BackgroundHypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension.Material/MethodsThe study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH.ResultsIOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000).ConclusionsIOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.

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We studied the influence of demographic characteristics, comorbidity, and type and duration of surgery and anesthesia on the occurrence of intraoperative hypertension (IOHTA). Logistic regression analyses were used in order to determine the predictors of occurrence of IOHTA. More than 60% of our patients had IOHTA. Multivariate analysis showed that independent predictors for IOHTA were older age, BMI 25 kg/m(2), and hypertension as a coexisting disease. Hypertension is common during thyroid surgery, and a significant number of patients remained hypertensive during the postoperative period.

Background and Aims: The aim of this study was to evaluate potential of prognostic cardiac biomarkers by predicting fatal events during perioperative period and the significance of their increased values in all patients and with coronary artery disease (CAD). Methods: The study included 87 patients who underwent major abdominal and vascular surgery. Blood samples were taken from all patients prior to surgery and levels of high-sensitive troponin T (hsTnT) and N-Terminal Pro B-type natriuretic peptide (NT-proBNP) were measured. It was analyzed how their increased values (above the predefined cutoffs of > 14 ng/L and > 300 pg/mL respectively) was associated with perioperative mortality in both all subjects and in patients with CAD.

Sažetak Uvod: Neuropatski bol je primarno prouzrokovan oštećenjem ili disfunkcijom perifernog ili centralnog nervnog sistema. Centralni tip neuropatskog bola najčešće podrazumeva talamički bolni sindrom, bol povezan sa multiplom sklerozom, bol nakon cerebrovaskularnog insulta i povrede kičmene moždine. Nakon povrede kičmene moždine, kod oko 60% pacijenata dolazi do nastanka neuropatskog bola, koji zahteva dugotrajno lečenje i veliko socio-ekonomsko angažovanje jedne društvene zajednice. Prikaz slučaja: Muškarac star 56 godina, prethodno zdrav, pregledan je u Kabinetu za terapiju bola Kliničkog centra Srbije zbog bolova u nogama i osećaja stezanja u predelu trupa. Bol je prisutan u mirovanju, a pogoršava se prilikom kretanja, jakog intenziteta 7/10 prema NRS. Tokom 2008. godine, prilikom skoka u bazen, došlo je do nastanka kompersivne frakture C7 pršljenskog tela i posledične kvadriplegije. Operisan je, podvrgnut intenzivnom fizikalnom tretmanu, nakon čega se u potpunosti oporavila motorna funkcija ruku sa delimičnim senzornim deficitom. Detaljnim neurološkim pregledom je utvrđeno prisustvo neuropatskog bola u predelu trupa, sa najizraženijim simptomima hiperalgezije, disestezije i hiperpatije u predelu T4-L1 dermatoma, uz minimalno očuvan senzibilitet. Samo je transdermalna primena fentanila imala pozitivan terapijski efekat, sa tendencijom povećanja doze, ali sa perzistiranjem bezbolnog osećaja stezanja. Takođe, primenjena je infuzija kombinacije lidokaina i ketamina, sa privremeno dobrim terapijskim učinkom. Sada, pacijent i dalje bol kupira transdermalnim fentanilom, baklofen tabletama i fizikalnim tretmanom. Diskusija: Lečenje neuropatskog bola predstavlja veliko socio-ekonomsko opterećenje i za razvijene države, zbog toga što ne postoji dobar dugotrajan terapijski učinak konvencionalne farmakoterapije. Terapija neuromo-Sumarry

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 χ 2 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.

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