Browsing by Author "Simić, Dušica (16679991000)"

Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood. It is manifested by a sudden occurrence of three or more watery or loose stools per day lasting for seven to 10 days, 14 days at most. It mainly occurs in children until five years of age and particularly in neonates in the second half-year and children until the age of three years. Its primary causes are gastrointestinal infections, viral and bacterial, and more rarely alimentary intoxications and other factors. As dehydration and negative nutritive balance are the main complications of AD, it is clear that the compensation of lost body fluids and adequate diet form the basis of the child’s treatment. Other therapeutic measures, except antipyretics in high febrility, antiparasitic drugs for intestinal lambliasis, anti-amebiasis and probiotics are rarely necessary. This primarily regards uncritical use of antibiotics and intestinal antiseptics in the therapy of bacterial diarrhea. The use of antiemetics, antidiarrhetics and spasmolytics is unnecessary and potentially risky, so that it is not recommended for children with AD. © 2015, Serbia Medical Society. All rights reserved.

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.

Introduction Idiopathic ulcerative colitis (IUC) represents a rare disease of childhood. It usually occurs at age over 10 years, and below that exceptionally rarely. Objective The aim of the paper was to analyze the clinical signs, symptoms and therapeutic procedures in children with IUC. Methods The aims of the paper were based on a sample of 17 children (11 male and 6 female, mean age 11.90±3.50 years; range 3.8-17.5 years) with IUC. The disease diagnosis was based on characteristic endoscopic and pathohistological findings. Results The basic signs of the disease involved chronic mucosal haemorrhagic diarrhoea which was confirmed in 16 of 17 patients, with body weight deficiency (10), recurrent abdominal pain (6), fever (5), slowed-down maturation (5), marked anorexia (4), and tenesmus (3). Two patients had recurrent aphthous stomatitis, 2 anal fissures, 2 arthralgia, one autoimmune hepatitis and one pyoderma gangrenosum. None of the children had longitudinal growth retardation. Elevated sedimentation rate and C-reactive protein in blood were registered in 11, sideropenia in 10, anaemia in 6 and hypoalbuminemia in 3 patients. The remission of proctosigmoiditis and left-sided colitis was achieved with aminosalicylates, and of pancolitis with the combination of aminosalicylates and glucocorticoids, except in cases of steroid-dependent colitis, which additionally required azathioprine. Conclusion The main signs of IUC in children are chronic mucous haemorrhagic diarrhoea, body weight loss and sideropenic anaemia, while the basic therapy consists of aminosalicylates, and in more severe cases of the disease the initial use of glucocorticoids and later azathioprine.

[No abstract available]

SUMMARY – The ultrasound-guided erector spinae plane (ESP) block is a novel interfascial plane block technique providing analgesic effects in different localizations of the body, in accordance with the level of administration. Although ESP block is usually performed in the thoracic region in pediatric patients, it is possible to achieve ESP block in the lumbar region as well. Postoperative pain management is essential in patients undergoing operative hip treatment, one of the most common procedures in pediatric orthopedic surgery. We report on a case of effective intraoperative analgesia achieved by ultrasound-guided lumbar ESP block and another case of effective intra-and postoperative analgesia accomplished with perineural catheter placement in addition to lumbar ESP block, both performed in children surgically treated for developmental hip disorders. © 2021, Dr. Mladen Stojanovic University Hospital. All rights reserved.

Food allergy represents a highly up-to-date and continually increasing problem of modern man. Although being present in all ages, it most often occures in children aged up to three years. Sensitization most often occurs by a direct way, but it is also possible to be caused by mother’s milk, and even transplacentally. Predisposition of inadequate immune response to antigen stimulation, reaginic or nonreaginic, is of nonselective character so that food allergy is often multiple and to a high rate associated with inhalation and/ or contact hypersensitivity. Also, due to antigen closeness of some kinds of food, cross-reactive allergic reaction is also frequent, as is the case with peanuts, legumes and tree nuts or cow’s, sheep’s and goat’s milk. Most frequent nutritive allergens responsible for over 90% of adverse reactions of this type are proteins of cow’s milk, eggs, peanuts, tree nuts, wheat, soy, fish, shellfish, crustaceans, and cephalopods. Allergy intolerance of food antigens is characterized by a very wide spectrum of clinical manifestations. Highly severe systemic reactions, sometimes fatal, are also possible. The diagnosis of food allergy is based on a detailed personal and family medical history, complete clinical examination, and corresponding laboratory and other examinations adapted to the type of hypersensitivity and the character of patient’s complaints, and therapy on the elimination diet. A positive effect of elimination diet also significantly contributes to the diagnosis. Although most children “outgrow” their allergies, allergy to peanuts, tree nuts, fish, shellfish, crustaceans, and cephalopods are generally life-long allergies. © 2016, Serbia Medical Society. All rights reserved.

BACKGROUND Decisions by anaesthesiologists directly impact the treatment, safety, recovery and quality of life of patients. Physical or mental collapse due to overwork or stress (burnout) in anaesthesiologists may, therefore, be expected to negatively affect patients, departments, healthcare facilities and families. OBJECTIVES To evaluate the prevalence of burnout among anaesthesiologists in Belgrade public teaching hospitals. DESIGN A cross-sectional survey. SETTING Anaesthesiologists in 10 Belgrade teaching hospitals. MAIN OUTCOME MEASURES Burnout was assessed using Maslach Burnout Inventory-Human Services Survey. RESULTS The response rate was 76.2% (205/272) with the majority of respondents women (70.7%). The prevalence of total burnout among anaesthesiologists in Belgrade teaching hospitals was 6.34%. Measured level of burnout as assessed by high emotional exhaustion, high depersonalisation and low personal accomplishment was 52.7, 12.2 and 28.8%, respectively. More than a quarter of the studied population responded in each category with symptoms of moderate burnout. We detected that sex, additional academic education, marital status and working conditions were risk factors for emotional exhaustion and depersonalisation. Ageing increased the likelihood of burnout by 21.3% with each additional year. Shorter professional experience and increased educational accomplishment increased the risk of total burnout by 272%. CONCLUSION Burnout rates in Belgrade teaching hospitals among anaesthesiologists are higher than in foreign hospitals. Emotional and/or physical breakdowns can have serious effects when these individuals care for patients in extremely stressed situations that may occur perioperatively. Causes for burnout should be examined more closely and means implemented to reverse this process. © Copyright 2016 European Society of Anaesthesiology. 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.

Surgical procedure causes multisystem stress response reactions. The aim of this study was to assess whether gender has an impact on the level of neuroendocrine response to surgical stress and intensity of postoperative pain in children undergoing inguinal hernia repair surgery, as well as satisfaction of their parents with preoperative and postoperative care. The study included 60 children aged 3-6 years, all of them the only child in the family. All children included in the study were categorized as American Society of Anesthesiologists PS Class I, and divided into two groups: group 1 composed of 30 boys and group 2 composed of 30 girls. After oral premedication with midazolam, general anesthesia with endotracheal intubation was performed in all patients. Ketorolac, 1 mg.kg-1, was administered for postoperative analgesia. Serum cortisol was measured in all children preoperatively and postoperatively.The quality of postoperative analgesia was evaluated by Wong-Baker (FAC-ES) scale, along with parental satisfaction. Male children who were the only child in the family had stronger neuroendocrine response to surgical stress and stronger intensity of postoperative pain. The parents of the girls expressed greater satisfaction with preoperative and postoperative care. © 2019, Klinicka Bolnica Sestre Milosrdnice. All rights reserved.

Introduction Ileostomy represents a necessary procedure to solve various surgical diseases in children. As the result of increased fluid loss and colonic exclusion in its regulation, it is often followed, particularly during the first months after birth, by chronic dehydration and failure to thrive. Objective The aim of the paper was to present our experience related to the application of oral rehydration solution (ORS) to compensate the intestinal loss of water and electrolytes in infants with ileostomy. Methods Treatment was performed with ORS containing 65 mmol/L of sodium in five infants aged 1.5-8 months (3.8±2.46 months) with dehydration and undernutrition after ileostomy performed in the first five days after birth. Results After rehydration, the continual application of ORS in the daily dosage of 63.90±25.03 ml/kg, i.e. approximately matching the volume of intestinal content elimination (57.00±19.23 ml/kg), resulted in all infants in optimal water and electrolyte homeostasis, and in further course also in the improvement of their nutritional status (p=0.023). Conclusion Our experience indicates that continual application of reduced sodium content of ORS in the approximate equal quantity of intestinal content loss represents the method of choice in water and electrolyte homeostasis maintenance in infants with ileostomy.

The beginnings of pediatric anesthesiology go back to the middle of the 19th century and it is associated with a rural physician Crawford W. Long, MD, who in the 1842 recorded the first case of giving diethyl ether anesthesia to an eight-year-old boy. The start of development of contemporary pediatric anesthesia is considered to be in 1930, which marked two periods of progress. In the first period, anesthesia techniques and accessories adjusted to different children’s ages were developed. In the second period, modern anesthetic medications and supervision were introduced into everyday clinical practice in order to better protect vital organs and their functions in the child’s body. The first multidisciplinary pediatric intensive care unit at the Children’s Hospital of Gothenburg in Sweden was established in 1955. Dr. Branka Mitrović is considered to be the founder of pediatric anesthesiology in Serbia, as she founded the Department of Anesthesiology and Reanimation at the University Children’s hospital in 1955. The history of pediatric regional anesthesia began after its introduction in adults, which occurred after the invention of cocaine in 1884. The Ministry of Health of the Republic of Serbia approved a specialization in pediatric anesthesiology in 2018. The development of pediatric anesthesia is fascinating because it completely followed the development of pediatric surgery. Modern pediatric anesthesiology is entirely prepared to meet the needs of the most complex surgical interventions, as well as the treatment of critically ill children, and significantly contributes to better treatment outcomes of pediatric surgical patients. © 2023, Serbia Medical Society. All rights reserved.

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.

Postoperative analgesia is imperative in the youngest patients. Pain, especially if experienced during childhood, has numerous adverse effects-from psychological, through complications of the underlying disease (prolonged treatment, hospital stay, and increased costs of the treatment) to an increase in the incidence of death due to the onset of the systemic inflammatory response. Peripheral blocks provide analgesia for 12-16 h, and are safer due to rare side effects that are easier to treat. The continuous peripheral block (CPNB) has been increasingly used in recent years for complete and prolonged analgesia of pediatric patients, as well as a part of multidisciplinary treatment of complex regional pain syndrome. It has been shown that outpatient CPNB reduces the need for parenteral administration of opioid analgetics. It has also been proved that this technique can be used in pediatric patients in home conditions. Safety of CPNB is based on the increasing use of ultrasound as well as on the introduction of single enantiomers local anesthetics (ropivacaine and levobupivacaine) in lower concentrations. It is possible to discharge patient home with catheter, but it is necessary to provide adequate education for staff, patients, and parents, as well as to have dedicated anesthesiology team. Postoperative period without major pain raises the morale of the child, parents. and medical staff. © 2018 Simić, Stević, Stanković, Simić, Dučić, Petrov and Milenović.