Medicinski pregled
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Postoperative nausea and vomiting (PONV) and pain are the most common complaints following anesthesia and surgery, and due to negative emotional impact on patients, they cause prolonged postoperative recovery. The incidence of PONV is 20-30% during the first 24 h after anesthesia. Both peripheral and central mechanisms are involved in control of emesis. ⋯ Many factors associated with anesthesia and surgery may affect PONV: patient's age and sex, history of PONV after pervious anesthesia, administration of antiemetics prior to operation, type and duration of operation, type of premedication, induction agent, maintenance agent, reversal of muscle relaxation, treatment of postoperative pain and movement of patients. ANTAGONISTS OF 5-HYDROXYTRYPTAMINE-3 (5-HT3) RECEPTORS: Ondansetron is a competitive serotonin type 3 receptor antagonist important in prevention of PONV. However, if 5-HT 3 receptor antagonists are effective against nausea and vomiting after a variety of anesthetic and surgical procedures, then at last we may have the key to the mechanism of PONV. Prophylaxis with a combination of antiemetic drugs is more effective in prevention of PONV.
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High thoracic epidural anesthesia and analgesia are being increasingly used for coronary artery bypass graft surgery. The reasons for this include excellent perioperative pain control with advantage of early tracheal extubation, improved postoperative pulmonary function, and cardiac protection due to sympthatetic blockade. ⋯ There is strong evidence for beneficial effects of high thoracic epidural anesthesia in patients undergoing surgical myocardial revascularization. However, it is still underutilized in current clinical practice.
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Common carotid artery intima-media thickness (CCA-IMT) measurements are widely used to study atherosclerosis. CCA-IMT is a useful outcome measure in clinical studies and intervention trials because it reflects early stages of atherosclerosis and cardiovascular risk. The present study examined the relationship between common carotid artery intima-media thickness and ischemic brain infarction. ⋯ An increased CCA-IMT was established in all subtypes of IBI and was significantly higher in those with anterior circulation infarctions versus posterior circulation and lacunar infarctions. This study points to importance of noninvasive measurement of CCA-IMT with ultrasonographic techniques as a diagnostic tool for selecting patients at high risk for IBI and identifying different subtypes of ischemic stroke.
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Job stress is a great problem in developed countries of the world, but in Yugoslavia, it is increased due to additional reasons associated with economic crisis in the society. Health services and health workers are in particularly difficult conditions. The aim of this paper was to examine sources and causes of job stress in health workers. ⋯ High sense of responsibility in health workers is a course of job stress.
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Forearm fractures make 13-18% of all injuries of the upper extremities in children. Most of them are older than 6 years. The degree of tolerance is different but children younger than 8 years can tolerate 15-20 degrees of angulation, 45 degrees of inadequate rotation and total displacement. Older children can tolerate angulation of 10 degrees, 30 degrees of inadequate rotation and complete dislocation. ⋯ Based on our experience it is concluded that orthopedic reposition and percutaneous pinning of unstable forearm fractures in children is very easy to perform, duration of intramedullar fixation is relatively short, removal of pins is also very easy without anesthesia and it requires short period of plaster immobilisation. This provides faster rehabilitation and improves quality of life.