Acta clinica Croatica
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Management of difficult airway is one of the most challenging tasks for anesthesiologists, and failure of securing it could have fatal consequences. We must be prepared to deal with problems in management of difficult airway at any time. ⋯ An anesthesiologist must be aware of the possibility of both situations to arise and preparations must be taken to deal with such cases and improve the safety of our patients. Practice guidelines are systematically developed recommendations that help anesthesiologists in the management of difficult airway.
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Acta clinica Croatica · Sep 2012
Review Case ReportsPostintubation tracheal injuries--case series and literature review.
SUMMARY - Post-intubation tracheal injury is a rare and potentially fatal complication. The most common causes are overinflation ofendotracheal tube cuffs and multiple intubation attempts in emergency cases. The diagnosis is based on clinical and radiological suspicion of tracheal injury confirmed by fiberoptic bronchoscopy. ⋯ We present three cases ofpost-intubation tracheal injury. In two cases, the patients were treated conservatively; in the third case, the patient died from asphyxia caused by thrombus occlusion of the trachea after a longitudinal tracheal lesion. Pre-anesthetic examination did not indicate any possibility of difficult intubation in any of the patients; however, in one of the patients admitted through the emergency department, emergency intubation was performed.
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Acta clinica Croatica · Sep 2012
ReviewNeuroplasticity mechanisms in the pathophysiology of chronic pain.
Chronic pain is a widespread healthcare problem with great impact on mental health, professional and family life of the patient. It can be a consequence of many disorders; however, its pathogenesis has not yet been fully understood. Neuroplasticity is the ability of the nervous system to adapt to different changes and it is present throughout life, not only in prenatal period, infancy and childhood. ⋯ These changes occur at the level of brain cortex as well at peripheral nerves and receptors. This review summarizes a significant portion of literature dealing with neuroplasticity processes in well known chronic pain conditions such as migraine, chronic posttraumatic headache, low back pain, fibromyalgia, and others. The relevance of this topic lies in providing a new insight in the pathophysiology of chronic pain, while also offering a possibility of new therapeutic approaches including not only pharmacological agents.
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Acta clinica Croatica · Sep 2012
Randomized Controlled TrialExtubation after anaesthesia: a randomised comparison of three techniques.
The mode of ventilation used during awake extubation has not previously been studied. We conducted a randomised controlled trial comparing spontaneous respiration, intermittent positive pressure ventilation, and pressure support ventilation (each n = 13) for incidence and severity of peri-extubation complications following routine elective surgery. ⋯ Other peri-extubation complications and time to extubation following cessation of anaesthesia were not significantly different across the three groups. We suggest that the use of pressure support ventilation for awake extubation may offer an advantage over spontaneous and intermittent positive pressure ventilation extubation strategies.
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Acta clinica Croatica · Sep 2012
Case ReportsRichter type of incarcerated obturator hernia: misleading all the way.
Obturator hernia is a rare type of abdominal hernia where herniation occurs through the obturator canal. It develops predominantly in elderly underweight women. It has unspecific early symptoms, which is the reason these hernias are usually discovered only after they have become incarcerated. ⋯ The patient recovered without complications. Obturator hernia, due to its rarity and unspecific early symptoms, can still be misleading even to the most experienced surgeons. Delayed diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.