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Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068-1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623-0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182-3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232-2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004-1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761-2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

Uvod: Cilj rada je da odredi uĉestalost i faktore rizika za pojavu intraoperativnih hemodianmskih poremećaja kod bolesnika sa komorbiditetima pobrgnutih hirurškom leĉenju oboljenja paraštitaste ţlezde. Metodologija: ovo je kohortna studija, u kojoj su ukljuĉena 269 bolesnika ASA 1,2,3 statusa. Ispitivani su sledeći faktori rizika: pol, godine ţivota, indeks telesne mase, ASA status, prijemna dijagnoza, vrsta hirurške intervencije, duţina trajanja operacije, vreme provedeno pod anestezijom,forma primarnog hiterparatireoidizma,vrednosti kalcijuma i fosfata,kao i sledeći komorbiditeti: hipertenzija, kardiomiopatija, poremećaji srĉanog ritma, angina pektoris-ishemijska bolest srca, dijebetes melitus, bubreţne bolesti. Registrovani su sledeći intraoperativni poremećaji: hipertenzija, hipertenzivna kriza, hipotenzija i poremećaji srĉanog ritma (tahikrdija, bradikardija, novonastala intraoperativna atrijalna fibrilacija i ekstrasistole). Za statistiĉku obradu korišćen je Pirsonov Hi kvadrat test, univarijantna i multivarijantna logistiĉka regresiona analizu. Rezultati: većinu bolesnika su ĉinile ţene 195 (87.3%). Intraoperativni hemodinamski poremećaji su registrovani kod 220 bolesnika (81.8%) bolesnika. Najĉesšći intraoperativni poremećaj je bila hipertenzija, registrovana kod 153(56.9%) bolesnika, kao i poremećaji srĉanog ritma kod bolesnika 129(48.0%) . Univarijanta analiza je registrovala sledeće faktore rizika: starije ţivotno doba, ASA 3 status, BMI >25kg/m², trajanje operacije, vreme provedeno pod anestezijom, hipertenzija, kadriomiopatija, vrsta kardiomiopatije. Multivarijantna regiresiona analiza je pokazala da su nezavisni prediktori pojave IOHP: godine starosti, hipertenzija i kardiomiopatija. Zakljuĉak: Intraoperativni hemodinamski poremećaji su ĉesti tokom paratireoidne hirurgije, pre svega intraoperativna hipertenzija. Starije ţivotno doba, hipertenzija i kardiomiopatija kao koegzistirajuće bolesti su nezavisni faktori rizika za pojavu IOHP., Introduction: The aim of this study is to determine the incidence and risk factors for intraoperative hemodianmskih disorder in patients with comorbid pobrgnutih surgical treatment of the parathyroid gland. Methodology: This is a cohort study, which included 269 patients ASA 1,2,3 status. We studied the following risk factors: gender, age, body mass index, ASA status, receiving a diagnosis, type of surgery, duration of surgery, time spent under anesthesia, form the primary hiterparatireoidizma, values of calcium and phosphate, as well as the following comorbidities: hypertension, cardiomyopathy, heart rhythm disorders, angina pectoris-ischemic heart disease, diabetes mellitus, renal disease. Registered the following intraoperative disorders: hypertension, hypertensive crisis, hypotension, and heart rhythm disorders (tahikrdija, bradycardia, the new intraoperative atrial fibrillation and extrasystoles). For statistical analysis we used the Pearson Chi-square test, univariate and multivariate logistic regression analysis. Results: The majority of patients were women 195 (87.3%). Intraoperative hemodynamic disturbances were registered in 220 patients (81.8%) patients. Najĉesšći intraoperative disorder was hypertension, deposited with the 153 (56.9%) patients, as well as cardiac rhythm disorders in patients 129 (48.0%). Univariate analysis has registered the following risk factors: older age, ASA 3 status, BMI> 25kg / m², duration of operation, time spent under anesthesia, hypertension, kadriomiopatija, type of cardiomyopathy. Regiresiona Multivariate analysis showed that independent predictors of occurrence IOHP: age, hypertension and cardiomyopathy. Conclusion: Intraoperative hemodynamic disturbances are common during parathyroid surgery, primarily intraoperative hypertension. Older age, hypertension and cardiomyopathy as a coexisting disease are independent risk factors for the occurrence of IOHP.

Cilj rada je da se odredi učestalost i faktori rizika za pojavu intraoperativnih poremećaja srčanog ritma i variranja krvnog pritiska. Metodologija: Ova kohortna, retrospektivna studija, uključila je 2304 pacijenta podvrgnuta maksilofacijalnoj ili hirurgiji uva, grla ili nosa. Ispitivani su sledeći faktori rizika: pol, životno doba, ASA status, otežana intubacija, vrsta hirurgije, trajanje anestezije, intraoperativna transfuzija, indukovana hipotenzijai sledeći komorbiditeti: hipertenzija, kardiomiopatija, poremećaji srčanog ritma, ishemijska bolest srca, prethodni cerebrovaskularni insult, hronična bubrežna insuficijencija, hiperlipoproteinemija i dijebetes melitus. Registrovani su sledeći intraoperativni poremećaji: hipertenzija, hipertenzivna kriza i poremećaji srčanog ritma (tahikardija, bradikardija, novonastala intraoperativna atrijalna fibrilacija, supraventrikularne i ventrikularne ekstrasistole). Za statističku obradu korišćen je Mann Whitney U test, Pirson-ov2test (tablicekontingencije), logistička regresiona analiza i ROC krive. Rezultati: Većina bolesnika je bila muškog pola pola (63.2%), starija od 50 godina i ASA1 klase (48%). Najviše bolesnika bilo je podvrgnuto hirurgiji grla (38.2%). Intraoperativno variranje krvnog pritiska i/ ili intraoperativne poremećaje srčanog ritma imalo je 29.4% pacijenata. Najveća učestalost intraoperativnih minor srčanih komplikacija bila je u maksilofacijalnoj hirurgiji (35.4%), odmah zatim u hirurgiji uva (35.1%),a najređe u hirurgiji nosa (21.3%). Od svih minor srčanih komplikacija najčešća je bila bradikardija (20.5%), zatim hipertenzija (5.3%), tahikardija (4.7%), ventrikularne ekstrasistole (0.5%), supraventrikularne ekstrasistole (0.3%), dok novonastala intraoperativn aritmija absoluta nije registrovana ni kod jednog pacijenta. Logističkom regresijom kao faktori rizika izdvojili su se: prethodna srčana aritmija, trajanje anestezije, indukovana hipotenzija i hirurgija uva. Zaključak: Intraoperativno variranje krvnog, The aim of our study was to determine the incidence and the risk factors for intraoperative cardiac rhythm disturbances and blood pressure variation in maxillofacial, ear, nose and throat surgery. Methods: This cohort retrospective study included 2304 patients who underwent either maxillofacial, ear, nose or throat surgery. These risk factors were studied:gender,age, ASA status, difficult airway management, type of surgery, duration of anaesthesia, intraoperative transfusion,induced hypotension and comorbidity such as: hypertension,cardiomyopathy,cardiac arrhythmias, ischemic heart disease, history of cerebrovascular insult,chronic kidney disease,hyperlipoproteinemiaana diabetes mellitus. These intraoperative minor cardiac complications were registered: hypertension, hypertension crisis, tachycardia, bradycardia, new onset of atrial fibrillation, supraventricular and ventricular extrasystoles. For statistical data analysis we used: Mann Whitney U test, Pirson’s2test, logistic regression and ROC curves. Results: The majority of patients were male (63.2%), older than 50 years and ASA status 1. The most of patients underwent throat surgery (38.2%). Intraoperative blood pressure variation and/or cardiac rhythm disturbances were present in 29.4% of patients. The highest incidence of intraoperative minor cardiac complications were in maxillofacial surgery (35.4%), then in ear surgery (35.1%), and the lowest incidence were in nose surgery (21.3%). Among all minor cardiac complications, the most frequent was bradycardia (20.5%), then hypertension (5.3%), tachycardia (4.7%), ventricular extrasystoles(0.5%),supraventricular extrasystoles(0.3%) and no new onset atrial fibrillation was registered. Logistic regression analysis idenified these risk factors: previous cardiac arrhythmia, anaesthesia suration, induced hypotension and ear surgery. Conclusion: Intraoperative blood pressure variation and cardiac rhythm disturbances, particularly bradycardia, are common in maxillofacia

Ciljevi istraživanja su procena uticaj primene kristaloidnih rastvora ili kombinacije koloidnih i kristaloidnih rastvora i njihovih volumena na vrednosti udarnog i minutnog volumena srca tokom kolorektalne operacija kao i utvrđivanje razlika u: količini neophodne tečnosti, vremenu do uspostavljanja intraoperativne hemodinamske stabilnosti, bilansu tečnosti, učestolasti primene vazopresora i inotropa, pojavi komplikacija, ukupnoj dužini hospitalizacije u ispitivanoj grupi. Metodologija: Ova randomizovana prospektivna studija obuhvata 80 pacijenata koji su se podvrgli elektivnoj hirurgiji zbog kolorektalnog karcinoma, na Klinici za onkološku hirurgiju Instituta za onkologiju i radiologiju Srbije. U kontrolnoj grupi koja je primala kristaloidni rastvor i u ispitivanoj grupi, koja je primala kombinaciju koloida i kristaloida, nadoknada je vršena hemodinamskim algoritmom. Merene su hemodinamske varijable i praćene su komplikacije i dužina boravka u bolnici. Rezultati: Pacijenti obe grupe bili su homogeni po osnovnim osobinama i pretećim oboljenjima. U kristaloidno-koloidnoj grupi postignute su više vrednosti udarnog volumena srca nakon sat vremena, do kraja operacije i nakon 24 sata. Vrednost minutnog volumena srca bila je značajno veća u ovoj grupi na kraju anestezije. Komlikacije su bile učestalije u kristaloidnoj grupi. Zaključak: Kombinacija rastvora daje veće vrednosti udarnog i minutnog volumena srca, brži oporavak i kraći ostanak u bolnici., Study aim is to estimate impact of crystalloids or colloids and crystalloids and their volumes on stroke volume and cardiac output during colorectal surgery and to estimate difference in volumes of these solutions, time till achieved hemodynamic stability, fluid balance, incidence of vasoactive drugs use, appearance of complications, duration of hospital stay. Methods: This is a randomized prospective study with 80 patients who underwent elective colorectal surgery on Clinic for oncological surgery of Institute for oncology and radiology of Serbia. In a control group, patients who received crystalloids and in the research group, patients who received colloids and crystalloids, we used hemodynamic algorithm for goaldirected fluid therapy. We measured hemodynamic variables such as stroke volume, cardiac output, cardiac index, mean arterial pressure, oxygen delivery. We recorded complications and duration of hospitalization. Results: Patients in both groups were homogenous according to baseline characteristics and comorbidity. Crystalloid-colloid group achieved higher values of stroke volume one hour from anesthesia induction till the end of surgeru, and after 24 hours. Also values of stroke volume and cardiac output were higher after 24 hours. Incidence of complications were higher in crystalloid group according to Clavien-Dindo clasiffication and also these patients had a longer period of hopitalisation. Both groups had a good hemodynamics. Conclusion: Combination of solutions provide higher values of stroke volume and cardiac output, faster postoperative recovery and faster hospital discharge.

Purpose: To determine whether there was a correlation between the type of administered infusion solutions intraoperatively with the quantity of administered infusion solutions, differences in values of cardiac output (CO) and cardiac index (CI) and need to use vasopressors and inotropes, between control and research groups. Methods: This randomized prospective study included 55 patients with colorectal cancer. Subjects in the control group received only crystalloid solutions intraoperatively and postoperatively. The patients in the research group received a combination of colloid in dosage of 10mg/kg and crystalloid solutions. Patients in both groups were given goal directed fluid therapy. Results: The control group received a significantly larger amount of crystalloid solution per kg of body weight during the entire surgical operation, in comparison with the volume of crystalloids in the research group (mean +/- SD 50.78 +/- 28.13 vs. 31.63 +/- 25.60 respectively, p=0.01). During the first hour of the surgery, the control group received a larger quantity of fluid in comparison with the research group (mean +/- SD 31.14 +/- 9.78 vs. 22.17 +/- 9.92 respectively, p=0.001). From the beginning of anesthesia until 6th postoperative hr the values of CI were significantly higher in the research group in comparison with the control group. Conclusions: Goal directed fluid therapy with colloids, followed by crystalloids during surgery, decreased the total intraoperative fluid volumes, and provided higher values of CI intraoperatively which were also maintained postoperatively.

Purpose: The purpose of this study was to compare two groups in postoperative recovery, whether there were any complications and whether the length of their hospital stay differed. One group received intraoperatively a combination of crystalloids and a small colloid dose, while the other group received only the crystalloids intraoperatively. Methods: This randomized prospective study included 80 patients with colorectal cancer prepared for major elective colorectal surgery. The patients were randomly assigned to either the control group (CG) which received only crystalloid solutions intraoperatively or to the research group (RG) which received a combination of colloid and crystalloid solutions. Regional and general endotracheal anesthesia techniques were combined in all patients. Goal-directed fluid therapy was administered to patients in both groups. After extubation, patients were transferred in the Intensive Care Unit (ICU). We measured the administered fluids, fluid balance, the volume of received red packed cells (RPC) and fresh frozen plasma (FFP). Recorded were the first bowel movement, the first flatus, the tolerance on oral food, complications by Clavian-Dindo classification, days of patient's recovery delay in the ICU, Surgery Department (SD) and the total length of hospital stay (LOS). Results: Statistically significant differences were present in all parameters of postoperative recovery. RG patients showed better results relative to the CG patients. RG patients were faster in restoring bowel movement and peristalsis, get the first postoperative stool and re-acquire oral food tolerance. According to the Clavian-Dindo classification of complications, no significant difference between these two groups was noted. Conclusions: Goal-directed colloid-crystalloid therapy significantly improved postoperative recovery.

Uvod: Neurogeni edem pluća (NEP) je klinički sindrom koji se karakteriše akutnim početkom edema pluća posle značajnog insulta centralnog nervnog sistema (CNS). Posledica je oslobađanje kateholamina u krv neposredno posle rupture aneurizme. Cilj ove studije je ispitivanje veze između EKG promena, vrednosti kardiospecifičnih enzima i biomarkera inflamacije na prijemu i drugog dana od prijema i pojave neurogenog edema pluća (NEP) kod pacijenata sa aneurizmatskom SAH. Materijal i metode: Ukupno 262 pacijenata sa aneurizmatskom SAH (162 žene je prospektivno uključeno u studiju. Kliničke karakteristike, elektrokardiografske (EKG) promene i vrednosti serumskih kardiospecifičnih i inflamatornih biomarkera je određeno na prijemu, a EKG promene i vrednosti biomarkera i 2 dana nakon prijema i na dan nastanka NEP-a kod pacijenata koji su razvili NEP. Sve vrednosti biohumoralnih parametara su takođe i dihotomizovane na povišene i normalne. Svi pacijenti su podeljenji u dve grupe, na one koji su razvili NEP i koji nisu. Podaci su analizirani radi određivanja značajnosti razlike karakteristika kod pacijenata sa NEP-om i bez i određivanja prediktora razvoja NEP-a. Da bismo isključili uticaj terapije na pojavu NEP-a, izdvojili smo pacijente primljene unutar 24 sata od nastanka SAH, podelili ih u grupu sa NEP-om i bez i analizirali podatke radi određivanja potencijalno različitih prediktora nastanka NEP-a. Rezultati: 19 pacijenata (7.25%) je razvilo NEP. Pacijenti koji će razviti NEP su imali teži oblik SAH. Bilo je značajno više pacijenata ženskog pola, sa anamnezom hipertenzije (HTA). Srčano oštećenje je bilo teže kod pacijenata sa NEP-om, što je predstavljeno značajno višim prosečnim vrednostima kardiospecifičnih enzima (p=0.000), izuzev srčanog troponina I (cTnI) koji je bio značajno niži (p=0.000). Nezavisni prediktori nastanka NEP-a kod pacijenata sa aneurizmatskom SAH su povišeni cTnI (OR 4.980, 95% CI 1.27-19.49, p=0.021) i leukociti (OR 22.195, 95% CI 3.99-123.50, p=0.000) k, Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema after a significant central nervous system (CNS) insult. It’s a consequence of releasing of catecholamines into blood immediately after aneurysmal rupture. The purpose of this project is to investigate the connection between cardiac biomarkers values on admission and occurrence of NPE in patients with aneurysmal subarachnoid hemorrhage. Methods: 262 SAH patients (162 females) are prospectively included in the study. Clinical characteristics, electrocardiographic (ECG) changes, serum cardiac and inflammatory biomarkers were determined on admission, 2 days after admission and also on the day of development of NPE. The values of the biohumoral parameters were also dichotomized on elevated and normal. All of the patients were separated into two groups, which developed NPE and not. Data were analyzed in order to determine the significance of difference between parameters of the groups and to predict the development of NPE. With intention to exclude the influence of SAH therapy on occurrence of NPE, we excluded the patients admitted into the hospital within 24 hours of SAH onset and analyzed the data to determine the potentially different predictors of NPE. Results: 19 patients (7.25%) developed NPE. Patients who will develop NPE sustained more severe SAH. There were significantly more women with history of hypertension (HTA). Cardiac damage was more severe in these patients as represented by significantly higher mean of all examined cardiac biomarkers (p=0.000), except cardiac troponin I (cTnI) which was significantly lower (p=0.000). Multivariate regression analysis revealed that elevated cTnI (OR 4.980, 95% CI 1.27-19.49, p=0.021) and white blood cells count (WBC) (OR 22.195, 95% CI 3.99-123.50, p=0.000) as well as being female (OR 5.253, 95% CI 1.14-24.16, p=0.033), Hunt and Hess of ≥3 (OR 12.593, 95% CI 1.27-124.79, p=0.030), and presence of HTA (OR

Uvod: Cilj studije je bio da se odrede serumske koncentracije proteina S100B i neuron specifične enolaze (NSE) i njihova sposobnost i preciznost u predikciji ranog neurološkog ishoda nakon traumatske lezije mozga. Materijal i metode: Stotrideset politraumatizovanih pacijenta sa udruženom traumatskom lezijom mozga je bilo uključeno u ovu prospektivnu kohortnu studiju. Serumski nivoi proteina S100B i NSE su mereni u 6, 24,48. i 72. satu nakon povređivanja. Rani neurološki ishod je procenjivan Glasgow Outcome Scale (GOS) skorom četrnaestog dana nakon povrede mozga. Rezultati: Koncentracije proteina S100B su bile maksimalne u 6. satu nakon povređivanja i praćene su naglim padom, a zatim sporijim oslobađanjem u naredna dva dana uz konstantno i signifikantno povišene vrednosti (p˂ 0.0001) kod pacijenata sa lošim ishodom. Sekundarni porast proteina S100B u 72. satu zabeležen je kod pacijenata koji su preminuli (GOS 1). Dinamiku promena za NSE karakteriše sekundarni porast koncentracija u 72. satu nakon povređivanja kod pacijenata sa lošim ishodom. Zaključak: Oba markera imaju dobru prediktivnu sposobnost lošeg neurološkog ishoda, mada NSE obezbeđuje bolji diskriminativni potencijal u 72. satu nakon povrede mozga, dok protein S100B ima bolji diskriminativni potencijal u predikciji mortaliteta., Background: The objective of our study was determination of serum concentrations of protein S100B and neuron specific enolase (NSE) as well as their ability and accuracy in prediction of an early neurological outcome after the traumatic brain injury. Methods: A total of 130 politraumatised patients with the associated traumatic brain injuries were included in this prospective cohort study. Serum protein S100B and NSE levels were measured at 6, 24, 48 and 72 hours after the injury. Early neurological outcome was scored by Glasgow Outcome Scale (GOS) on day 14 after the brain injury. Results: The protein S100B concentrations were maximal at 6 hours after the injury, followed there upon by abrupt fall, and subsequently by slower release in the following two days with continual and significantly increased values (p˂0.0001) in patients with poor outcome. Secondary increase of protein S100B at 72 hours was recorded in patients with lethal outcome (GOS 1). Dynamics of NSE changes was characterized by secondary increase of concentrations at 72 hours after the injury in patients with poor outcome. Conclusion: Both markers have good predictive ability for poor neurological outcome, although NSE provides better discriminative potential at 72 hours after the brain injury, while protein S100B has better discriminative potential for mortality prediction.

Objective: To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT). Subjects and Methods: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure >= 20% compared to baseline values which lasted for 15min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH. Results: Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR = 2.080, 95% CI: 1.102-3.925, p = 0.024) and age (OR = 0.569, 95% CI: 0.360-0.901, p = 0.016). Conclusion: In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH.

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.

Uvod: Akutno oštećenje bubrega u sepsi (S-AOB) značajno utiče na morbiditet i mortalitet hirurških bolesnika sa sepsom. Cilj: Cilj naše studije je bio da se ispitaju vrednosti novih biomarkera bubrežnog oštećenja, inflamacije i oksidativnog stresa kod septičnih hirurških bolesnika sa S-AOB kao i da se evaluira njihov značaj kao dijagnostičkih, prediktivnih i prognostičkih biomarkera S-AOB i sepse. Bolesnici i metode: U ovoj prospektivnoj observacionoj studiji je poređeno 53 abdominalnih hirurških bolesnika obolelih od sepse, od čega 37 sa S-AOB i 16 bez S-AOB, sa kontrolnom grupom operisanih (n = 53) i kontrolnom grupom neoperisanih (n = 53) bolesnika sličnih po godinama, polu, komorbiditetima i tipu hirurške intervencije. Uzorci krvi i urina su uzimani pri prijemu u jedinicu intenzivnog lečenja i 24, 48, 72 i 96 sati kasnije od septičnih bolesnika i jednom od bolesnika kontrolnih grupa. U prikupljenim uzorcima su merene vrednosti standardnih biomarkera bubrežne funkcije kao i novih biomarkera bubrežnog oštećenja, inflamacije i oksidativnog stresa. Skorovi težine bolesti su računati svakog dana posmatranja za sve bolesnike. Rezultati: Septični bolesnici sa S-AOB su imali statistički značajno različite vrednosti novih biomarkera bubrežnog oštećenja, inflamacije i oksidativnog stresa u poređenju sa septičnim bolesnicima bez S-AOB i kontrolnim grupama. Vrednosti ovih biomarkera se nisu značajno menjale tokom 96 sati. Nađena je značajana korelacija između vrednosti novih biomarkera bubrežnog oštećenja, inflamacije, oksidativnog stresa i vrednosti standardnih biomarkera bubrežne funkcije i skorova težine bolesti. Pojedinačno ili u kombinaciji, ispitivani biomarkeri su bili dobri dijagnostički, prediktivni i prognostički biomarkeri S-AOB i sepse. Zaključci: Novi biomarkeri bubrežnog oštećenja, inflamacije i oksidativnog stresa su potencijalno dobri dijagnostički, prediktivni i prognostički biomarkeri S-AOB i sepse., Introduction: Sepsis-associated acute kidney injury (SA-AKI) severely impacts morbidity and mortality in the surgical patients with sepsis. Aim: The aim of our study was to investigate the levels of the novel biomarkers of kidney injury, inflammation and oxidative stress in the septic surgical patients with SA-AKI and to evaluate their diagnostic, predictive and prognostic value in SA-AKI and sepsis. Patients and methods: This prospective observational study compared 53 major abdominal surgery patients with sepsis divided into SA-AKI (n = 37) and non-SA-AKI (n =16) groups to 50 operated controls and 50 not-operated controls matched by age, gender, comorbidities and type of surgery. Blood and urine samples from the septic patients were collected on admission to Intensive Care Unit and 24 h, 48 h, 72 h and 96 h later and once from the controls. Standard and novel biomarkers of kidney function and injury, inflammation and oxidative stress were measured. Disease severity scores were calculated for all patients daily during the entire observational period. Results: The septic patients with SA-AKI had altered levels of the novel biomarkers of kidney injury, inflammation and oxidative stress compared to the septic patients without sepsis and control groups. The levels of these biomarkers did not change significantly over 96 h. The novel biomarkers of kidney injury, inflammation and oxidative stress significantly correlated with the standard biomarkers of kidney function and disease severity scores. These biomarkers, independently or in combination, were good diagnostic, predictive and prognostic biomarkers of SA-AKI and sepsis. Conclusions: The novel biomarkers of kidney injury, inflammation and oxidative stress could serve as potential diagnostic, predictive and prognostic biomarkers of SA-AKI and sepsis.

Uvod: Preoperativna procena anatomskih parametara i kliničkih faktora je važna u otkrivanju pacijenata sa povišenim rizikom za otežanu endotrahealnu intubaciju (OEI). Odnos hiomentalne distance (Hyomental Distance Ratio - HMDR) je odnos između hiomentalne distance – HMD (rastojanje od hioidne kosti do vrha brade) u položaju maksimalne ekstenzije vrata (HMDe) i u neutralnom položaju vrata (HMDn). Mandibulohioidna distanca (MHD) je vertikalno rastojanje od gornje ivice hioidne kosti do ravni donje ivice mandibule u neutralnom položaju vrata. U radu je ispitivana prediktivna vrednost, senzitivnost i specifičnost različitih prediktora OEI, sa posebnim osvrtom na HMDR, hiomentalnu distancu i mandibulohioidnu distancu. Takođe, ispitivano je postojanje eventualnih razlika u senzitivnosti i specifičnosti HMDR i drugih prediktora OEI u zavisnosti od grane hirurgije. Osnovna hipoteza istraživanja bila je da vrednost HMDR manja ili jednaka 1.2 i mandibulohioidna distanca predstavljaju značajne prediktore otežane endotrahealne intubacije u svim granama hirurgije. Metodologija: Istraživanje je obuhvatilo 262 pacijenta koji su podvrgnuti elektivnim hirurškim intervencijama u Kliničkom Centru Srbije (KCS) u periodu od aprila 2011. godine do aprila 2012. godine, a operisani su na Klinikama za urologiju, abdominalnu hirurgiju, ginekologiju, endokrinu hirurgiju i otorinolaringologiju. Pored HMDR, MHD, HMDe i HMDn ispitivani su Mallampati skor i Indeks telesne mase (Body Mass Index - BMI). Kao pokazatelj OEI ispitivane su vrednosti HMDe<5.3 cm, HMDn≤5.5 cm, MHD<2.0 cm, MHD>3.5 cm i HMDR≤1.2. Osnovni ishodi koji su praćeni su: učestalost otežane vizuelizacije larinksa i OEI. Procena postojanja otežane vizuelizacije larinksa i OEI je vršena na osnovu klasifikacije Kormaka i Lihena (Cormack, Lehane) čiji stepeni III i IV su prediktori OEI..., Background: Provision and maintenance of the airway is one of the basic postulates in the work of anaesthesiologists being an integral part of the everyday work in operating rooms and intensive care units. The Hyomental Distance Ratio (HMDR) is the ratio between the Hyomental Distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The vertical distance between the mandible and the hyoid bone (mandibulohyoid distance- MHD) was measured in the neutral position of the head. The objective of the paper is to examine the predictive value, sensitivity and specificity of HMDe, MHD, HMDn and HMDR in predicting difficult endotracheal intubation (DEI) in different surgical specialties. Methods: A prospective study included 262 patients that underwent elective surgical operations at the Clinical Centre of Serbia in the period from April 2011 to April 2012. The patients underwent surgical operations at the Urology Clinic, Abdominal Surgery Clinic, Gynaecology Clinic, Endocrine Surgery Clinic and the Otorhinolaryngology Clinic. The following parameters were observed as possible predictors of DEI: HMDR, MHD, HMDe, HMDn, Mallampati score and Body Mass Index (BMI). The cut-off points for the DI predictors were: HMDe<5.3 cm, HMDn≤5.5 cm, MHD<2.0cm, MHD>3.5cm and HMDR≤1.2. The basic criteria that were observed were as follows: frequency of difficult visualisation of the larynx and DEI. The assessment that DEI existed was made by the anaesthesiologist while doing laryngoscopy by applying the Cormack-Lehane classification. Results: Difficult intubation was present in 13 patients (5 %). As for the frequency of DEI no considerable statistical difference was recorded concerning the sex, age and BMI of the patients. Also, concerning HMDn and MHD no considerable difference was recorded between the groups with and without DEI, while as for the Mallampati score, HMDe and HMDR a considerable