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Publications (5)1.72 Total impact

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    ABSTRACT: Korist Kirurškog Apgar skora kod bolesnika sa frakturom kuka- prikaz rezultata retrospektivnog istraživanja u KBC Zagreb Sanja Sakan, Daniela Bandić Pavlović, Igor Virag, Petar Martinović, Igor Balenović, Mladen Perić Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KBC Zagreb Uvod Kirurški Apgar skor ( eng. Surgical Apgar Score –SAS) je sustav bodova u rasponu od 0 ( najniži broj bodova) do 10 ( najviši broj bodova) koji se dodjeljuje bolesniku na završetku operacije. Temelji se na mjerenju vrijednosti 3 intraoperativne varijable: najniži srednji arterijski tlak, najniža srčana frekvencija i procijenjeni gubitak krvi. Kirurški Apgar skor je jednostavno, jeftino i objektivno kliničko mjerilo koje odmah po završetku operativnog zahvata daje neposrednu povratnu informaciju o kliničkom stanju bolesnika, potrebi za pojačanim postoperativnim nadzorom bolesnika i mogućnosti razvoja postoperativnih komplikacija. Dosadašnja istraživanja su pokazala da je Kirurški Apgar skor neovisan prediktor za razvoj velikih postoperativnih komplikacija i smrtnost bolesnika unutar 30 dana od operacije. Istraživanja su pokazala da je fraktura kuka vodeća ozljeda koja uzrokuje bolničku smrtnost od 4,3% u starijoj populaciji. Kratkoročni mortalitet je 5-10% unutar 30 dana, a 12-37% unutar godinu dana. Ispitanici i metode U KBC-u Zagreb u razdoblju od ožujka 2013. godine do svibnja 2014. godine provedeno je retrospektivno istraživanje. Kriteriji uključenja: ispitanici oba spola stariji od 18 godina, dijagnoza frakture kuka,elektivni, poluelektivni i hitni operativni zahvati, postoperativno su bili smješteni u opći kirurški šok, potpisan informirani pristanak. Na temelju podataka iz anestezioloških lista, a prema SAS tablici, za svakoga ispitanika izračunat je SAS skor. Također iz elektroničke baze podataka KBC-a Zagreb te povijesti bolesti, dobiveni su podaci o postoperativnim komplikacijama i smrtnosti ispitanika. Rezultati Medijan SAS vrijednosti je bio 6 (raspon 1-9), a medijan trajanja operacije 90 min (raspon 40-375 min). Od ukupno 43 anestezije, 27 je bilo općih i 16 spinalnih anestezija. Medijan duljine boravka u JIL-u je bio 2 dana (raspon 1-30), a boravka u bolnici 10 dana (0-61 dan). S obzirom na jednaku srednju vrijednost i medijan SAS skora sve smo ispitanike podijelili u dvije grupe: grupa SAS ≤5(N=18) i grupa SAS ≥6 (N=25). Za usporedbu SAS vrijednosti s perioperativnim kategorijskim varijablama ispitanika koristili smo Pearson Chi-Square test. Statistička značajna razlika( p<0.05) između dvije SAS grupe je dobivena u intraoperativnom gubitku krvi i velikim kirurškim komplikacijama unutar 30 dana. Grupa ispitanika sa SAS≤5 je imala intraoperativno veća krvarenja u odnosu na grupu SAS≥6 (p=0.007), te veću incidenciju velikih komplikacija unutar 30 dana (p=0.035). Bolnička smrtnost je bila 2,3% (1 umrli), 30-dnevna smrtnost 11,6% (5 umrlih). Incidencija velikih postoperativnih komplikacija ( krvarenje, srčani arest, IM, DVT, plućna embolija, pneumonija, neplanirana intubacija, strojna ventilacija >48h, CVI, sepsa/septički šok, akutno bubrežno zatajenje) unutar 30 dana je bila 18,6% ( 8 bolesnika), a unutar 6 mjeseci 9,3% ( 4 bolesnika). Zaključak Grupa bolesnika sa frakturom kuka sa SAS vrijednosti ≤5 bodova imala je statistički značajno veći broj velikih postoperativnih komplikacija unutar 30 dana, te veći postotak ispitanika sa razvojem postoperativnih komplikacija unutar 6 mjeseci od operativnog zahvata. Vrijednost SAS-a ≤5 upućuje na potrebu za pojačanom medicinskom skrbi i nadzorom bolesnika sa frakturom kuka ne samo tijekom bolničkog liječenja, nego i unutar 6 mjeseci od operativnog zahvata.
    XXXVIII. Simpozij intenzivne medicine,, Zagreb; 11/2014
  • Zeljka Martinović, Nikolina Basić-Jukić, Daniela Bandić Pavlović, Petar Kes
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    ABSTRACT: The exact etiology of the conflicting hemostatic disorder in the advanced stage of chronic renal disease, i.e. prothrombotic versus bleeding tendency, is not completely understood. Abnormal platelet function in patients with renal failure is not caused by high concentrations of urea, although the presence of fibrinogen fragments may prevent binding of normal fibrinogen and formation of platelet aggregates. Hemostatic abnormalities in end-stage kidney disease may be affected, to some extent, by the choice of renal replacement therapy. Patients on hemodialysis have an increased risk of thrombotic events, primarily due to the release of thromboxane A2 and adenosine diphosphate into the circulation, as well as platelet degranulation. Some activation of platelets occurs due to the exposure of blood to the roller pump segment, but microbubbles may also play a role. Renal transplantation is the treatment of choice for patients with end-stage renal disease. Immunosuppressive therapy is associated with an increased risk of thromboembolic complications. Additional research is required to identify the potential benefits of different immunosuppressive therapies in relation to platelet aggregation, keeping in mind the long- term need for immunosuppression in renal transplant patients.
    Acta clinica Croatica 12/2013; 52(4):472-7. · 0.28 Impact Factor
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    ABSTRACT: Rhabdomyolysis induced acute renal failure is a rare postoperative complication, particularly aft er neurosurgical operations. On the other hand, complex and specifi c neuroanesthesia conduction exposes patients to many risk factors. We report a rare case of acute renal failure triggered by asymptomatic rhabdomyolysis in a healthy male patient aft er frontotemporal craniotomy. Despite all applied intensive care measures, the patient’s clinical status exacerbated and he died aft er one month. Conclusion: Rhabdomyolysis in neurosurgical patients is more frequent than expected. Clinical picture varies from the asymptomatic to extremely elevated creatine kinase levels. Associated with other perioperative risk factors, the development of acute renal failure is sometimes unavoidable.
    Neurologia croatica: glasilo Udruzenja neurologa Jugoslavije = official journal of Yugoslav Neurological Association 06/2013; 62(Suppl2):21-26.
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    ABSTRACT: Epidermolysis bullosa is a rare genetic hereditary disease characterized with mechanobullous dermatosis. Except cutaneous, these patients have various extracutaneous manifestations and some types of epidermolysis bullosa comprise almost all organ systems. Because of prolonged life span, chronic renal insufficiency has become an important cause of morbidity and death in these patients. Establishment of functional vascular dialysis access is a great challenge for both the doctors and the patients. Multidisciplinary approach is essential. We present a case of successful establishment of dialysis access via Tesio catheter in a young woman suffering from epidermolysis bullosa dystrophica Hallopeau-Siemens and end-stage renal disease. Since then, the Tesio catheter inserted via the right internal jugular vein has been the functional mean of dialysis. The patient was given the opportunity to lead a quality and active life in spite of disabling disease. Several cases of successful dialysis access establishment with dialysis catheters via central veins have been reported. We report the successful establishment of long-term dialysis access via Tesio catheter and suggest this approach as ideal for these patients. This is the first report dealing with vascular access in this group of patients.
    Hemodialysis International 04/2012; · 1.44 Impact Factor
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    ABSTRACT: Delirium is a common problem in intensive care patients, frequently underdiagnosed and resulting in prolonged hospital stay and a high risk of morbidity and mortality. On the other hand, reversibility of the condition points to the importance of prevention, early diagnosis and immediate therapy. Management strategy is directed to nonpharmacological interventions as preventive measures and pharmacological treatment, which includes typical and atypical neuroleptics. Delirium management includes haloperidol as the first line medication, but also olanzapine and risperidone as atypical neuroleptics. Benzodiazepines are used in delirium caused by alcohol withdrawal.
    Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 03/2012; 66(1):49-53.