Lijec̆nic̆ki vjesnik
-
Sugammadex is a new pharmacological agent for neuromuscular block reversion. It is a cyclic oligosaccharide, a gamma cyclodextrin with lipophylic inner coat that enables forming of stable complexes with steroidal neuromuscular blocking drugs, especially with rocuronium. A physical encapsulation of the relaxants is a novel elimination pathway and it produces fast and complete reversion of both deep and shallow neuromuscular block. ⋯ After the adjusted dose of sugammadex was given, the duration of action of rocuronium can be made as short as that of succinylcholine. This characteristic is especially important in the 'can't intubate, can't ventilate' situation and after surgical procedure was unexpectedly finished. Clinical studies involving more patients are needed to show the real risk-benefit profile and safety in the special patients' populations.
-
Lijec̆nic̆ki vjesnik · Mar 2011
Editorial Practice Guideline[European guidelines on the diagnosis and management of pulmonary embolism].
We report on the 2008 update of Guidelines on the diagnosis and management of acute pulmonary embolism (PE) of the European Society of Cardiology that have been endorsed and recommended by the Croatian Cardiac Society. The guidelines focus on currently available and validated methods of diagnosis, prognostic assessment (prediction of outcome and death risk), treatment of pulmonary embolism and management in specific settings including pregnancy, malignancy, non-thrombotic PE, right heart thrombi, heparin-induced thrombocytopenia, chronic thromboembolic pulmonary hypertension. The novelty of these guidelines is the stratification of PE into high-risk, low-risk and intermediate-risk of PE-related early death, which has important consequences for treatment, rather than the use of misleading terms such as zmassive', zsubmassive' and znon-massive' pulmonary embolism. The anticoagulants remain the mainstay of therapy, with thrombolytic therapy being an therapeutic option in patients with high-risk PE presenting with cardiogenic shock and/or persistent arterial hypotension.