Aleksandar Pavlovic

Scoring Systems in Assessing Survival of Critically Ill ICU Patients.

Background The aim of this study was to determine which of the most commonly used scoring systems for evaluation of critically ill patients in the ICU is the best and simplest to use in our hospital. Material/Methods This prospective study included 60 critically ill patients. After admittance to the ICU, APACHE II, SAPS II, and MPM II0 were calculated. During further treatment in the ICU, SOFA and MPM II were calculated at 24 h, 48 h, and 72 h and 7 days after admittance using laboratory and radiological measures. Results In comparison with survivors, non-survivors were older (p<0.01) and spent significantly more days on mechanical ventilation (p<0.01). ARDS was significantly more common in patients who survived compared to those who did not (chi-square=7.02, p<0.01), which is not the case with sepsis (chi-square=0.388, p=0.53). AUROC SAPS II was 0.690, and is only slightly higher than the other 2 AUROC incipient scoring systems, MPM II and APACHE II (0.654 and 0.623). The APACHE II has the highest specificity (81.8%) and MPM II the highest sensitivity (85.2%). MPM II7day AUROC (1.0) shows the best discrimination between patients who survived and those who did not. MPM II48 (0.836), SOFA72 (0.821) and MPM II72 (0.817) also had good discrimination scores. Conclusions APACHE II and SAPS II measured on admission to the ICU were significant predictors of complications. MPM II7day has the best discriminatory power, followed by SOFA7day and MPM II48. MPM II7day has the best calibration followed by SOFA7day and APACHE II.

Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients.

Background The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia. Material/Methods The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO2). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4). Results Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO2 values did not differ significantly between the groups (p=0.081). Conclusions Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.

Thrombophlebitis of the internal jugular vein after tonsillectomy

Saša Z. Tabaković1, Maja Đukić-Božović2, Goran Videnović1, Aleksandar Pavlović1,3, Jelena Todić1, Jasna Pavlović1, Brankica Martinović1 1University of Priština, Faculty of Medicine, Department of Dentistry, Kosovska Mitrovica, Serbia; 2Dr. Dragiša Mišović University Hospital Center, Hospital of Otorhinolaryngology, Belgrade, Serbia; 3University of Priština, Faculty of Medicine, Clinic for Surgery and Anesthesia, Kosovska Mitrovica, Serbia

Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient’s blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068–1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623–0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182–3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232–2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004–1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761–2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

Accidental Drowning: The Importance of Early Measures of Resuscitation for a Successful Outcome

Case Report The case of a drowning teenager is described involving application of cardiopulmonary resuscitation (CPR) by an untrained rescuer in the field and fast transport to a hospital enabling a positive resuscitation outcome despite an underorganized emergency medical service in a rural area. In our case hypoxia led to extended functional disorders of the cardiovascular system, which fully recovered after adequate therapy. Conclusion Knowledge about BLS measures by ordinary citizens, together with continuous education of health professionals concerning modern techniques of CPR, is crucial for increasing the number of patients surviving after cardiac arrest.

Application of ultrasound diagnostics in cardiopulmonary resiscitation

Slađana Anđelić1, Aleksandar Pavlović2, Slađana Trpković2, Ana Šijački3, Aleksandra Janićijević4, Biljana Putniković4 1Municipal Institute for Emergency Medical Care, Belgrade, Serbia; 2University of Priština, Faculty of Medicine, Kosovska Mitrovica, Serbia; 3University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic for Emergency Surgery, Belgrade, Serbia; 4University of Belgrade, Faculty of Medicine, Zemun Clinical Hospital Centre, Department of Cardiology, Belgrade, Serbia

Is there a doctor on the plane? The distinctive conditions of cardiopulmonary resuscitation on commercial flights

Even today, when over 3.5 billion passengers travel on commercial flights each year, there is confusion about the duties and role of doctors and other licensed medical professionals volunteering to provide assistance to a passenger whose life is in jeopardy, especially when it comes to measures of cardiopulmonary resuscitation in the distinctive conditions of an airborne commercial aircraft. There are still no international, standardized guidelines, rulebooks, or instructions applying to all airlines when it comes to training and organizing the cabin crew, equipping emergency medical kits and covering the role of medical professionals volunteering their services in medical emergency situations. The aim of this work was to attempt to solve a common quandary among medical professionals when it comes to airplane travel. Based on the available literature, national and regional guidelines and rulebooks of airlines, in accordance with the ethical and legal principles binding medical professionals, we have attempted to answer the major questions related to cardiopulmonary resuscitation on commercial flights. All aspects are covered – from a doctor volunteering to provide emergency medical care, through the marshalling of the cabin attendants, the availability of equipment, interaction with the flight captain and the captain’s decision whether to perform an emergency landing, to the possibility of obtaining additional information from medical call centers on the ground and calling medical crews to the nearest airport.

Development of acute respiratory distress syndrome (ARDS) in patients with chest trauma

Conclusion: Briefly, these results indicate that preand posttreatment with HQ can protect against ischemic damage induced by transient focal and global ischemia, and the neuroprotective effects of HQmay be closely associatedwith the attenuation of glial activation and the maintenance of the expression of endogenous antioxidants.

ENDOTRACHEAL ADMINISTRATION OF ADRENALINE IN CARDIOPULMONARY RESUSCITATION OF ANAESTHETIZED DOGS

In this study, we wanted to determine the effectiveness of endotracheal (ET) adrenaline administration on an anesthetized model of dog in hypoxia and cardiac arrest. We wanted to simulate the most frequent clinical state where urgent administration of drugs is necessary, but its difficult to provide an intravenous (IV) route. Healthy dogs (n=37) were used for this study. They were anesthetized, endotracheally intubated and ventilated mechanically. A precordial lead II ECG was recorded throughout the experiment. The animals were provided with arterial and central venous lines. During the experiment we measured arterial blood pressure (SP, DP, MAP) by an invasive technique, central venous pressure by H2O manometer, hearth rate, acid-base value, glycemia and electrolytes. Control group: after IV adrenaline administration, concentrations in the arterial blood were continually measured. I exp. group: Under equal conditions, we used ET route for adrenaline administration whereby measuring their concentration and following their haemodynamic effects. In exp. group II adrenalin in a dose of 1.5 mg was administered endotracheally using the same tehnique as in group I. In the second part of the experiment, ET administration of adrenaline under conditions of cardiac arrest was studied. Hypoxia and cardiac arrest were induced by disconnecting from the breading machine. The influence of ET adrenalin administration on lung tissue were established by histophatological analysis and acid-base values. The maximum concentration of adrenalin in the blood after the ET route are almost equal to the concentrations of the drugs after IV administration, but ET doses of adrenaline must be higher than IV doses. Adrenalin was retained in the blood for a longer period after ET administration than after IV route. As the optimal solvent for adrenalin we recommend 0.9% NaCL, and we recommend using a long cateter via the endotracehal tube deep in to the tracheobronchial system as the optimal technique for ET administration. Hypoxia and cardiac arrest do not derange absorption of drugs after ET administration. By measuring the concentration of adrenalin in arterial blood following their haemodynamic effects in different experimental conditions and by evaluating the successfulness