Objective: We evaluated the utility of preoperative midregional (MR) pro-adrenomedullin (proADM) and cardiac troponin T (TnT) for improved detection of patients at high risk for perioperative cardiac events and mortality after major noncardiac surgery. Subjects and Methods: This prospective, single-center, observational study enrolled 79 patients undergoing major noncardiac surgery. After initial clinical assessment (clinical history, physical examination, echocardiogram, blood tests, and chest X-ray), MR-proADM and high-sensitivity TnT (hsTnT) were measured within 48 h prior to surgery by immunoluminometric and electrochemiluminescence immunoassay. Patients were followed by the consulting physician until discharge or up to 14 days in the hospital after surgery. Perioperative cardiac events included myocardial infarction and development or aggravation of congestive heart failure. Data were compared between patients who developed target events and event-free patients. Results: Within 14 days of monitoring, 14 patients (17.72%) developed target events: 9 (11.39%) died and 5 (6.33%) developed cardiovascular events. The average age of the patients was 71.29 ± 6.62 years (range: 55–87). Sex, age, and hsTnT did not significantly differ between groups. MR- proADM concentration was higher in deceased patients (p = 0.01). The upper quartile of MR-proADM was associated with a fatal outcome (66.7 vs. 20.0%, p < 0.01) and with cardiovascular events (64.3 vs. 16.9%, p < 0.01). MR-proADM above the cutoff value (≥0.85) was associated with a fatal outcome (88.9 vs. 20.0%, p < 0.01) and cardiovascular events (71.4 vs. 28.6%, p < 0.01); this association was not observed for hsTnT. Conclusion: Preoperative measurement of MR-proADM provides useful information for perioperative cardiac events in high-risk patients scheduled for noncardiac surgery.

The stage of the disease seem to be the most significant factor in the development of intraoperative ureter and bladder injuries. The stage of the disease, intraoperative bladder injury, diabetes mellitus and postoperative infection of surgical site are the most significant factors in the development of postoperative fistuls.

Ortopedska hirurgija danas predstavlja veliki izazov za anesteziologe sa aspekta stanja pacijenta, tipa operacije, kao i položaja koji pacijent zauzima u toku operacije. U skladu sa trendom porasta gerijatrijske populacije, ortopedski pacijenti su najčešće stari sa brojnim komorbiditetima, ali i mladi, zdravi, najčešće traumatizovani, kod kojih postojanje udruženih povreda ima značajan uticaj na izbor tipa anestezije. Prilikom izbora tipa anestezije kod ortopedskih pacijenata neophodno je da se napravi adekvatna preoperativna procena i priprema i da se sagleda celokupno stanje pacijenta, a ne samo deo od značaja za hirurgiju. U okviru preoperativne pripreme kod ortopedskih pacijenata je najčešće neophodna kardiološka, pulmološka, ali i neurološka evaluacija, zatim nazalni skrining i dekolonizacija, preoperativna priprema kože, kontrola glikemije, kao i primena antibiotske profilakse. Ortopedska hirurgija ima najveći rizik za nastanak venskog tromboembolizma. Pravovremeno započinjanje tromboprofilakse, kao i njen nastavak posle operacije, kod ortopedskih pacijenata je od izuzetnog značaja. Za optimalnu upotrebu adekvatne tromboprofilakse postoji nekoliko objavljenih vodiča sa jasnim preporukama za dnevnu kliničku praksu. Poznavanje specifičnosti operacije, toka hirurgije, kao i položaja koji pacijent zauzima omogućava obezbeđivanje adekvatnih uslova rada uz minimalne gubitke krvi i komplikacije. Smanjenje krvarenja, kako intraoperativno tako i postoperativno, postiže se normovolemijskom hipotenzijom, bledom stazom uz pomoć poveske (touriquet), ali i primenom traneksamične kiseline, bilo sistemski ili lokalno. Kao hirurgija sa velikim postoperativnim zahtevima u analgeziji, u okviru multimodalnog pristupa se sve češće, pored perifernih nervnih blokova, u svakodnevnom radu primenjuje i periartikularno ubrizgavanje lokalnog anestetika. Poznavanje specifičnosti, ali i zahteva ortopedske operacije sa adekvatnom preoperativnom pripremom, iz-Revijalni članak

PurposeOptimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones.Materials and MethodsThis prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement.ResultsThe average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups.ConclusionPre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.