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  1. Article: Analysis of blood pressure changes in patients undergoing total hip or knee replacement in spinal and general anesthesia.

    Kordić, Kresimir / Sakić, Katarina / Oberhofer, Dagmar

    Acta clinica Croatica

    2012  Volume 51, Issue 1, Page(s) 17–23

    Abstract: The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who underwent total hip or knee replacement surgery in the ... ...

    Abstract The aim of this study was to analyze hemodynamic changes in hypertensive and normotensive patients undergoing total hip or knee replacement in spinal and general anesthesia. Eighty patients who underwent total hip or knee replacement surgery in the period between July 2010 and February 2011 at Sveti Duh University Hospital were retrospectively evaluated. Seventeen patients underwent the operation in general anesthesia and 63 patients in regional anesthesia. They were allocated into groups of normotensive (n=24) or hypertensive patients (n=56). The anthropologic and hematologic parameters of normotensive and hypertensive patients were compared, as well as their blood pressures immediately before and during the operation. Blood pressure immediately before anesthesia induction, the highest and the lowest intraoperative blood pressures were recorded. Blood pressure immediately before anesthesia induction was significantly higher in hypertensive patients who underwent the operation in regional anesthesia compared to normotensive patients (158.48 mm Hg vs. 144.71 mm Hg, P<0.01). The highest intraoperative systolic blood pressure was also significantly higher in hypertensive patients operated on in regional anesthesia compared to normotensive patients (161.20 mm Hg vs. 146.76 mm Hg, P<0.01). The difference between the highest and the lowest intraoperative systolic blood pressure was significantly greater in hypertensive patients undergoing the operation in regional anesthesia compared to normotensive patients (46.41 mm Hg vs. 35.88 mm Hg, P<0.05). The results presented in this paper indicate that the fluctuations of intraoperative blood pressure were greater and the highest intraoperative systolic blood pressure was higher in hypertensive compared to normotensive patients undergoing the operation in regional anesthesia. In our study, there were no significant differences in intraoperative blood pressure between hypertensive and normotensive patients who underwent the operation in general anesthesia.
    MeSH term(s) Aged ; Anesthesia, General ; Anesthesia, Spinal ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Blood Pressure ; Female ; Humans ; Hypertension/physiopathology ; Intraoperative Period ; Male
    Language English
    Publishing date 2012-03
    Publishing country Croatia
    Document type Journal Article
    ZDB-ID 1478635-7
    ISSN 0353-9466
    ISSN 0353-9466
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5057: Show issues Location:
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  2. Article: Kako poboljsati transfuzijsko lijecenje bolesnika podvrgnutih ugradnji totalnih endoproteza kuka i koljena?

    Oberhofer, Dagmar / Sakić, Kata / Janković, Sasa / Tonković, Dinko / Vrgoc, Goran

    Lijecnicki vjesnik

    2012  Volume 134, Issue 11-12, Page(s) 322–327

    Abstract: Total hip and knee arthroplasty is associated with significant perioperative blood loss, necessitating often blood transfusions. Because of risks and cost of allogenic blood transfusion and elective types of surgery several alternative methods have been ... ...

    Title translation How to improve perioperative blood management in patients undergoing total hip or knee replacement surgery?.
    Abstract Total hip and knee arthroplasty is associated with significant perioperative blood loss, necessitating often blood transfusions. Because of risks and cost of allogenic blood transfusion and elective types of surgery several alternative methods have been developed to reduce allogenic blood use. We prospectively audited 65 consecutive patients undergoing primary total hip (THR; n = 30) or knee replacement (TKR; n = 35) at our Department of Orthopaedic Surgery which did not use autologous blood collection methods. Total blood loss in THR (1329.7 +/- 364.8 ml) and TKR (1427.3 +/- 660.4 ml) was similar to previously reported and without significant difference between the groups. However, we reported high transfusion rates with 63.3% of THR and 82.6% of TKR patients receiving allogenic blood. Important steps to reduce allogenic blood use would include implementation of restrictive transfusion protocols with a defined hemoglobin value as a transfusion trigger, correction of preoperative anemia with i.v. iron +/- erythropoietin, use of one or more modalities of autologous transfusion (postoperative autotransfusion, preoperative blood donation), pharmacological agents like tranexamic acid (anti-fibrinolytic) and other complementary procedures. There is sufficient evidence in literature about the cost-benefit of certain methods which makes routine use of allogenic blood in THR and TKR surgery unacceptable even at general orthopaedic surgery departments.
    MeSH term(s) Aged ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Blood Transfusion, Autologous ; Erythrocyte Transfusion ; Female ; Humans ; Male
    Language Croatian
    Publishing date 2012-11
    Publishing country Croatia
    Document type English Abstract ; Journal Article
    ZDB-ID 128938-x
    ISSN 1849-2177 ; 0024-3477 ; 1330-4917
    ISSN (online) 1849-2177
    ISSN 0024-3477 ; 1330-4917
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  3. Article: Karotidna endarterektomija u simptomatskih bolesnika u ranoj fazi - naša iskustva.

    Ivkošić, Ante / Trajbar, Tomislav / Budinčević, Hrvoje / Antolić, Stanko / Lojo, Nermin / Oberhofer, Dagmar

    Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti

    2014  Volume 68, Issue 3, Page(s) 289–293

    Abstract: Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an ... ...

    Title translation Early carotid endarterectomy in symptomatic patients - our experience.
    Abstract Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlin's sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61 %) patients had TIA symptoms with verified significant ACl stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid endarterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely.
    MeSH term(s) Carotid Artery, Internal/surgery ; Early Diagnosis ; Endarterectomy, Carotid/statistics & numerical data ; Female ; Humans ; Ischemic Attack, Transient/diagnosis ; Ischemic Attack, Transient/surgery ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Secondary Prevention ; Stents/adverse effects ; Stroke/etiology
    Language Croatian
    Publishing date 2014-06
    Publishing country Croatia
    Document type English Abstract ; Journal Article
    ZDB-ID 1108025-5
    ISSN 1330-0164 ; 0375-8338
    ISSN 1330-0164 ; 0375-8338
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    Zs.A 342: Show issues Location:
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  4. Article: Nekrotizirajuća infekcija mekih cesti ruke uz razvoj sindroma toksicnog soka--klinicki tijek i lijecenje.

    Oberhofer, Dagmar / Kucisec-Tepes, Nastja / Huljev, Dubravko

    Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti

    2008  Volume 62, Issue 5, Page(s) 505–510

    Abstract: Necrotizing soft tissue infections (NSTI) are uncommon infections associated with considerable morbidity and mortality (20%-40%). They are characterized by rapidly progressive necrosis of soft tissue that primarily involves subcutaneous fat and fascia ... ...

    Title translation Necrotizing soft tissue infection of upper extremity complicated with toxic shock syndrome--clinical presentation and treatment options.
    Abstract Necrotizing soft tissue infections (NSTI) are uncommon infections associated with considerable morbidity and mortality (20%-40%). They are characterized by rapidly progressive necrosis of soft tissue that primarily involves subcutaneous fat and fascia with variable involvement of the overlying skin and muscle. Extensive soft tissue necrosis is often accompanied by systemic toxicity. Establishing the diagnosis in the early stage of the infection can be difficult, which leads to a delay in surgical treatment and a poor outcome. The principles of treatment are early and aggressive surgical debridement, broad spectrum antimicrobial therapy administered empirically and reassessed pending culture and sensitivity results, and intensive care management. We report a case of NSTI of the arm in a 64-year-old female patient caused by group A Streptococcus and Staphylococcus aureus complicated with toxic shock-like syndrome with emphasis on the pathophysiology of toxic shock-like syndrome and treatment modalities. NSTI developed 10 days after a knife cut wound of the thumb. The patient had no significant comorbidity. Treatment included aggressive surgical debridement with removal of necrotic tissue and extensive fasciotomies 24 h of admission, cardiovascular stabilization and monitoring at intensive care unit, and repeat surgical debridement at 72 h of admission. Early triple drug antimicrobial therapy included high-dose clindamycin, which inhibits protein synthesis and bacterial exotoxin production that is responsible for inflammatory response and toxic shock-like syndrome. In addition, the patient received hyperbaric oxygen therapy (8 treatments in total). The above management led to control of the infective process. Prolonged surgical wound care followed by thin split-skin grafting and placement of secondary sutures on day 36 of admission preserved the extremity with good functional and cosmetic result.
    MeSH term(s) Arm ; Female ; Humans ; Middle Aged ; Necrosis ; Shock, Septic/diagnosis ; Shock, Septic/etiology ; Shock, Septic/microbiology ; Soft Tissue Infections/complications ; Soft Tissue Infections/diagnosis ; Soft Tissue Infections/microbiology
    Language Croatian
    Publishing date 2008-12
    Publishing country Croatia
    Document type Case Reports ; English Abstract ; Journal Article
    ZDB-ID 1108025-5
    ISSN 1330-0164 ; 0375-8338
    ISSN 1330-0164 ; 0375-8338
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  5. Article ; Online: Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery.

    Oberhofer, Dagmar / Juras, Josip / Pavicić, Ana Marija / Rancić Zurić, Iva / Rumenjak, Vlatko

    Croatian medical journal

    2012  Volume 53, Issue 6, Page(s) 612–619

    Abstract: Aim: To assess diagnostic value of perioperative procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels in early detection of infectious complications following colorectal surgery.: Methods: This prospective observational study ... ...

    Abstract Aim: To assess diagnostic value of perioperative procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels in early detection of infectious complications following colorectal surgery.
    Methods: This prospective observational study included 79 patients undergoing elective colorectal surgery. White blood cell count, CRP, and PCT were measured preoperatively and on postoperative days (POD) 1, 2, 3, 5, and patients were followed for postoperative complications. Diagnostic accuracy of CRP and PCT values on each day was analyzed by the receiver operating characteristics (ROC) curve, with infectious complications as an outcome measure. ROC curves with the largest area under the curve for each inflammatory marker were compared in order to define the marker with higher diagnostic accuracy.
    Results: Twenty nine patients (36.7%) developed infectious complications. CRP and PCT concentrations increased in the early postoperative period, with a significant difference between patients with and without complications at all measured postoperative times. ROC curve analysis showed that CRP concentrations on POD 3 and PCT concentrations on POD 2 had similar predictive values for the development of infectious complications (area under the curve, 0.746 and 0.750, respectively) with the best cut-off values of 99.0 mg/L for CRP and 1.34 μg/L for PCT. Diagnostic accuracy of CRP and PCT was highest on POD 5, however the cut-off values were not considered clinically useful.
    Conclusion: Serial postoperative PCT measurements do not offer an advantage over CRP measurements for prediction of infectious complications following colorectal surgery.
    MeSH term(s) Aged ; Biomarkers/blood ; C-Reactive Protein/metabolism ; Calcitonin/blood ; Calcitonin Gene-Related Peptide ; Colorectal Surgery ; Early Diagnosis ; Elective Surgical Procedures ; Female ; Humans ; Leukocyte Count ; Luminescent Measurements ; Male ; Middle Aged ; Nephelometry and Turbidimetry ; Postoperative Complications/blood ; Postoperative Complications/diagnosis ; Postoperative Period ; Prospective Studies ; Protein Precursors/blood ; ROC Curve
    Chemical Substances Biomarkers ; CALCA protein, human ; Protein Precursors ; Calcitonin (9007-12-9) ; C-Reactive Protein (9007-41-4) ; Calcitonin Gene-Related Peptide (JHB2QIZ69Z)
    Language English
    Publishing date 2012-12-28
    Publishing country Croatia
    Document type Comparative Study ; Journal Article
    ZDB-ID 1157623-6
    ISSN 1332-8166 ; 0353-9504
    ISSN (online) 1332-8166
    ISSN 0353-9504
    DOI 10.3325/cmj.2012.53.612
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  6. Article: Poslijeoperacijski poremećaji mentalnih funkcija u kardiovaskularnoj kirurgiji.

    Tonković, Dinko / Marinić, Dragan Korolija / Baronica, Robert / Oberhofer, Dagmar / Pavlović, Danijela Bandić / Perić, Mladen

    Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti

    2012  Volume 66, Issue 1, Page(s) 67–72

    Abstract: Postoperative mental disorders are a common complication of cardiovascular surgery, with serious consequences. The main types of postoperative mental disorders include postoperative delirium and postoperative cognitive dysfunction. Their incidence ranges ...

    Title translation Postoperative mental disorders in cardiovascular surgery.
    Abstract Postoperative mental disorders are a common complication of cardiovascular surgery, with serious consequences. The main types of postoperative mental disorders include postoperative delirium and postoperative cognitive dysfunction. Their incidence ranges up to 15%-80%. Postoperative mental disorders may be reversible and irreversible. Although reversible in most cases, postoperative mental disorders are associated with increased mortality, morbidity and increasing costs of treatment. The treatment is usually symptomatic and may be associated with dangerous side effects. Safer and more effective is preventive action. Preoperative preventive action need to recognize, avoid and optimize risk factors. Intraoperative prevention involves maintaining optimal oxygenation of the brain during cardiovascular surgery. For postoperative prevention, multimodal approach is applied. It includes early extubation, early enteral nutrition, early mobilization, regular evaluation of cognitive function, activation of cognitive function and optimal analgesia, which requires teamwork of medical staff who care for patients. Combining all these methods can show promising results in reducing the incidence of postoperative mental disorders as a complication in cardiovascular surgery.
    MeSH term(s) Cardiovascular Surgical Procedures/adverse effects ; Cognition Disorders/etiology ; Cognition Disorders/prevention & control ; Cognition Disorders/therapy ; Delirium/etiology ; Delirium/prevention & control ; Delirium/therapy ; Humans ; Postoperative Complications/prevention & control
    Language Croatian
    Publishing date 2012-03
    Publishing country Croatia
    Document type English Abstract ; Journal Article ; Review
    ZDB-ID 1108025-5
    ISSN 1330-0164 ; 0375-8338
    ISSN 1330-0164 ; 0375-8338
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    Zs.A 342: Show issues Location:
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  7. Article: Upalni pokazatelji u bolesnika nakon operacija debelog crijeva.

    Oberhofer, Dagmar / Rumenjak, Vlatko / Lazić, Jasenka / Vucić, Niksa

    Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti

    2006  Volume 60, Issue 5, Page(s) 429–433

    Abstract: Background and aims: Despite recent advances in surgical techniques and intensive care management, infectious complications and sepsis remain significant problem after abdominal surgery. Therefore, inflammatory parameters were looked for that could help ...

    Title translation Inflammatory indicators in patients after surgery of the large intestine.
    Abstract Background and aims: Despite recent advances in surgical techniques and intensive care management, infectious complications and sepsis remain significant problem after abdominal surgery. Therefore, inflammatory parameters were looked for that could help achieve an early and more reliable diagnosis of postoperative infections. C-reactive protein (CRP) is a nonspecific inflammatory mediator which is significantly increased postoperatively, regardless of the type of operation and the presence or absence of complications. Procalcitonin (PCT), the prohormone of calcitonin, referred to as a marker of sepsis, is increased significantly in severe bacterial and fungal infections. Quantitative PCT measurements in surgical patients have shown that postoperative PCT concentrations depend on the type and extent of surgery. PCT increased most after major abdominal surgery, although PCT concentrations were significantly higher in patients with complications compared to patients with uneventful postoperative course. The aim of the study was to determine PCT concentrations with a rapid semiquantitative PCT-Q test in the early postoperative period after colon surgery and to investigate its potential use in the diagnosis of infectious complications compared to CRP.
    Methods: Thirty-eight adult patients undergoing elective surgery of the intestine were followed up. None of the patients had clinical or laboratory signs of infection preoperatively. Leukocytes, CRP and PCT were determined preoperatively and on postoperative days 1-3 and 5. PCT was measured with the B. R. A. H. M. S PCT-Q semiquantitative test. CRP and PCT measurements in 30 patients with normal recovery were statistically analyzed.
    Results: CRP was significantly elevated postoperatively in all patients at the 4 time points with maximum values on postoperative day 2. There was no difference in CRP values between patients with and without complications. Although PCT concentration was increased in 15 of 30 patients with normal recovery, only mild increase (>0.5-2 ng/L) was recorded in 13, and moderate increase (>2-10 ng/L) in only two patients. PCT increase was most frequently found on postoperative day 1 or 2, and more rarely on postoperative day 3. The number of patients with elevated PCT was significantly higher (8 of 8 patients) in the group with complications, which included postoperative infections in 7 of 8 patients, than in the group without complications.
    Conclusion: In the early postoperative period after major abdominal surgery, CRP is invariably increased and cannot help in recognizing infectious complications. In our study, which included a relatively small number of patients after colon surgery, PCT >2 ng/mL, as measured with semiquantitative PCT-Q test on postoperative days 1-5, or >0.5 ng/ml after postoperative day 3, was rarely recorded in patients with normal postoperative course. We conclude that PCT-Q test can be helpful in the early diagnosis of infectious complications after abdominal surgery.
    MeSH term(s) Aged ; Biomarkers/blood ; C-Reactive Protein/analysis ; Calcitonin/blood ; Calcitonin Gene-Related Peptide ; Female ; Humans ; Infection/diagnosis ; Inflammation Mediators/blood ; Intestine, Large/surgery ; Male ; Postoperative Complications/diagnosis ; Protein Precursors/blood
    Chemical Substances Biomarkers ; CALCA protein, human ; Inflammation Mediators ; Protein Precursors ; Calcitonin Gene-Related Peptide (83652-28-2) ; Calcitonin (9007-12-9) ; C-Reactive Protein (9007-41-4)
    Language Croatian
    Publishing date 2006-12
    Publishing country Croatia
    Document type Journal Article
    ZDB-ID 1108025-5
    ISSN 1330-0164 ; 0375-8338
    ISSN 1330-0164 ; 0375-8338
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  8. Article: Intravenous ketoprofen in postoperative pain treatment after major abdominal surgery.

    Oberhofer, Dagmar / Skok, Jasna / Nesek-Adam, Visnja

    World journal of surgery

    2005  Volume 29, Issue 4, Page(s) 446–449

    Abstract: In recent years considerable attention has been paid to the treatment of postoperative pain, with regard to the favorable effect of adequate analgesia on patient outcome. Multimodal analgesia (e.g., opioids and nonsteroidal anti-inflammatory drugs [ ... ...

    Abstract In recent years considerable attention has been paid to the treatment of postoperative pain, with regard to the favorable effect of adequate analgesia on patient outcome. Multimodal analgesia (e.g., opioids and nonsteroidal anti-inflammatory drugs [NSAIDs] or local anesthetics) is recommended for effective postoperative pain relief. There are few data on the use of NSAIDs in postoperative pain treatment after abdominal surgery. We conducted a randomized, double-blind, placebo-controlled study to assess the analgesic efficacy and safety of ketoprofen after major abdominal surgery. One and nine hours postoperatively patients received 100 mg of ketoprofen i.v. (n = 21) or placebo (n = 22) in addition to a pain-treatment protocol consisting of continuous infusion of tramadol 200 mg and metamizol 5 g over 24 hours with additional 25 mg i.v. tramadol in case of inadequate analgesia. Pain was assessed by numeric rating scale at rest and at deep breath 3, 6, 12, and 24 hours postoperatively and the total dose of tramadol used in the first 24 hours was recorded. Patients in the ketoprofen group had significantly lower pain scores both at rest and at deep breath, at 3 (p < 0.01), 6, and 12 hours (p < 0.05) postoperatively. The 24-hour use of tramadol was significantly lower in the ketoprofen group (p < 0.01), with less nausea and vomiting. There were no bleeding complications or other adverse events related to ketoprofen therapy. The study showed the value of short-term use of ketoprofen to improve the quality of analgesia after major abdominal surgery without significant adverse effects.
    MeSH term(s) Aged ; Analgesics, Opioid/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Digestive System Surgical Procedures ; Dipyrone/administration & dosage ; Double-Blind Method ; Female ; Humans ; Infusions, Intravenous ; Ketoprofen/administration & dosage ; Male ; Middle Aged ; Pain, Postoperative/prevention & control ; Tramadol/administration & dosage
    Chemical Substances Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Tramadol (39J1LGJ30J) ; Dipyrone (6429L0L52Y) ; Ketoprofen (90Y4QC304K)
    Language English
    Publishing date 2005-04
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-004-7612-0
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  9. Article ; Online: Post-intubation long-segment tracheal stenosis of the posterior wall: a case report and review of the literature.

    Nesek-Adam, Visnja / Mrsić, Viviana / Oberhofer, Dagmar / Grizelj-Stojcić, Elvira / Kosuta, Dragutin / Rasić, Zarko

    Journal of anesthesia

    2010  Volume 24, Issue 4, Page(s) 621–625

    Abstract: Tracheal stenosis, a well-known complication of endotracheal intubation and artificial ventilation, is most likely to occur in critically ill patients requiring prolonged mechanical ventilation. Although a rare complication, and despite technological ... ...

    Abstract Tracheal stenosis, a well-known complication of endotracheal intubation and artificial ventilation, is most likely to occur in critically ill patients requiring prolonged mechanical ventilation. Although a rare complication, and despite technological improvements and better patient care in intensive care units, tracheal stenosis still constitutes a serious clinical problem which can also develop after a short period of mechanical ventilation. In this article, we present a very rare case report of a patient who developed a long-segment tracheal stenosis localized at the posterior wall after a relatively short period of endotracheal intubation with a high-volume, low-pressure cuffed endotracheal tube, and a review of the literature.
    MeSH term(s) Adult ; Female ; Humans ; Intubation, Intratracheal/adverse effects ; Tracheal Stenosis/etiology
    Language English
    Publishing date 2010-05-08
    Publishing country Japan
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1107821-2
    ISSN 1438-8359 ; 0913-8668
    ISSN (online) 1438-8359
    ISSN 0913-8668
    DOI 10.1007/s00540-010-0956-8
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  10. Article: Patofizioloski ucinci CO2-pneumoperitoneja u laparoskopskoj kirurgiji.

    Nesek-Adam, Visnja / Mrsić, Viviana / Smiljanić, Aleksandra / Oberhofer, Dagmar / Grizelj-Stojcić, Elvira

    Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti

    2007  Volume 61, Issue 2, Page(s) 165–170

    Abstract: Today, laparoscopic surgery is one of the most important diagnostic and therapeutic tools in general surgery. This minimally invasive procedure requires pneumoperitoneum for adequate visualization and operative manipulation. Carbon dioxide is the most ... ...

    Title translation Pathophysiologic effects of CO2-pneumoperitoneum in laparoscopic surgery.
    Abstract Today, laparoscopic surgery is one of the most important diagnostic and therapeutic tools in general surgery. This minimally invasive procedure requires pneumoperitoneum for adequate visualization and operative manipulation. Carbon dioxide is the most commonly used gas for creating pneumoperitoneum, because of its high diffusibility and rapid rate of absorption and excretion. Certain specific operations that in the past required long hospitalization and were associated with severe postoperative pain and frequent complications are today performed laparoscopically. This minimally invasive technique potentially offers reduced operative time and morbidity, decreased hospital stay and earlier return to normal activities, less pain and less postoperative ileus compared with the traditional open surgical procedures. Because the postoperative benefits are superior to open surgical procedures, laparoscopy is today also used in many high risk patients in advanced age and pre-existent cardiopulmonary and respiratory diseases. However, insufflations of carbon dioxide into the peritoneum may lead to alteration in the acid-base balance, cardiovascular and pulmonary physiology. Although these changes may be well tolerated in healthy patients, in high risk patients they may increase the rate of perioperative complications. Therefore, it is very important that the anesthesiologist thoroughly understands the pathophysiology of carbon dioxide-pneumoperitoneum and treatment of potential complications. In this article, the acid-base balance, cardiovascular and pulmonary changes associated with laparoscopic surgery, and their potential complications and management are discussed based on our experience and literature data.
    MeSH term(s) Carbon Dioxide/adverse effects ; Cardiovascular Physiological Phenomena ; Humans ; Laparoscopy/adverse effects ; Pneumoperitoneum, Artificial/adverse effects ; Respiration
    Chemical Substances Carbon Dioxide (142M471B3J)
    Language Croatian
    Publishing date 2007-04
    Publishing country Croatia
    Document type English Abstract ; Journal Article ; Review
    ZDB-ID 1108025-5
    ISSN 1330-0164 ; 0375-8338
    ISSN 1330-0164 ; 0375-8338
    Database MEDical Literature Analysis and Retrieval System OnLINE

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