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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Severe brain injuries in children


Injury is the leading cause of death or permanent disability in children up to 19 years of age and is one of the primary reasons for hospital treatment. Blunt injuries due to traffic accidents or falls and especially blunt head injuries are the most frequent child injuries.

Appropriate care and correct treatment of the injured child require multidisciplinary teamwork (medical emergency team, surgeons, radiologists, paediatric intensive care physicians and other specialists).

Key words: child, injury, treatment, intensive therapy

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The treatment of posthaemorrhagic hydrocephalus


The paper presents the authors’ analysis of their own treatments of intraventricular bleeding and posthaemorrhagic hydrocephalus in premature infants in the period from December 2009 to January 2016.

Infants who are born before the 37th week of pregnancy are at a higher risk for perinatal complications. Intraventricular bleeding is a common complication in premature infants with low birth weight who are treated in units for intensive care and therapy.

Infants who are most at risk are those with low birth weight (under 1,500 g) and born before the 30th week of gestation. According to data from literature, 30 – 50% of infants born before the 30th week suffer intraventricular haemorrhage. More severe haemorrhage results in posthaemorrhagic hydrocephalus.

High morbidity and mortality require an early recognition, treatment and regular follow-up of these infants.

Key words: premature infant, intraventricular bleeding, hydrocephalus, treatment

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Inadvertent hypothermia during the perioperative period


Inadvertent hypothermia, which is defined as temperature below 36°C, is common in the perioperative setting. Patients under general or regional anaesthesia have impaired temperature regulation/homeostasis. Temperature monitoring should be an established standard for all procedures that last more than 30 minutes. Unfortunately, study shows that it is not a common practice in European hospitals. Passive and active patient warming should be used to prevent and treat hypothermia. Warming should start in the preoperative period and last throughout all perioperative phases. In that way, well-known complication of hypothermia should be prevented. Cardiac event, coagulopathy and wound infection are the leading causes of delayed discharge and more adverse outcomes related to hypothermia. It is especially important to undertake all necessary intervention procedures to prevent hypothermia in a group of patients with known high number of risk factors for hypothermia. Ambient temperature, an important risk factor, should be monitored and maintained at about 21°C. According to reviewed evidence, the protocol to prevent, monitor and treat hypothermia should be established. Further studies about the implementation of temperature monitoring and regulation are needed in order to raise awareness about this issue.

Key words: hypothermia, core temperature, anaesthesia, warming devices, prevention, treatment

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Thrombosis in newborns: experience from 31 cases


Thrombosis is the result of congenital or acquired prothrombotic risk factors. The incidence of thrombosis in the paediatric population is highest in newborns, as about 10% of thrombotic events occur in the first four weeks of life. Haemostasis in a newborn, though still developing, is a well balanced mechanism. About 90% of all thrombotic events are due to acquired and the rest to congenital risk factors.
The aim of our study was to estimate the incidence of thrombosis in a population of Slovenian newborns and to study risk factors, location and treatment of thrombotic events.
Inpatient charts of newborns with thrombosis, admitted to a tertiary neonatology centre and paediatric intensive care unit between 2004 and 2011, were studied retrospectively. Family history, location, aetiology and treatment of thrombosis were analysed.
Thirty one newborns, 17 boys (54.8%) and 14 girls (45.2%), with 31 thrombotic events were found. There were 17 cases (54.8%) of arterial and 14 cases (45.2%) of venous thrombosis. A  family history of thrombophilia was found in two cases (6.5%). Twenty six cases (83.9%) were contributed to acquired risk factors and five (16.1%) to congenital aetiology. Four cases (12.8%) were treated, two with anticoagulation, one with thrombolysis and one with both. The estimated incidence of thrombosis was 0.17 per 1000 live births. Our data showed a higher incidence of thrombosis in Slovenian newborns and a higher incidence of congenital prothrombotic risk factors than in the data published so far.


Key words: newborn, thrombosis, incidence, risk factor, treatment

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Promethazine in the treatment of postoperative nausea and vomiting: a systematic review


Postoperative nausea and vomiting (PONV) is among the most important concerns of patients undergoing surgery. The incidence ranges  from 30% to 70%. The incidence of PONV correlates with a number of risk factors a patient possesses. Patient-related risk factors in adults are: female gender, history of PONV, duration of surgery > 60 min, nonsmoking status, history of motion sickness, and postoperative use of opioids. Risk factors in children are: duration of surgery ≥ 30 minutes, age ≥ 3 years, strabismus surgery, and a history of PONV in the patient, parent or sibling. Treatment of PONV includes various classes of medications and none of them is entirely effective. If it is necessary to use combination therapy, then  medicines with different sites of activity should be used. Promethazine is a phenothiazine derivate available as a medicine since its introduction in 1946. In this article, a search was performed to identify all published papers and reports evaluating the effectiveness of promethazine for the management of postoperative nausea and vomiting in adults and children. The results of this review support the finding that promethazine is not recommended as a first-line agent  in the treatment of PONV, but can be considered for use as a rescue antiemetic.

Key words: promethazine, postoperative nausea and vomiting, treatment

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