[Early complications in surgical treatment of thyroid diseases: analysis of 2100 patients]. / Rane komplikacije operativnog lecenja oboljenja stitaste zlezde: analiza 2100 bolesnika.

Thyroid gland surgery today is not saddled with high incidence of main complications. Miscellaneous surgical institutions with different surgical approach, operative technique and radicality have published reports with great discrepancy in incidence of complications, analyzing them with different methods of diagnosis and result evaluation. In the same way it is well known that higher latitude of operative procedure gave better control of thyroid diseases, but it can be accompanied with more complications. All of that motivate us to analyze complications of operative treatment in our patients under well known criteria, with hypothesis that higher radicality of operative procedure do not increase incidence of complications, and that this incidence is in correlations with results published in world literature. Aim of this nonrandomized study was to analyze results of operative treatment for huge number of consecutively operated patients in our teaching hospital, to analyze and compare results according to group of diseases and operative procedures, and to compare final results with results published in the world literature. Complications of operative treatment were analyzed retrospectively for period 1988-1997 (Group I) and prospectively in period 1998-2002 (Group II). Operations were performed by 20 surgeons and 20 young surgeons during their education. We have analyzed only complications during first 30 days after operation. In Group I there was 1425 patients with 1451 operations (192 thyroid malignancies, 247 hyperthyreosis, 98 reoperations, 13% thyroidectomies and 14.8% lobectomies), with complication rate of 14.3%. Most common complication was recurrent laryngeal nerve injury in 9.3% patients or 6.3% according to number of exposed nerves (nerve at risk), then postoperative hypocalcemia with rate of 4.7% (persistent in 1.3%). In Group II in 675 patients there was 687 operations (96 thyroid malignancies, 111 hyperthyreosis, 35 reoperations, 36.6% thyreoidectomies and 25% lobectomies), with complication rate of 10.7%. Most common postoperative complication was hypocalcemia with 5% rate (persistent in 0.7%), then recurrent laryngeal nerve injury in 4.4% patients or 2.9% according to number of exposed nerves. Incidence of recurrent laryngeal nerve injury in Group II is less frequent than in Group I, highly statistically significant (p < 0.01), while for other complications there is no statistically significant difference. Totally for both groups there was 0.7% tracheotomies, postoperative bleeding in 1.1% of patients, wound hemathoma in 0.5%. wound infections in 0.9%, pneumonia in 0.5%, mortality 0.5% and most common cause of death (8/11) was problem with respiration, Airway obstruction. In Group II complications were less frequent in total thyroidectomies in relation to lobectomy with contra lateral subtotal lobectomy. In both groups and totally incidence of complications was higher in reoperations, in patients with more extensive operative procedure, in malignant diseases and hyperthyreosis. In thyroid gland surgery more extensive operative treatment with improved operative technique (micro dissection, recurrent laryngeal nerve visualization and parathyroid gland preservation), in our teaching hospital, do not have influence on incidence of postoperative complications, even recurrent laryngeal nerve injury was significantly less frequent. This results are in correlation with published results of similar hospitals around the world.

[Total intravenous anesthesia using remifentanil and propofol with midazolam co-induction in laparoscopic surgery of the gallbladder]. / TIVA remifentanilom i propofolom uz koindukciju midazolamom za laparoskopske operacije zucne kese.

We investigated effects of total intravenous anesthesia (TIVA) with propofol and remifentanil (in two parallel continuous infusions), on 28 ASA I-II patients undergoing laparoscopic cholecystectomy. All patients received midazolame (0.05 mg/kg b.w.), and 90 sec thereafter, remifentanil (0.5 g/kg b.w.). Computer controlled intravenous infusion of propofol started at dose of 6 mg/kg/h (by Graseby 3400 Syringe Pump). Muscle relaxation was achieved by rocuronium (0.6 mg/kg b.w.). After endotracheal intubation, rate of propofol was decreased on 3 mg/kg/h and started with another infusion of remifentanil (0.5 ug/kg/min). Before (T0) and after induction (T1), after start of surgery (T2), and at the end of surgery (T3), we evaluated: systolic, diastolic, and medial arterial blood pressure (SAP, DAP, MAP), heart rate (HR), peripheral saturation of O2 (O2Sat), and capnometry (ETCO2), by Datex-Engstrome AS/3 Monitore. It was followed side effects of anaesthesia, early and complete recovery rate, and frequency of nausea and vomiting in postoperative period. Results showed haemodynamic stability of patients after induction in anaesthesia (defined as decreasing of MAP 20%, compared with preinduction values). During investigation (T0-T3), results of 0.2Sat and ETCO2 were excellent (0.60 +/- 2 and 5.1 +/- 2.4 min). There wasonly one case of postoperative nausea and vomiting, and no significant side effects of anaesthesia. TIVA remifentanil-propofol and co-induction with midazolame makes possible haemodynamic stability of patients after induction in anaesthesia, good oxygenation during surgery, fast early and complete recovery, and avoiding of side effects of anaesthesia and postoperative nausea and vomiting. We concluded that it is a good choice of anaesthesia for laparoscopic cholecystectomy.

[Total intravenous anesthesia with propofol with midazolam coinduction--the anesthesia of choice in cataract surgery]. / Totalna intravenska anestezija propofolom uz koindukciju midazolamom-- anestezija izbora za operacije katarakte.

Comparative clinical investigation was performed in 80 ASA I/II patients undergoing cataract surgery on one eye. Patients were randomly divided in to four groups, according to the method of anesthesia. Intraoperatively (T0-T6), decreasing of intraocular pressure (IOP) to the optimal values at the start of the operation (T3), and the hemodynamic stability of patients after the induction (T1) were evaluated. Postoperatively, the recovery rate, and the incidence of vomiting were measured. Optimal decreasing of IOP was noticed in the second group (75% of patients). Best hemodynamic stability was observed in the second group (80% patients). Fast recovery rate was noticed in the first and the second groups (13.9 +/- 1.1 and 14.4 +/- 0.8 min). Vomiting was noticed in 5% patients in the first group, 15% in the third group, and in 20% in the 4th group. The authors have concluded that TIVA fourth propofol and coinduction with midazolam is anesthesia of choice in the cataract surgery.

[Acute normovolemic hemodilution]. / Akutna normovolemijska hemodilucija.

Performing acute normovolemic hemodilution reduces needs for transfusion of stored homologous blood, exposure of patients to homologous blood and incidence of diseases transmitted by transfusion. Apart from that it provides significant quantities of immunologically best, completely fresh blood and/or some blood components necessary for transfusion. Apart from the latest literature data, in this paper represent the first experiences considering acute normovolemic hemodilution performed in 20 patients operated for having low localized colon's neoplasm in whom amputation of rectum was performed. 780 ml of blood was exfunded from each patient with simultaneous infusion of three times larger volume of lactated Ringer's solution (In 10 patients) one volume of Haemacell (in 5 patients) and one volume of Soludex 70 (in 5 patients). Considering these patients 15600 ml autologous and 2500 ml of homologous blood was used up for transfusion.