Browsing by Author "Budić, Ivana (16548855200)"

Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and func tional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient. During the preoperative assessment, the risk-benefit ratio should be estimated and preoperative plan established in order to optimize the preoperative status. An anaesthesiologist must also understand pharmacology of drugs being used and should tailor anaesthetic management to the type of surgery. An interdisciplinary team approach is the cornerstone for the safe delivery of anaesthesia to this paediatric patient population. The team should comprise an anesthesiologist, a paediatric cardio logist, a surgeon, a cardio-surgeon and a neonatologist. This re view is meant to explain the classification of congenital heart diseases and to equip the anaesthesiologist with the necessary information about preoperative assessment, anaesthesiology management, monitoring tools important for the safe non-cardiac surgery procedures as well as therapeutic strategies during the postoperative period.

Due to the increasing incidence of terminal illnesses in children, there is great urgency within pediatric medicine to give these patients the best palliative care possible. The main focus of palliative care is to alleviate suffering resulting from the psychophysical condition of the child, which is mostly due to physical pain. The first phase of managing pain in palliative care is quantifying and qualifying pain levels, although this is sometimes difficult to do with pediatric patients. In addition to implementing strategies that alleviate or remove pain for patients, it is also crucial to give patients and their families a feeling of full control over pain. In practice, non-pharmacological and pharmacological methods of analgesia are present. Pharmacological methods include non-opioid and opioid analgesics, followed by co-analgesics as well as methods of regional anesthesia. In order to give these patients the best care possible, it is necessary that the approach be individual, multimodal, multidisciplinary, and considerate of every detail. © 2020, Serbia Medical Society. All rights reserved.

Introduction/Objective Acute appendicitis is one of the most common surgical conditions in children that may be followed by inflammatory postoperative complications. The aim of this study was to determine the association of the preoperative levels of C-reactive protein (CRP) and procalcitonin (PCT) and occurrence of inflammatory postoperative complications in children with appendicitis. Methods Fifty-four patients were separated into two groups. The first group contained patients with uncomplicated appendicitis (UA) whereas the second group comprised patients with complicated appendicitis (CA). Clinical and laboratory parameters in preoperative period were used for prediction of complications after open appendectomy in children. Results Patients with CA had significantly higher values of rectal temperature (p < 0.05), longer length of fever (p < 0.001), CRP (p < 0.001), PCT (p < 0.001), longer duration of stay at the intensive care unit (ICU) (p < 0.001), and prolonged hospitalization (p < 0.001) than the UA group. In the CA group, 41.93% had postoperative complications; these patients also had longer duration of fever (p < 0.05), higher level of CRP (p < 0.05), and prolonged hospitalization (p < 0.01) compared to patients in the CA group without complications. Preoperative cut-off values of CRP and PCT (75.8 mg/l and 0.36 ng/ml, respectively) pointed towards higher probability for development of postoperative complications. Rectal temperature and duration of fever had predictive influence in determination of postoperative complications in the CA group. Conclusion The cut-off values of preoperative levels of CRP and PCT were able to discriminate the subset of patients with higher risk for postoperative complications. Rectal temperature and duration of fever had predictive influence on the occurrence of postoperative complications, while other clinical and laboratory parameters were not able to predict appearance of the complications after open appendectomy in children. © 2017, Serbia Medical Society. All rights reserved.

“Refeeding syndrome” is described in the literature as a range of metabolic and electrolyte disorders that result from starting nutritional rehabilitation in malnourished patients. Without a universally accepted definition, data on “refeeding syndrome” incidence are heterogeneous. In most cases, a clinician will subjectively identify “refeeding syndrome,” many authors have developed their purposes and criteria for it in their studies. Using the PubMed database and the appropriate filters (“refeeding syndrome”-related terms: refeeding syndrome, pediatrics, child, nutrition support, nutrition assessment, malnutrition), a search of the published literature was conducted. The American Society for Parenteral and Enteral Nutrition’s 2020 recommendations are the only guidelines for identifying children with or at risk for “refeeding syndrome”. High-quality scientific evidence regarding the clinical syndrome is absent, so we need further research in all “refeeding syndrome”-related areas, from validation to better identification of risk factors, definitions of “refeeding syndrome,” and standardization of treatment protocols. For now, clinicians must remain vigilant to protect patients from the potentially devastating consequences of the “refeeding syndrome.”. © 2024, Serbia Medical Society. All rights reserved.

Moebius syndrome is a rare nonprogressive congenital neurological disorder with a wide range of severity and variability of symptoms. This diversity is a consequence of dysfunction of different cranial nerves (most often facial and abducens nerves), accompanying orofacial abnormalities, musculoskeletal malformations, congenital cardiac diseases, as well as specific associations of Moebius and other syndromes. The authors present anesthesia and airway management during the multiple tooth extraction surgery in a 10-year-old girl with Moebius syndrome associated with Poland and trigeminal trophic syndromes.

Burns are the eleventh leading cause of deaths in childhood and the fifth most common cause of non-fatal childhood injury, and most often occur in children under 4. 80% to 90% of all severe burns occur in low to middle income countries. Anaesthesiologists are crucial members of the multi-disciplinary team caring for children with burns. Provision of adequate analgesia, sedation, anesthesia and intensive care treatment are roles of anaesthesiologists and non-physician anaesthetists. There are several anaesthetic challenges with managing the child with burns such as a potential difficult airway, challenging intravascular line placement, water and electrolyte disturbances, altered temperature regulation, sepsis, cardiovascular and respiratory insufficiency, altered pharmacokinetic and pharmacodynamics pathways. The majority of critical adverse events in burn injured patients are associated with the airway and hemodynamic instability. The specific anaesthetic technique required depends on the individual patient pathophysiology condition. With the progress in burn care trauma protocols and with the development of multidisciplinary teams at special burn units, outcomes have improved over the past two decades. This review provides insights into existing therapeutic approaches for the management of paediatric burns. © 2023, World Federation of Societies of Anesthesiologists. All rights reserved.

The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice. © 2018 John Wiley & Sons Ltd

Introduction/Objective Pain is a disturbing experience associated with existing or potential tissue damage, with a sensory, emotional, cognitive, and social component. The aim of this study was to show the efficiency of regional anesthetic techniques in postoperative pain in children. Methods The retrospective cohort study was conducted on a group of 564 pediatric patients during the period from 2013 to 2016. Types of regional anesthesia were classified into the following six groups: caudal, epidural, spinal block, upper limb blocks, lower limb blocks, and truncal nerve block. From statistical methods, we used descriptive statistical methods of absolute and relative numbers, measurements of variability, central tendencies for numerical features, and methods of inferential statistics. We used the ?2 test for the attributive features of observations. Results In relation to the postoperative time when an analgesic was required, a statistically significant difference was observed in the age of children (p = 0.000), disease diagnosis (p = 0.000), type of block (p = 0.000), type of local anesthetic (p = 0.000), and type of anesthesia or sedation preoperatively (p = 0.005). Conclusion Postoperative analgesia was most needed by older children and children who were awake during surgery. Children with injuries and tumors need postoperative analgesia the earliest. The longest postoperative analgesia was recorded in patients who received caudal block. The longest postoperative analgesia can be seen in patients who received levobupivacaine, bupivacaine or levobupivacaine combined with lidocaine to perform the block. © 2019, Serbia Medical Society. All rights reserved.