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Background and Goal of Study: Carotid endarterectomy (CEA) is a common procedure performed under regional anaesthesia providing monitoring of cerebral function in real time. Numerous techniques of regional cervical blocks exist but superficial cervical plexus block (SCB) is one most commonly used. The aim of this study was to compare regional anaesthesia using only superficial cervical plexus block with an ultrasound-guided carotid sheath block combined with superficial cervical plexus block for CEA. Materials and Methods: Patients undergoing elective CEA surgery were randomly assigned into two groups: one received ultrasoundguided carotid sheath block and SCB (n=12) while another group received SCB only (n=18). Patients did not receive any premedication. All patients were ASA grade II and III and had invasive blood pressure monitoring with parameters noted every 5 minutes. Both groups received mixture of 2 mg/kg 0.5% levobupivacaine and 2 mg/kg 2% lidocaine supplemented with saline to a volume of 50 mL. The onset and duration of sensory block and time to first analgesia were recorded. Analgesia was measured using numeric pain rating scale (NPRS) every 2 hours, up to 12 hours af ter regional block was performed. A log-rank test was performed to compare a probability of NPRS≤ 3 during follow-up time, with results described as Kaplan-Meier curves. Results and Discussion: Demographic data and surgical characteristics were comparable in both groups. Block onset time and duration of sensory block were not statistically dif ferent in both groups. Time to first analgesia was slightly higher in the group of patients receiving ultrasound-guided carotid sheath block with SCB (dif ference of medians 124 minutes), but the dif ference was Regional Anaesthesiology 93 not statistically significant. Also, postoperative pain in the first 12 hours described as a probability of NPRS≤ 3 was more prominent in patients having received only superficial cervical plexus block (66.6% as opposed to 58, 3%), but log-rank test showed no significant dif ference. Conclusion(s): Our early research data do not show benefits of addition of ultrasound-guided carotid sheath block in prolonged postoperative analgesia i.e., time to first analgesia. However, a larger sample size is needed for better statistical power to confirm whether the use of ultrasound-guided technique could prove more beneficial in prolonging postoperative analgesia and sensory block duration time.

Background: Carotid endarterectomy (CEA) is a common procedure performed under regional anaesthesia providing monitoring of cerebral function in real time. Numerous techniques of regional cervical blocks exist but superficial cervical plexus block (SCB) is one most commonly used. The aim of this study was to compare infiltration anaesthesia using only superficial cervical plexus block with an ultrasound-guided carotid sheath block combined with superficial cervical plexus block for CEA. Comparison of superficial cervical plexus block and combination of superficial cervical plexus and carotid sheath block in carotid endarterectomy. Methods: Patients undergoing elective CEA surgery were randomly assigned into two groups: one received ultrasound- guided carotid sheath block and SCB (n=12) while another group received SCB alone (n=18). Patients did not receive any premedication. All patients were ASA grade II and III and had invasive blood pressure monitoring with parameters noted every 5 minutes. Both groups received mixture of 2 mg/kg 0.5% levobupivacaine and 2 mg/kg 2% lidocaine supplemented with saline to a volume of 50 mL. The onset and duration of sensory block and time to first analgesia were recorded. Analgesia was measured using numeric pain rating scale (NPRS) every 2 hours, up to 12 hours after regional block was performed. Results: Demographic data and surgical characteristics were comparable in both groups. Block onset time and duration of sensory block were not statistically different in both groups. Time to first analgesia was slightly higher in the group of patients receiving ultrasound-guided carotid sheath block with SCB (difference of medians 124 minutes), but the difference was not statistically significant. Postoperative pain in the first 12 hours described as a probability of NPRS≤ 3 was more prominent in patients having received only superficial cervical plexus block (66.6% as opposed to 58, 3%), but log-rank test showed no significant difference. Cpnclusions: Our early research data do not show benefits of addition of ultrasound-guided carotid sheath block in prolonged postoperative analgesia i.e., time to first analgesia.However, a larger sample size is needed for better statistical power to confirm whether the use of ultrasound-guided technique could prove more beneficial in prolonging postoperative analgesia and sensory block duration time.

Ovaj rad donosi pregled literature o diferencijalnoj dijagnozi smrti mozga. Smrt mozga definirana je kao ireverzibilni prestanak svih funkcija mozga i moždanog debla. Tri osnovna nalaza u smrti mozga su koma, odsutnost refleksa moždanog debla i apneja. Utvrđivanju smrti mozga pristupa se kod pacijenata koji su pretrpjeli masivnu, ireverzibilnu ozljedu mozga utvrđenog uzroka. Pacijent koji je proglašen moždano mrtav, legalno je i klinički mrtav. Potrebno je naglasiti važnost pravodobne i točne dijagnoze smrti mozga, isključujući stanja koja oponašaju smrt mozga. U pregledu su prikazana stanja koja mogu zavarati i tako dovesti do nesigurnosti i kašnjenja u donošenju ispravne dijagnoze smrti mozga. Locked-in sindrom, posljedica katastrofalne ozljede gornjeg dijela ponsa, u kojoj je pacijent potpuno svjestan svega, ali se ne može kretati ili verbalno komunicirati s okolinom, osim vertikalnih pomaka očiju. Fulminantni GBS, stanje je koje u samo nekoliko dana može progredirati u stanje nalik smrti mozga gdje, ako se ne utvrdi reverzibilnost, može ostaviti trajne posljedice na pacijenta. Duboka hipotermija, najimpresivnije je stanje koje oponaša smrt mozga, sa temperaturama ispod 28°C, gdje se gube svi refleksi moždanog debla. Trovanje barbituratima i ostalim CNS depresorima česti su uzrok zabuna u dijagnosticiranju smrti mozga te se danas obavezno rade toksikološke analize kod pristupa dijagnosticiranja komatoznih pacijenata. Akinetički mutizam, stanje duboke apatije, sa očuvanom svijesti, ali slabih i sporih dobrovoljnih pokreta, razlikuje se od smrti mozga te se parakliničkim testom uz pomoć EEG-a jasno može dokazati da takav pacijent nije moždano mrtav. Važnost isključivanja stanja koja oponašaju smrt mozga leži u mogućnosti doniranja organa moždano mrtvih osoba (DBD protokol). Iako medicina i tehnologija napreduju i ostvaruju maestralna otkrića, potražnja za organima i dalje premašuje ponudu., The goal of this paper is to provide a systematic overview of literature regarding the differential diagnosis of brain death. Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined as brain dead is legally and clinically dead. It is necessary to emphasize the importance of timely and accurate diagnosis of brain death, by excluding conditions that mimic brain death. In this review are presented conditions that can mislead and thus lead to uncertainty and delays in making a proper diagnosis of brain death. Locked-in syndrome is a catastrophic result of an infarction of the upper part of the pons cerebri, in which the patient is fully aware of everything, but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body, except for vertical eye movements. Fulminant GBS, a condition that can rapidly progress to a brain death - like state in just a few days where, if no reversibility is established, it can leave permanent consequences for the patient. Deep hypothermia is the most impressive condition that mimics brain death, with temperatures below 28 ° C, where all the reflexes of the brain stem are lost. Barbiturates overdose and other CNS depressants intoxications are a common cause of confusion in the diagnosis of brain death. Therefore, today, toxicological screenings are mandatory when diagnosing comatose patients. Akinetic mutism, a state of deep apathy, with conserved consciousness, but weak and slow voluntary movements, is different from brain death and an instrumental test such as EEG can clearly prove that such a patient is not brain dead. The importance of excluding conditions that mimic brain death lies in the possibility of organ donation from brain dead patients (DBD protocol). Although medicine is progressing and making maestral discoveries, the demand for organs continues to exceed the bid.