Many papers have been published investigating the effects of intraoperative mechanical ventilation on the incidence of intra- and postoperative respiratory complications. The potential advantages of protective pressure over volume-controlled ventilation mode during laparoscopic surgery have yet to be proven. This study included 60 patients aged between 18 and 70 with ASA score 1-3, body mass index (BMI) ≤35 kg/m2, and without prior history of chronic respiratory diseases, who were scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were assigned randomly to protective pressure or volume-controlled mechanical ventilation mode. The initial results showed no significant differences in respiratory and hemodynamic parameters between the groups. Comparison of patients with BMI ≥25 showed significantly lower peak inspiratory pressure (Ppeak) at 15 (18.52 vs. 21.83 cm H2O, p=0.022), 30 (18.73 vs. 21.83 cm H2O, p=0.009) and 45 (18.94 vs. 22.667 cm H2O, p=0.010) minutes after tracheal intubation in the pressure-controlled ventilation (PCV) group. Other measured parameters were of similar characteristics. It is concluded that PCV and volume-controlled ventilation were equally effective in maintaining adequate ventilation, oxygenation and hemodynamic stability in the groups of patients observed. However, comparison of obese patients revealed some advantages of PCV which, given the present pace of change, should be additionally investigated.

This study was conducted with Croatian fourth grade students (N=691) that were divided into two groups. The characters presented in vignettes had some type of stigmatizing feature (e.g., Roma nationality, wheelchair usage, or being overweight) in the experimental group, while these features were left out in the comparison group. The first goal was to examine the impact of each stigmatizing feature on the non-acceptance of the described characters. The second goal was to analyze the relationship between the non-acceptance of the stigmatized character and children's established contact with people with similar features, as well as the relationship between the afore-mentioned and the perceived attitudes of parents and friends. Roma ethnicity had a significant influence on non-acceptance of the character, while contact was related to an increase in the level of non-acceptance of the Roma character. Negative perceived opinions of friends regarding individuals with stigmatizing features (regardless of the type) were related to a lower level of acceptance of that character.

Background: This study aimed to determine the potential advantages of midazolam co-induction with general anesthesia (GA) over the use of propofol alone.Methods: We conducted a randomized, placebo-controlled, single-blinded clinical trial of 102 patients, aged 18 to 65, American Society of Anesthesiologists II and III, who underwent elective laparoscopic gallbladder surgery. Patients were randomly divided into 3 groups: the placebo group (C) received 1 mL of 0.9% saline intravenously and the test groups received intravenous midazolam at doses of 0.03 mg/kg (M1) or 0.06 mg/kg (M2) before induction of GA. We assessed effects of midazolam co-induction on arterial pressure and heart rate (HR) in the early stage of GA prior to surgical incision and effects on perioperative and postoperative glycemia and cortisol levels. Systolic/mean/diastolic (SAP/MAP/DAP) arterial pressure and HR were measured 4 times (preoperative, on the third, sixth and ninth minute after atracurium administration). Cortisol was measured on 3 occasions (preoperatively, 60 minutes after surgical incision, and the following morning) and glucose on 4 occasions (preoperatively, 15 and 60 minutes after incision, and the following morning). We also assessed the incidence of postoperative anxiety, postoperative nausea and vomiting (PONV), and propofol requirement for induction.Results: SAP/MAP/DAP were significantly higher in M2 immediately after induction compared to the other study groups (P = .002/.004/.013). Midazolam co-induction led to a significant reduction in postoperative anxiety (P = .03), reduced cortisol concentration 60 minutes after surgical incision (P < .001) and propofol requirements (P < .001). Conclusion subsections:Midazolam co-induction prevented a marked decline in SAP/MAP/DAP immediately after induction of GA, led to reduced postoperative anxiety and cortisol response to surgery, and reduced propofol requirements for induction.Abbreviations: BIS = bispectral index monitoring, C = placebo/control group of patients, COR = cortisol, GA = general anesthesia, GLU = glucose, HR = heart rate, M1 = group of patients that received intravenous midazolam at dose of 0.03 mg/ kg, M2 = group of patients that received intravenous midazolam at dose of 0.06 mg/kg, MAC = minimum alveolar concentration, PONV = postoperative nausea and vomiting, SAP/MAP/DAP = systolic/mean/diastolic blood pressure, SAS = Zung's Self-rating Anxiety Scale, TIVA = total intravenous anesthesia.

Uvod: Cilj je ovog istraživanja utvrditi pojavnost bolničkih infekcija u multidisciplinarnoj jedinici za intenzivno liječenje (JIL) Sveučilišne kliničke bolnice Mostar i ustanoviti koji su patogeni mikroorganizmi najčešći uzročnici istih. Ispitanici i metode: U ovu retrospektivnu studiju uključeni su pacijenti hospitalizirani u JIL-u duže od 48 sati, u razdoblju od 1.1.2017. do 31.12.2017. godine. Za analizu su korišteni uzorci hemokultura, urinokultura i bronhoaspirata koji su uzimani 48 sata nakon prijema bolesnika u JIL. Svi su podaci preuzeti iz informacijskog bolničkog sustava, a za analizu su korištene deskriptivne statističke metode. Rezultati: Od ukupno 644 bolesnika primljenih u JIL u datom razdoblju, 277 je odgovaralo postavljenim kriterijima, od kojih je pak 70 (25,27%) sa stopom 33,3/1000 bolesničkih dana bilo s potvrđenom bolničkom infekcijom (BI). Od navedenih bolesnika, 13 (18,57%) je imalo infekciju dvaju organskih sustava, dok su kod 5 (7,15%) bolesnika klinički uzročnici dokazani u trima organskim sustavima. Prevladavale su infekcije respiratornog sustava (54,84%) – sa stopom 18,3/1000, potom infekcije mokraćnog sustava (26,88%) – sa stopom 8,9/1000, a najrjeđe su dokazane infekcije krvotoka (18,28%) – sa stopom 6,1/1000. Acinetobacter baumannii i Pseudomonas aeruginosa bili su najčešći uzročnici respiratornih infekcija i infekcija krvotoka. Najčešći uzročnici urinarnih infekcija su Enterococcus spp i Candida albicans. Zaključak: Bolničke infekcije značajan su zdravstveni problem koji povećava morbiditet i mortalitet bolesnika, naročito u jedinicama za intenzivno liječenje te je, stoga, potrebno poduzeti značajne mjere kako bi se smanjila njihova učestalost. Prema rezultatima našeg istraživanja, zastupljenost infekcija respiratornog sustava u JIL-u viša je nego u većini drugih sličnih istraživanja.

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