Sepsis is a significant health problem, considering that, annually, over 20 million people fall ill from sepsis. Despite the significant development of medicine in recent decades, the mortality rate of sepsis is exceptionally high (about 26%). The definition of sepsis developed together with the understanding of the mechanism of sepsis. At the beginning of the 1990s, the first definition of sepsis was created, according to which sepsis was defined as systemic inflammatory response syndrome (SIRS), with the presence of suspicion or evidence of infection. Due to many inadequately diagnosed patients with sepsis, another definition was created, according to which sepsis is defined as a clinical syndrome. As the result of the lack of clarity of the previous definitions and the new information on the pathophysiological process of sepsis, a third definition of sepsis was developed in 2016. According to this definition, sepsis is a life-threatening condition based on organic dysfunction resulting from the body's inappropriate response to infection. Septic shock manifests as circulatory, cellular and metabolic instability. It is characterized by a serum lactate level higher than 2 mmol/l and hypotension, which requires vasopressor therapy after the administration of intravenous solutions. This definition of sepsis and septic shock enables early recognition and treatment of patients with sepsis, which are critical steps in reducing the incidence and mortality from this disease.
Introduction/Objective. Despite frequent side effects such as hypotension,
spinal anesthesia (SA) is still one of the best anesthetic methods for
elective cesarean section (CS). Intermittent, oscillometric, non-invasive
blood pressure monitoring (NIBP) frequently leads to the missed hypotensive
episodes. Our goal was to compare continuous non-invasive arterial pressure
(CNAP) monitoring with NIBP in the terms of efficiency to detect
hypotension. Methods. In this study, we compared CNAP and NIBP monitoring
for hypotension detection in 76 patients divided into two groups of 38
patients treated with ephedrine (E) or phenylephrine (P), during 3 min
intervals, starting from SA, by the end of the surgery. Results. In group
E, significantly lower mean systolic blood pressure (SBP) values with CNAP
compared with NIBP (p = 0.008) was detected. CNAP detected 31 (81.6%)
hypotensive patients in E group and significantly lower number 20 (52.6%)
with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%)
and NIBP, only 18 (47.3%), p = 0.001. CNAP detected significantly higher
number of hypotensive intervals in E and P groups (p < 0.001). Umbilical
vein pH was lower within hypotensive compared with normotensive patients in
E and P groups, with CNAP and NIBP, respectively (p < 0.001, p = 0.027 in E,
and p = 0.009, p < 0.001, in P group). Conclusion. CNAP is much more
efficient in hypotension detection for CS during SA, which allows faster
treatment of hypotension, thus improving fetal and maternal outcome.
Napredak minimalno invazivne hirurgije rezultirao je smanjenjem postoperativnih komplikacija, doprineo boljoj kontroli bola, skraćenju hospitalizacije i bržem oporavku pacijenata. Anestezija za endoskopske operacije u ginekologiji se odnosi na histeroskopske i laparoskopske hirurške procedure. Danas se ovim operacijama podvrgavaju pacijentkinje svih uzrasta, uz brojna prateća oboljenja. Specifi čnosti novih hirurških tehnika uslovljavaju čitav niz patofi zioloških promena u organizmu žene u toku trajanja procedure koje savremena anesteziologija mora dobro da poznaje i kontroliše izborima: tehnika anestezije, mehaničke ventilacije, medikamentima i različitim manevrima.
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