Tatjana Goranović

Complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study.

Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam-fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane-fentanyl anesthesia was induced and maintained with sevoflurane (5-8 vol% and 0.8-1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam-fentanyl group) and 4 of 64 children (sevoflurane-fentanyl group) (P=0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane-fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane-fentanyl group (17 cases; P<0.001); postoperative nausea and vomiting occurred in 2 children (midazolam-fentanyl group) and 3 children (sevoflurane-fentanyl group) (P=0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.

Perioperative evaluation of glycaemic status in neck dissection: a retrospective analysis at a single hospital centre

Diabetes mellitus is generally considered a risk factor for impaired wound healing. This study aimed to evaluate the glycaemic status of patients undergoing neck dissection and describe its impact on postoperative outcomes, especially wound healing. A retrospective analysis was performed of the preoperative, intraoperative, and postoperative glycaemic data obtained from the medical charts of 60 adult patients who had undergone 64 neck dissections. Nine of the 64 procedures were performed in diabetic patients (14.1%). The average glucose values were: preoperative 5.99 ± 1.25 mmol/l, intraoperative 8.90 ± 2.62 mmol/l, and postoperative 10.01 ± 2.49 mmol/l. All registered preoperative hyperglycaemia cases (eight cases) were diabetic. Postoperative insulin therapy was done in 14 procedures (21.9%). Wound healing complications were found in five patients (7.8%); there was no wound infection. There was no association of wound healing complications with preoperative diabetic status (P = 1.000), preoperative glucose control (P = 1.000), preoperative (P=0.469), intraoperative (P = 0.248), and postoperative (P = 0.158) glucose values, or with postoperative glucose control (P = 0.577). These data do not support the association of stress-induced hyperglycaemia or diabetes mellitus with postoperative wound healing problems in neck dissection.

Severe tracheal stenosis after short-term endotracheal intubation: A case report

Introduction: Prolonged endotracheal intubation is a risk factor for the development of tracheal stenosis. the incidence of stenosis is very low if intubation lasts less than a week and patients may be asymptomatic for a long time. case report: We present a case of an 86-year-old female who developed severe tracheal stenosis after short-term endotracheal intubation, with her first hospital admission for stridor only two weeks after the intubation. One month after the intubation computed tomography (ct) scan revealed an 18-mm long tracheal stenosis Tatjana Goranović1, Zoka Milan2, Irena Pirkl3, Višnja Nesek Adam4 Affiliations: 1MD, PhD, Senior Teaching Assistant, Consultant Anesthetist and Intensivist, Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Department for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; Senior Teaching Assistant, Faculty of Medicine, University of Osijek, Croatia; 2MD, PhD, Honorary Senior Lecturer, Visiting Professor, Consultant Anesthetist and Intensivist, Honorary Senior Lecturer, Visiting Professor, Anesthetic Department, King’s College Hospital, London, United Kingdom; 3MD, Consultant Otorhinolaryngologist, Department of Otorhinolaryngology and Head and Neck Surgery, Sveti Duh University Hospital, Zagreb, Croatia; 4MD, PhD, Assistant Professor, Consultant Anesthetist and Intensivist, Head of University Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Sveti Duh University Hospital, Zagreb, Croatia; Assistant Professor, Faculty of Medicine, University of Osijek, Croatia. Corresponding Author: Tatjana Goranović, Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Department for Tumours, Sestre milosrdnice University Hospital Centre, Ilica 197, 10000 Zagreb, Croatia; Email: tanjagoranovic@hotmail.com Received: 23 March 2016 Accepted: 13 May 2016 Published: 26 May 2016 at the level of the thyroid gland, 1 cm below the glottis, with 3 mm of free tracheal lumen at the narrowest part. During ct scan, the patient rapidly became dyspnoeic, cyanotic, and agitated. An urgent tracheostomy was performed under local anesthesia with the patient in a semi-sitting position. When ventilation through this tube was possible, the patient was anesthetised, repositioned in the supine position and a permanent tracheostomy was performed. conclusion: An atypical medical history delayed the diagnosis and treatment, which would have been different if the appropriate diagnosis had been made earlier. Presentation with symptoms of airway obstruction and a history of mechanical intubation, no matter how short and recent, requires detailed history taking, careful examination and diagnostic approach to make the diagnosis of tracheal stenosis in a timely manner and treat it adequately.