Browsing by Author "Lakićević, Mirko (12647605400)"

The hyomental distance ratio (HMDR) is the ratio between the hyomental distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The objective of the study was to examine the predictive value, sensitivity, and specificity of HMDe, HMDn, and HMDR in predicting difficult endotracheal intubation (DI). A prospec-tive study included 262 patients that underwent elective surgical operations. The following parameters were observed as possible predictors of DI: HMDR, HMDe, HMDn, Mallampati score, and body mass index (BMI). The cut-off points for the DI predictors were HMDe <5.3 cm, HMDn ≤5.5 cm, and HMDR ≤1.2. The assessment that DI existed was made by the anesthesiologist while performing laryngoscopy by applying the Cormack-Lehane classification. DI was present in 13 patients (5%). No significant difference was observed in the frequency of DI with regard to the sex, age, and BMI of the patients. Our research indicated HMDR as the best predictor of DI with a sensitivity of 95.6% and specificity of 69.2%. HMDR can be used in the everyday work of anesthesiologists because HMDR values ≤1.2 may reliably predict DI. © 2016 ABMSFBIH.

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient’s blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068–1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623–0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182–3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232–2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004–1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761–2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB. © 2017, Springer-Verlag GmbH Germany, part of Springer Nature.

Introduction/Objective Intraoperative variations in blood pressure and/or cardiac dysrhythmias (IOVBP/CD) represent one of the most common causes of morbidity and mortality in surgical patients. The aim of the study was to determine the incidence and risk factors for IOVBP/CD in thyroid surgery patients with comorbidities. Methods The study included 1,252 euthyroid patients with ASA 2 and ASA 3 status (American Society of Anesthesiologists – physical status classification) who underwent thyroid surgery. The following risk factors were examined: sex, age, body mass index (BMI), ASA status, admission diagnoses, type of operation, duration of surgery, time under general anesthesia, difficult intubation of trachea, and coexisting diseases – hypertension, cardiomyopathy, cardiac arrhythmias, angina pectoris, diabetes mellitus, kidney disease. The following intraoperative events were recorded: hypertension, severe hypertension, hypotension, and cardiac arrhythmias. We used Pearson χ2 square test, univariate, and multivariate logistic regression for statistical analysis. Results The majority of patients were female (86.3%). In 903 (72.1%) patients IOVBP/CD were detected. The most common problem was intraoperative hypertension (61.4%). Eight risk factors for IOVBP/CD were registered by univariate analysis: advanced age, ASA 3 status, BMI > 25 kg/m², duration of surgery, time under general anesthesia, hypertension, and cardiomyopathy as a coexisting disease. The multivariate regression model identified three independent predictors for IOVBP/CD: age, hypertension, and cardiomyopathy. Conclusion IOVBP/CD are common in thyroid surgery. The most common is intraoperative hypertension. Older age, hypertension, and cardiomyopathy as a coexisting disease are independent risk factors for IOVBP/CD. © 2018, Serbia Medical Society. All rights reserved.