Predictors of unfavourable outcome in aneurysmal subarachnoid haemorrhage.

Background: Mortality rates following aneurysmal subarachnoid haemorrhage (aSAH) have decreased due to improvements in diagnoses and the management of complications, as well as early obliteration of the aneurysms. Neurogenic pulmonary oedema (NPO) is a clinical syndrome associated with an acute increase in intracranial pressure and a release of catecholamines into the circulation. This study investigated independent predictors of unfavourable outcomes (Glasgow Outcome Scores 1, 2 or 3) in patients with aSAH.

Could cardiac biomarkers predict neurogenic pulmonary edema in aneurysmal subarachnoid hemorrhage?

Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema after a significant central nervous system (CNS) insult. NPE occurs as a result of release of catecholamines into the blood immediately after aneurysm rupture. The aim of this study is to investigate the connection between the value of cardiac biomarkers on admission and incidence of NPE in patients with aneurysmal subarachnoid hemorrhage (SAH).

Manual versus target-controlled infusion of balanced propofol during diagnostic colonoscopy – A prospective randomized controlled trial.

Introduction: There is an increasing interest in balanced propofol sedation (BPS) for colonoscopy in outpatient settings. Propofol is a potent anesthetic agent for this purpose and has a narrow therapeutic range, which increases a risk of cardiovascular and respiratory complications in case of improper administration.

Objective: The aim of this study was to compare patients’ safety and comfort of endoscopists in two methods of BPS targeting deep sedation – propofol target-controlled infusion (TCI) and manual intravenous titration technique (MT) – during colonoscopy.

[Reductions in anesthesia direct costs is not the right way for racionalization of anesthesia costs].

Introduction: Anesthesia management is characterized by salary limiting and pressure for decreasing anesthetics and other drug budget. The aim of this paper is to determine the possibility of reducing the direct costs in anesthesia.

Materials And Methods: This paper is a part ofa five-year (2005-2009), academic, pharmaco-economic retrospective- prospective study (phase IV).

[Awareness detection in anaesthesia during otorhino-maxillofacial surgery using bispectral index-monitoring technology].

Introduction: Awareness is characterized by intraoperative presence of consciousness and recollecting of the events occurring during general anaesthesia. The study was aimed at detecting awareness during general anaesthesia in otorhino-maxillofacial procedure.

Methods: The study is a part of a prospective, phase IV academic study carried out at the Department for Otorhinolaringology, Clinical Centre of Serbia, and Maxillofacial Surgery.

[Anesthetic dose correction in hospital pharmacology using bispectral index monitoring technology].

Introduction: Modern hospital pharmacology insists on assessing each patient's individual characteristics because of their influence on drug pharmacokinetics and pharmacodynamic effect. The study was aimed at evaluating anesthetic doses in patients with benign larynx tumors treated by general endotracheal anesthesia during endoscopic surgery procedures.

Material And Methods: The study is a part of a prospective, phase IV, academic study carried out at the Clinical Center of Serbia.

[Costs of anesthetics and other drugs in anesthesia].

Introduction: Drugs are real and transparent costs of treatment, which are subject to constant monitoring and changes. The study was aimed at measuring and analyzing consumption of anesthetics and other drugs in anesthesia in the Clinical Centre of Serbia.

Material And Methods: This paper is part of a five-year (2005-2009), academic, pharmacoeconomic retrospective-prospective study (the 4th phase).

[Operating cost analysis of anaesthesia: activity based costing (ABC analysis)].

Introduction: Cost of anaesthesiology represent defined measures to determine a precise profile of expenditure estimation of surgical treatment, which is important regarding planning of healthcare activities, prices and budget.

Objective: In order to determine the actual value of anaestesiological services, we started with the analysis of activity based costing (ABC) analysis.

Methods: Retrospectively, in 2005 and 2006, we estimated the direct costs of anestesiological services (salaries, drugs, supplying materials and other: analyses and equipment.

Preoperative evaluation of patients with history of allergy.

The prevalence of allergic reactions in general opulation shows a constant rise. It has been estimated that up to 40% of surgical patients have a positive history of some kind of allergy. These patients represent a challenge during perioperative evaluation, since they can be exposed to a large variety of drugs and substances during surgery and anesthesia.

Osteo-articular diseases as comorbidity in non-orthopaedic surgery.

Osteo-articular diseases have significant presence among general population. Osteo-articular disorders can be caused by disease or by trauma. There are many osteo-articular diseases which have influence on general state of the organysm and on other present diseases in a various level.

Preoperative preparation of alcohol and psychoactive substances-addicted patients.

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist.

Preoperative preparation of patients with pituitary gland disorders.

This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients. Pituitary function manages almost the entire endocrine system using the negative feedback mechanism that is impaired by these diseases. The cause of acromegaly is a pituitary adenoma, which produces growth hormone in adults.

Preoperative assessment and preparation of patients with diseases affecting the central nervous system.

Purpose Of Review: This review will examine the most important issues of preoperative evaluation and preparation in relation to patients with deseases affecting the central nervous system. Those patients may undergo various forms of surgery unrelated to the central nervous system disease. We discuss the effect of physiologic and pharmacological factors on cerebral autoregulation and control of intracranial pressure alongside its clinical relevance with the help of new evidence.

[Descriptive analysis of work and trends in anaesthesiology from 2005 to 2006: quantitative and qualitative aspects of effects and evaluation of anaesthesia].

Introduction: In anaesthesiology, economic aspects have been insufficiently studied.

Objective: The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost.

Methods: The costs of anaesthesiological services were counted based on "unit" prices from the Republic Health Insurance Fund.

[Carpal tunnel syndrome--surgical and anesthesiology considerations].

Carpal tunnel syndrome presents the most common peripheral nerve entrapment, and section of carpal transverse ligament is the most common procedure in peripheral nerve surgery. Favourable outcomes depend on several factors including correct diagnosis, careful patient selection, precise operative technique and appropriate postoperative care. The goal of this paper is to establish the most common causes of failed surgery analysing primary and secondary outcomes, and to give the possibility for better results in the future.

A retrospective analysis of anesthesiologic complications in pediatric neurosurgery.

Background And Objective: Different clinical and surgical factors can influence the occurrence of anesthesiologic complications in pediatric neurosurgery. Preoperative knowledge of these factors is of great importance in the application of safe anesthetics and a favorable surgical outcome. The objective was to establish the importance of clinical and surgical risk factors on the frequency of anesthesia complications in pediatric neurosurgery.

[Difference between values of gas analysis of arteries and internal jugular vein in patients with cerebral infarction].

Introduction: Cerebral infarction is more and more frequently present by massive participation and high percentage of mortality even in young population. It is notified as very hard, vitally endangered disease.

Objective: To prove whether there is a difference in the gas analyses of the arterial and cerebral venous blood between the patients with the cerebral infarction of the left and right hemisphere and why it is significant for the treatment of those patients.

[New trends in neuromonitoring patients with with aneurysmal subarachnoid haemorrhage].

Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in "real time", at the time when they can still be managed.

[Analysis of the therapeutic modalities when cerebral vasospasm occurs and the outcome of the treatment of patients with SAH].

Vasospasm is the principal cause of a poor outcome in patients with SAH. The aim of the study is to establish the effect of the therapeutic modalities on vasospasm, to establish morbidity and mortality of patients with SAH, as well as the causes of the poor outcome. The study is prospective and analyzes 192 patients treated at C ward of the INH KCS.

[Cerebral vasospasm after subarachnoid hemorrhage].

Cerebral vasospasm causes permanent neurolological deficit or death occurance in 13% of clinical cases. Peak frequency is from 8-10th day after SAH. The purpose of this study is factor analysis that may have influence on vasospasm development , as well as predictor determination.

[Reverse Trendelenburg's position vs. supine-horizontal position for induction of general anesthesia in obese neurosurgical patients].

Introduction: The induction of general endotracheal anesthesia (GETA) is associated with variable period of apnea. Obese patients have reduced oxygen supply during period of apnea. Hypoxemia and subsequent hypercarbia, during period of apnea, are strong stimuli of cerebral blood flow and intracranial pressure increase.

[Effect of infusion of hypertonic-hyperoncotic solution on cardiovascular function in surgery of the abdominal aorta during the perioperative period].

Introduction: When blood flow is decreased, as in prolonged hypovolaemia and hypotension, or in the course of transversal clamping of the aorta during aortic reconstruction, nutritive tissue perfusion can also fall below the critical level.

Aim: The objective of this study was to analyse the effects of hypertonic-hyperoncotic solution on cardiovascular function during reconstruction of the abdominal aorta.

Method: This prospective randomised study included 40 patients.

Strategies for postoperative pain relief in neurosurgical intensive care unit.

Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be undertreated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.