efficient in the various surgical sub... more A wound infiltration is a method of postoperative analgesia efficient in the various surgical subdisciplines. This technique resulted from the observation that patients whose surgical procedures were performed under regional anaesthesia techniques have reduced postoperative analgesic consumption. Owing to the advances in the drug discovery and to the introduction of local anaesthetics with prolonged effects, this technique has less adverse reactions and considerable analgesic effects. New local anaesthetics with long duration of action and low toxicity like levobupivacaine and ropivacaine are currently available at the market. Such drugs with lower potential for systemic toxicity provided additional safety dimension to local infiltration techniques. A variety of methods were developed to achieve painless recovery period, better patient comfort and to improve patient outcome. Probably the most common technique is a field block at the end of the surgery that can be performed both duri...

Research paper thumbnail of Postsurgical respiratory complications folowing abdominal tumors procedures: a randomised clinical trial

Autori prikazuju rezultate prospektivnog klinickog ispitivanja pojavnosti respiracijskih komplika... more Autori prikazuju rezultate prospektivnog klinickog ispitivanja pojavnosti respiracijskih komplikacija nakon kirurgije abdominalnih tumora.

Research paper thumbnail of The use of an ultrasound-guided popliteal block for hallux valgus surgery in a patient with myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disease which affects neuromuscular transmission, causing... more Myasthenia gravis (MG) is an autoimmune disease which affects neuromuscular transmission, causing muscle fatigue and weakness (1). The myasthenic patients are always a challenge to the anesthesiologist, because they demonstrate various responses to the neuromuscular blocking agents. The post-operative risk of respiratory failure has always been a matter of concern (2, 3). We report a successful use of the ultrasound guided popliteal block for elective foot surgery in a 46-year old woman with MG, showing that this regional anesthesia technique, by avoiding the use of neuromuscular blocking agents, provided safe care for this patient.

Research paper thumbnail of Zašto nadzirati moždane desaturacijske događaje tijekom operacija u sjedećem položaju

Takve operacije su operacija srca (1), abdominalne operacije koje zahtijevaju anti-Trendelenburgo... more Takve operacije su operacija srca (1), abdominalne operacije koje zahtijevaju anti-Trendelenburgov položaj (2), torakalni kirurški zahvati s ventilacijom jednog plućnog krila, neurokirurški zahvati u stražnjoj lubanjskoj jami, endarterektomija karotida (3) i operacije ramena u sjedećem položaju, koji se u inozemnoj literaturi često naziva “the beach chair position” (engl. skraćenica BCP) (4). Postavljanje bolesnika u posebne položaje potrebne za određene kirurške zahvate iznimno je važno za kirurga zbog vizualizacije kirurškog polja, ali pokreće različite i ziološke mehanizme regulacije za prilagodbu na novi položaj tijela (5). Tijekom postavljanja bolesnika iz ležećeg u druge položaje tijela, kao što je to sjedeći položaj, zbog gravitacijskog utjecaja dolazi do redistribucije cirkulirajućeg volumena krvi u trbuh i udove (6). Anestezirani bolesnici imaju promijenjeni simpatički odgovor na promjene položaja tijela, koji dovodi do hipotenzije, posebno prigodom postavljanja iz ležećeg ...

Research paper thumbnail of Arterial pressure and heart rate changes in patients during “beach chair position” for shoulder surgery: comparison of the regional and general anesthesia techniques

Background and Purpose: Patients scheduled to shoulder surgery are placed in a sitting position c... more Background and Purpose: Patients scheduled to shoulder surgery are placed in a sitting position called “the beach chair position” during the operation. This type of surgery can be performed with two anesthetic techniques: general anesthesia or regional anesthesia (interscalene block). This patient positioning is characterized by changes in heart rate and systemic blood pressure. The aim of this study is to show whether the type of anesthetic technique influence the changes in systemic pressure and heart rate in this particular patient position. Materials and methods: Retrospective clinical study with reviewed anesthetic charts and medical documentation of the patients scheduled for elective shoulder surgery. Point measurements of systolic and diastolic blood pressure and heart rate were: before surgery, after the positioning of the anesthetized patient, at the end of the operation (lodging of the patient) and then the lowest recorded pressure and heart rate during surgery. Results: ...

Research paper thumbnail of Clinical Anaesthesiology : Reanimatology and Intensive Care Medicine

Knjiga je uvod u anesteziologiju i prvi udžbenik za studente i specijalizante na Medicinskom faku... more Knjiga je uvod u anesteziologiju i prvi udžbenik za studente i specijalizante na Medicinskom fakultetu, Sveucilista Josipa Jurja Srossmayera u Osijeku. Namjera je prikazati fundamentalne ciljeve i koncizne izvore klinicke prakse na pocetku specijalizacije iz anesteziologije. Sažeti opisi klinicke prakse priprema su za kvalifikacijsko ispitivanje ili postupak sa specijalnim bolesnicima. U stivu se naglasava važnost medicinskog postupka i esencijalni temelji znanosti u klinickoj anesteziologiji koji se najbolje uce u klinickom okruženju. Knjiga je uređena tako da su znanstveni principi opisani sa raspravom klinickog postupka.

Research paper thumbnail of Trodimenzionalna transezofagusna ehokardiografija: nova intraoperacijska perspektiva u praćenju kardijalnih bolesnika

Research paper thumbnail of Does the Anesthesia Technique Affect Arterial Pressure and Regional Cerebral Oxygen Saturation During Shoulder Arthroscopy in the Beach Chair Position?

Acta Clinica Croatica

-Th is study aimed to investigate the impact of posture and anesthesia techniques on blood pressu... more -Th is study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefi ned points during perioperative period. Th e GA group patients had signifi cantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). Th ere was a signifi cant diff erence in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10 th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). Th is correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically signifi cantly diff erent. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.

Research paper thumbnail of Premedication with midazolam is equally effective via the sublingual and intravenous route of administration

Signa Vitae - A Journal In Intensive Care And Emergency Medicine

Background. The aim of this study was to investigate the clinical efficacy and potential side eff... more Background. The aim of this study was to investigate the clinical efficacy and potential side effects of sublingual midazolam, used for premedication, in comparison with intravenous midazolam. The second aim was to explore cost-effectiveness of sublingual midazolam administration. Methods. A prospective, randomized, controlled, single-blinded trial was conducted at the Clinical Hospital Centre Osijek, Croatia, during the period 1st of May till 31st of October, 2012. We enrolled 140 patients (American Society of Anesthesiologists (ASA) physical status I-II, age≥18 years) scheduled for some kind of elective surgical procedure. Exclusion criteria were ASA III or higher, psychiatric disorders, allergy to midazolam and use of psychotropic drugs. Patients were randomized into one of two groups. One group received 2.5 mg of midazolam intravenously and the other group received 1/4 of a midazolam tablet (approximately 3.75 mg) sublingually. Sedation was clinically evaluated using the Ramsey sedation scale at 0, 10, 20 and 30 minutes after drug administration. We also noted side effects and degree of amnesia. Results. Ten minutes after administration of premedication, a significantly higher number of patients in the intravenous group had a Ramsey score of 2 (p=0.000). Ten and twenty minutes after drug administration, most of the patients in the sublingual group had a Ramsey score 1-2, and after 30 minutes most of them had a Ramsey score 2-3, which is comparable with the intravenous (p=0.642) group. Conclusion. Sublingual application of midazolam has an equivalent sedative effect as intravenous midazolam 20 minutes after administration but is associated with a bitter taste and weaker amnestic effect.

Research paper thumbnail of Transcranial Cerebral Oxymetric Monitoring Reduces Brain Hypoxia in Obese and Elderly Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy

Surgical laparoscopy, endoscopy & percutaneous techniques, 2017

The aims of this prospective, observational study were to evaluate the changes of the regional ce... more The aims of this prospective, observational study were to evaluate the changes of the regional cerebral saturation (rSO2) measured by near-infrared spectroscopy during elective laparoscopic cholecystectomy under total intravenous anesthesia and the association between patient's characteristics and critical decline of rSO2. Hemodynamics, rSO2, and oxygen saturation were recorded in different time points: before the anesthesia (Tbas), 2 minutes after the induction (supine position) (Tind), 2 minutes after CO2 insufflation (supine) (TCO2), 10 minutes after CO2 insufflation (reverse Trendelenburg) (TrevT), and 2 minutes after deflation (supine) (Tpost). Average age was 53±13 (range: 22 to 79 y). In 12 of a total of 62 patients (19.4%) the rSO2 decreased >20% (20.5% to 28.4%) in TCO2 or TrevT times. Significantly higher decrease of the rSO2 was found in patients older than 65 years and those with body mass index >30 kg/m (P<0.05). Noninvasive monitoring of cerebral oxygenati...

Research paper thumbnail of Klinička anesteziologija: reanimatologija i intenzivno liječenje

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