Risk factors for postoperative acute kidney injury after major abdominal surgery.

AIM: Acute kidney injury (AKI) worsens the outcome in a significant number of hospitalized patients. Risk models mainly address cardiac surgery, while significantly less attention is paid to AKI after major abdominal surgery (MAS). This study aims to evaluate the incidence, along with risk factors, and intrahospital outcomes of AKI after MAS. MATERIAL AND METHODS: Our retrospective study included 200 adult patients treated with MAS (in the same institution). Exclusion criteria were obstructive nephropathy, contrast-induced nephropathy, and dialysis dependence whether due to end-stage renal disease (ESRD) or AKI before MAS. Data on preoperative, intraoperative, as well as postoperative variables were collected from patients' medical history and electronic medical records. RESULTS: AKI was diagnosed in 33 (16.5%) patients, with 2 patients treated with hemodialysis. The multivariate logistic regression model showed that the number of intraoperative blood transfusions (p = 0.01), pneumonia (p < 0.001), and vasoactive drug use (p = 0.02) were independently associated with postoperative AKI. Each blood transfusion administered increased the risk of developing AKI by 1.41, vasoactive drug use by 4.13, and the risk of AKI in those with pneumonia was 15.32 times higher. The lethal outcome was observed significantly more frequently in patients with AKI (39.4 vs. 4.8%, p < 0.001). CONCLUSION: Identification of independent predictors of AKI after MAS such as the number of transfusions during surgery, sepsis, pneumonia, and the need for vasoactive drug therapy could help prevent AKI and lower the probability of lethal outcomes after MAS.

TRANEXAMIC ACID IN SURGICAL TREATMENT OF SCOLIOSIS IN CHILDREN: A CASE REPORT.

INTRODUCTION: Children who are subjected to surgical treatment for scoliosis usually end up receiving a lot of blood transfusions since they tend to lose one or more blood volumes during the surgery. Tranexamic acid is an antifibrinolytic agent, increasingly used in children to reduce perioperative blood loss in various settings, including corrective surgery of scoliosis. CASE REPORT: A 12-year-old girl, weighing 44 kg, was admitted to our hospital for scoliosis correction. She had congenital scoliosis caused by congenital malformation of vertebrae. The surgery was performed under balanced general anesthesia. Two central and one peripheral line were cannulated in case massive transfusion would be required. Invasive monitoring was used, as well as prevention of hypothermia. Since massive blood loss was expected, bolus of tranexamic acid had been administered prior to the surgery. Tranexamic acid was given continuously in an intravenous infusion during the surgery. Blood loss was only 10 ml/kg, and since the hemoglobin value was orderline (89 g/l) during the surgery, the patient received 10 ml/kg of packed red blood cells. The child was hemodynamically stable throughout the surgery. After the completion of surgery, which lasted for 5 hours, the patient was extubated in the operating room. Postoperatively, the patient was transferred to the surgical ward. Hemoglobin values were stable and there was no need for additional blood replacement. CONCLUSION: Extensive blood loss is common in pediatric scoliosis correction surgery, transfusion being unavoidable in the majority of cases. In our patient, tranexamic acid proved safe and effective in reducing perioperative blood loss and transfusion requirement.

Cancer mortality in central Serbia.

PURPOSE: Cancer is the one of the leading cause of death worldwide. The aim of this study was to examine cancer mortality trends in the population of central Serbia in the period from 2002 to 2011. METHODS: The descriptive epidemiological method was used. The mortality from all malignant tumors (code C00-C96 of the International Disease Classification) was registered. The source of mortality data was the published material of the Cancer Registry of Serbia. The source of population data was the census of 2002 and 2011 and the estimates for inter-census years. Non-standardized, age-adjusted and age-specific mortality rates were calculated. Age adjustment of mortality rates was performed by the direct method of standardization. Trend lines were estimated using linear regression. RESULTS: During 2002-2011, cancer caused about 20% of all deaths each year in central Serbia. More men (56.9%) than women (43.1%) died of cancer. The average mortality rate for men was 1.3 times higher compared to women. A significant trend of increase of the age-adjusted mortality rates was recorded both for males (p<0.001) and for females (p=0.02). Except gastric cancer, the age-adjusted mortality rates in men were significantly increased for lung cancer (p=0.02), colorectal cancer (p<0.05), prostate cancer (p=0.01) and pancreatic cancer (p=0.01). Age-adjusted mortality rates for breast cancer in females were remarkably increased (p=0.01), especially after 2007. CONCLUSIONS: In central Serbia during the period from 2002 to 2011, there was an increasing trend in mortality rates due to cancers in both sexes. Cancer mortality in males was 1.3-fold higher compared to females.

Stress indicators during general anesthesia with opioid analgesics in children.

BACKGROUND/AIM: To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. MATERIALS AND METHODS: This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). RESULTS: The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P= 0.939). CONCLUSION: Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.

[Specific features of general anesthesia in stomatology for disabled people].

INTRODUCTION: People who have either developed or acquired disability are the patients with special needs. They often require general anesthesia for stomatological interventions. These patients often develop a complex disorder which interferes with a successful collaboration. General anesthesia should be adapted to the kind and length of intervention, to the physical condition of the patient and to the fact that majority of these interventions are performed under the "one day surgery" circumstances. The patient's preoperative preparation is of great importance. The anesthetics initially used and those to maintain anesthesia must be short-lived with minimal side-effects. The "gold standard" for the airway protection is the application of nasally placed endotracheal tubes, but the airway can also be protected by orally placed endotracheal tubes as well as by armored version of laryngeal mask airway during minor interventions. In the postoperative period patients are given analgetics and other necessary symptomatic therapy. The patient can be released no sooner than/four hours after the end of the operation. CONCLUSION: An appropriate preoperative preparation and the selection of the adequate kind of general anesthesia result in a reduced number of complications in this particular group of patients.