Acta clinica Croatica
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Acta clinica Croatica · Mar 2016
ReviewCHALLENGES OF OBSTETRIC ANESTHESIA: DIFFICULT LARYNGEAL VISUALIZATION.
Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. ⋯ Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.
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Acta clinica Croatica · Mar 2016
ReviewTHE INCIDENCE OF JACKAL BITES AND INJURIES IN THE ZAGREB ANTI RABIES CLINIC DURING THE 1995-2014 PERIOD.
Rabies is a zoonotic disease (a disease transmitted to humans from animals) that is caused by a virus. The disease affects domestic and wild animals, and is spread to people through close contact with infectious material, usually saliva, via bites or scratches. Rabies is present on all continents with the exception of Antarctica, but more than 95% of human deaths occur in Asia and Africa. ⋯ When the imported case is excluded, the incidence was 0.0055%. Accordingly, it is concluded that jackal bites and injuries are exceptionally low and that they pose no risk for patients who present routinely to the Zagreb Anti Rabies Clinic. Therefore, it is justified that jackal as an animal species be classified in the group of 'other animals', when officially reported.
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Acta clinica Croatica · Mar 2016
Case ReportsBILATERAL PNEUMOTHORAX AS A COMPLICATION OF PERCUTANEOUS TRACHEOSTOMY: CASE REPORT.
Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. ⋯ Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.
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Acta clinica Croatica · Mar 2016
Comparative Study Observational StudyEARLY VERSUS LATE PERCUTANEOUS TRACHEOTOMY IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE SINGLE CENTER OBSERVATIONAL STUDY.
Despite decades of experience in tracheotomy, there still exists a controversy over its ideal timing. The aim of our study was to compare the impact of early and late percutaneous tracheotomy in terms of their ability to reduce mechanical ventilation duration and length of stay in Intensive Care Unit, as well as the frequency of ventilator-associated pneumonia and mortality rates in tracheotomized patients. This retrospective observational study indicated that early tracheotomy in surgical and neurosurgical patients was associated with a reduced duration of mechanical ventilation and reduced length of stay in Intensive Care Unit, but was unable to reduce the frequency of ventilator-associated pneumonia and mortality. The reason behind the shorter duration of mechanical ventilation and shorter length of stay in Intensive Care Unit in the early tracheotomy arm was shorter duration of mechanical ventilation carried out prior to tracheotomy, while the duration of mechanical ventilation and the length of stay in Intensive Care Unit after tracheotomy were similar in both groups, suggesting that the procedure itself and not its timing influenced the duration of mechanical ventilation and the length of stay in Intensive Care Unit of tracheotomized patients.
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Acta clinica Croatica · Mar 2016
Observational StudyPREDICTORS OF DIFFICULT AIRWAY MANAGEMENT IN THYROID SURGERY: A FIVE-YEAR OBSERVATIONAL SINGLE-CENTER PROSPECTIVE STUDY.
Difficult tracheal intubation (DI) is more common in thyroid than in other surgical branches due to thyromegaly. Proper preoperative airway evaluation is necessary in order to reduce the potential numerous complications. The study examined the incidence of DI in thyroid surgery and the influence of tracheal dislocation and other risk factors on DI. ⋯ Neck circumference and small neck length had highest sensitivity. Previous DI had highest specificity. Thyromegaly, if causing tracheal dislocation and/or stenosis, represents a significant DI predictor, not individually, but in combination with other factors.