Croatian Journal of Anaesthesiology and Intensive Medicine
type: channel
description: The Croatian Journal of Anaesthesiology and Intensive Medicine (CJAIM) is a peer-reviewed medical journal that publishes original research articles, review articles, case reports, editorials, and letters to the editor in the fields of anaesthesiology, intensive care medicine, perioperative medicine, pain medicine, and emergency medicine. The journal is published biannually and is dedicated to the dissemination of high-quality scientific and clinical knowledge relevant to anaesthesiologists, intensivists, and related healthcare professionals.
publisher: Anestezija
language: en
publication name: Croatian Journal of Anaesthesiology and Intensive Medicine
issn: 3102-3584
items: We endured. We move forward.
items: Use of Esketamine Combined with Dexmedetomidine for Difficult Tracheal Intubation in an Uncooperative Pediatric Patient with Severe Trismus: A Case Report
items: Urosepsis Complicated by Septic Shock After Endoscopic Combined Intrarenal Surgery for a Staghorn Calculus: A Case Report
items: Sufentanil-Induced Generalized Tonic–Clonic Seizure in a Patient with Pituitary Macroadenoma and Hypopituitarism: A Case Report
items: Principles and role of photoplethysmography in anesthesiology and intensive care medicine
items: From burn to paralysis: delayed spinal cord injury in high-voltage electrical burns
items: Airway management education in medical students: a cross-sectional study of knowledge and practical experience
items: Tackling Infections in Intensive care unit setting
items: Ketamine and Spine Surgery – Review
items: A knotted central venous catheter discovered at removal: when resistance should prompt imaging, not traction
items: Managing Anaesthesia in GLUT1 Deficiency Syndrome: Case Report
items: Acute Kidney Injury in a Patient with Aneurysmatic Subarachnoid Haemorrhage: A Case Report
items: Anesthetic Management of a Patient with Chiari Malformation Type I and Syringomyelia Undergoing Total Hip Replacement
items: Prolonged postoperative urinary retention following spinal anesthesia for knee arthroscopy - a case report
items: Should We Use Sugammadex in Rocuronium-Induced Anaphylaxis?
items: Conflicting Strategies in the Management of an ARDS Patient with Airway Leak
items: Perioperative Management of Patients with Durable Left Ventricular Assist Devices Undergoing Non-Cardiac Surgery
items: Maternal Care Under Pressure: Providing Obstetric Anesthesia During Disasters and Low-Resource Settings
items: When to Let Go: Physician Ethical Dilemmas in CPR Initiation During In-Hospital Arrests
items: Sources of Preoperative Information and Satisfaction of Pregnant Women Undergoing Cesarean Section

We endured. We move forward.
type: item
description: Launching a new scientific journal is rarely a quiet undertaking. The first issue of CJAIM was an act of trust — in the profession, in colleagues, and in the belief that knowledge should be shared openly and responsibly. Today, with a second issue in hand, we can state something simpler and truer: we endured. Not as a figure of speech, but as the outcome of shared work by authors, reviewers, the editorial board, and the institutions that recognised the value of this project. In the meantime, a steady and encouraging stream of submissions has emerged. That does not make us complacent; it reminds us that there is a space where clinical experience, educational questions, and scientific curiosity can meet without unnecessary barriers. CJAIM does not belong to a single institution or a single city — it belongs to a clinical and scientific community centred on anaesthesiology and intensive care, yet open to colleagues whose work intersects with ours: internists, infectologists, cardiac surgeons, pain specialists, and others in Croatia, the region, and beyond. Our duty is to preserve that space: transparently, ethically, and open to criticism. This issue reflects that diversity. Alongside original research on medical students' knowledge and practical experience in airway management (Plaftak et al.), we publish review articles that connect everyday practice with a broader context: ketamine in spinal surgery (Krezić et al.), the role of photoplethysmography in anaesthesiology and intensive care (Džaja et al.), and approaches to infections in the ICU (Đurić et al.). The issue closes with a letter to the editor by Tomić Mahečić on central venous catheter complications — a reminder that even routine procedures deserve critical scrutiny, especially when things do not go as planned. Case reports remain at the heart of what connects us to the hospital. Jiang et al. describe the safe and effective use of esketamine in a difficult paediatric intubation scenario; Brigljević Kniewald …
subject: Editorials
  topic: section
subject: CJAIM
  topic: keywords
subject: Cjaim
  topic: subjects
creator: Slobodan Mihaljević
creator: Ivan Šitum
rights: Copyright (c) 2026 Slobodan Mihaljević, Ivan Šitum (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 4
ending page: 5

Use of Esketamine Combined with Dexmedetomidine for Difficult Tracheal Intubation in an Uncooperative Pediatric Patient with Severe Trismus: A Case Report
type: item
description: Managing difficult airways in pediatric patients with severe trismus and poor cooperation is challenging because conventional sedatives may suppress spontaneous respiration. We report a case of a 15-year-old girl (weight 50 kg) with recurrent rhabdomyosarcoma causing severe trismus (0-finger mouth opening) and facial deformity. After premedication with atropine and methylprednisolone, sedation was achieved with a slow infusion of dexmedetomidine (20 μg over 10 minutes) followed by intravenous esketamine (20 mg, 0.4 mg/kg). This regimen preserved spontaneous breathing with oxygen saturation maintained at 99–100% throughout the procedure. Topical anesthesia of the nasopharynx was performed using 2% lidocaine spray (total dose 100 mg, approximately 2 mg/kg) via spray-as-you-go technique. Fiberoptic nasotracheal intubation was then successfully accomplished without coughing, body movement, or hemodynamic instability. No adverse events such as emergence reactions or hallucinations occurred. This multimodal sedation approach may offer a safe and effective alternative when preserving spontaneous respiration is critical in uncooperative pediatric patients with severely restricted mouth opening.
subject: Case Reports
  topic: section
subject: General Anesthesia
  topic: keywords
subject: Head and Neck Neoplasms
  topic: keywords
subject: Intratracheal Intubation
  topic: keywords
subject: Trismus, Sedation
  topic: keywords
subject: General Anesthesia
  topic: subjects
subject: Head and Neck Neoplasms
  topic: subjects
subject: Intratracheal Intubation
  topic: subjects
subject: Trismus, Sedation
  topic: subjects
creator: Jue Jiang
creator: Guifang Yu
rights: Copyright (c) 2026 Jue Jiang, Guifang Yu (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-06
publication date: 2026-07-06
starting page: 60
ending page: 64
doi: 10.66166/cjaim.2.1.8

Urosepsis Complicated by Septic Shock After Endoscopic Combined Intrarenal Surgery for a Staghorn Calculus: A Case Report
type: item
description: Endoscopic combined intrarenal surgery (ECIRS) is used for complex renal stones because it combines retrograde and percutaneous access and may allow complete stone clearance in a single session. Infectious complications are recognised after stone surgery. Rapid progression to septic shock, however, is not expected after an apparently uncomplicated procedure, and patients are usually managed postoperatively on the ward. We present a 51-year-old woman with a right-sided staghorn calculus and multiple documented antibiotic allergies who developed urosepsis complicated by septic shock after ECIRS. The procedure was technically successful, but septic shock developed approximately 10 hours postoperatively, requiring intensive care unit admission. Treatment included fluid resuscitation, noradrenaline, oxygen therapy, and antimicrobial therapy guided by previous susceptibility results and the allergy profile. This case supports better preoperative identification of patients at risk and early recognition of postoperative deterioration after ECIRS.
subject: Case Reports
  topic: section
subject: ECIRS; urosepsis; septic shock; staghorn calculus
  topic: keywords
subject: urosepsis septic shock endoscopic combined intrarenal surgery staghorn calculus urolithiasis
  topic: subjects
creator: Iverka Brigljević Kniewald Brigljević Kniewald
creator: Marina Nakić Pranjić
creator: Katarina Lojna
creator: Sandra Nenadić Šprajc
creator: Ante Erceg
creator: Eleonora Goluza
rights: Copyright (c) 2026 Dr. Iverka Brigljević Kniewald , Dr. Marina Nakić Pranjić , Dr. Katarina Lojna , Dr. Sandra Nenadić Šprajc , Dr. Ante Erceg , Eleonora Goluza (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 54
ending page: 59
doi: 10.66166/cjaim.2.1.7

Sufentanil-Induced Generalized Tonic–Clonic Seizure in a Patient with Pituitary Macroadenoma and Hypopituitarism: A Case Report
type: item
description: Background: Opioid-induced convulsive episodes are exceedingly rare during anesthesia induction. When they occur, they typically manifest within seconds of intravenous opioid administration as generalized tonic–clonic movements without epileptiform EEG activity, suggesting a pharmacodynamic origin. Case: We present a 67-year-old male with a pituitary macroadenoma and panhypopituitarism who experienced a generalized tonic–clonic seizure immediately after receiving 20 μg of sufentanil during anesthesia induction. The seizure lasted ~30 seconds, accompanied by a blood pressure spike to 220/110 mmHg and oxygen desaturation to 65%. It resolved spontaneously with supportive care. Surgery was postponed, and the patient was monitored in intensive care; later that day, neurological examination and EEG showed no acute abnormalities. Conclusions: Even small doses of sufentanil may precipitate seizures in susceptible patients. Endocrine disturbances (such as cortisol deficiency) can lower the seizure threshold by impairing neurosteroid-mediated GABAergic inhibition. This case underscores the importance of optimizing endocrine function and cautiously titrating opioids in vulnerable individuals to mitigate the risk of peri-induction seizures.
subject: Case Reports
  topic: section
subject: Sufentanil
  topic: keywords
subject: Generalized tonic–clonic seizure
  topic: keywords
subject: Hypopituitarism
  topic: keywords
subject: Pituitary macroadenoma
  topic: keywords
subject: Adrenal insufficiency
  topic: keywords
subject: Anesthesia induction
  topic: keywords
subject: Sufentanil
  topic: subjects
subject: Generalized tonic–clonic seizure
  topic: subjects
subject: Hypopituitarism
  topic: subjects
subject: Pituitary macroadenoma
  topic: subjects
subject: Adrenal insufficiency
  topic: subjects
subject: Anesthesia induction
  topic: subjects
creator: Ana Piršljin
creator: DInko Tonković
creator: Vasilije Stambolija
rights: Copyright (c) 2026 Ana Piršljin, DInko Tonković, Vasilije Stambolija (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 49
ending page: 53
doi: 10.66166/cjaim.2.1.6

Principles and role of photoplethysmography in anesthesiology and intensive care medicine
type: item
description: Photoplethysmography (PPG) is a non-invasive optical method that detects blood volume changes in the skin microcirculation. Since it's first description in 1938, PPG has evolved from a research tool into a key component of clinical monitoring, particularly with pulse oximetry. This narrative review summarizes the principles, waveform characteristics, contemporary theories, as well as future application of finger PPG in anesthesiology and intensive care medicine. A literature search was conducted using PubMed and Google Scholar with the keywords "photoplethysmography," "anesthesiology," and "intensive care medicine." OpenEvidence AI was used as a supplementary tool. Retrieved articles were independently reviewed for relevance and methodological quality. Finger PPG signals comprise pulsatile and non-pulsatile components, reflecting cardiac cycle. Waveform morphology is influenced by microcirculatory blood volume, arterial pressure, autonomic tone, and vascular compliance. Clinically, PPG underlies pulse oximetry and provides information on nociceptive stimuli, anesthesia depth, and sympathetic activity. Parameters such as perfusion index (PI), pulse transit time (PTT), and area under the photoplethysmographic curve (AUCPPG) have been explored to assess regional anesthesia efficacy and volume status. Emerging technologies enable continuous, non-invasive arterial pressure and cardiac output monitoring via algorithmic interpretation of PPG-derived signals. Finger PPG is a versatile, non-invasive tool with established and emerging applications in anesthesiology and critical care. Advances in signal analysis and device technology are expanding it's role in continuous hemodynamic monitoring, potentially enhancing patient management and safety in perioperative and intensive care settings.
subject: Review Articles
  topic: section
subject: photoplethysmography, anesthesiology, intensive care medicine
  topic: keywords
subject: photoplethysmography, anesthesiology, intensive care medicine
  topic: subjects
creator: Nikolina Džaja
creator: Krešimir Reiner
creator: Anita Lukić
rights: Copyright (c) 2026 Nikolina Džaja, Krešimir Reiner, Anita Lukić (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-22
publication date: 2026-07-22
starting page: 23
ending page: 33
doi: 10.66166/cjaim.2.1.3

From burn to paralysis: delayed spinal cord injury in high-voltage electrical burns
type: item
description: Electrical burn injuries, though uncommon, can cause severe neurological complications, with sequelae observed in up to 67% of high-voltage cases. This report presents two cases of spinal cord injuries following high-voltage electrical burns in male patients aged 29 and 53. The first patient, a 29-year-old male, sustained 9% total body surface area (TBSA) burns. His initial neurological assessment was unremarkable, but post-injury he developed quadriplegia with preserved sensation. Imaging was inconclusive, and he required prolonged intensive care unit care, showing only modest neurological improvement over time. The second patient, a 53-year-old male, suffered 25% TBSA burns, initially presenting unconscious and requiring resuscitation. He developed delayed paraplegia, with electromyoneurography confirming severe bilateral lumbosacral plexus injury despite normal spinal imaging. Both patients underwent supportive treatment, surgical interventions, and rehabilitation, showing varying degrees of motor recovery. Neurological sequelae in electrical injuries may result from direct electrical damage, vascular injury, or ischemic changes. Despite no clear spinal abnormalities on imaging, significant neurological deficits were present. No specific treatment exists, and corticosteroid use remains controversial. These cases underscore the need for early neurological evaluation, awareness of long-term consequences, and further research to develop standardized treatment protocols.
subject: Case Reports
  topic: section
subject: electrical injury
  topic: keywords
subject: spinal cord injury
  topic: keywords
subject: quadriplegia
  topic: keywords
subject: electrical injury
  topic: subjects
subject: spinal cord injury
  topic: subjects
subject: quadriplegia
  topic: subjects
subject: paraplegia
  topic: subjects
subject: neurologic deficit
  topic: subjects
creator: Goran Sabo
creator: Agata Skunca
creator: Morana Banic
creator: Tihana Magdic Turkovic
creator: Marinko Vucic
rights: Copyright (c) 2026 Goran Sabo, MD, Agata Skunca, MD, Morana Banic, MD, Tihana Magdic Turkovic, Associate Professor, Primarius, PhD, Marinko Vucic, Associate Professor, Primarius, PhD (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-06
publication date: 2026-07-06
starting page: 40
ending page: 48
doi: 10.66166/cjaim.2.1.5

Airway management education in medical students: a cross-sectional study of knowledge and practical experience
type: item
description: Introduction: Airway management is a fundamental clinical skill, and failure to secure the airway remains a major cause of morbidity and mortality. Objective: To assess medical students’ knowledge and practical competence in airway management. Methods: A cross-sectional study was conducted among 79 medical students using a structured, anonymous questionnaire administered to 5th- and 6th-year students at the School of Medicine, University of Zagreb. Results: Most students (94.9%) reported that endotracheal intubation should be included in undergraduate training. Basic airway maneuvers were well recognized, while advanced techniques such as laryngoscopy were identified by over 90% of participants. Fewer students (75.9%) recognized supraglottic airway devices. Practical experience was limited: 65.8% had placed a supraglottic airway device on a mannequin, but only 15.2% on a patient. Similarly, 59.5% had performed intubation on a mannequin compared with 19.0% on patients. Conclusion: While theoretical knowledge is strong, practical experience—particularly with advanced airway techniques—is limited. Enhanced structured and simulation-based training is needed to improve competence and patient safety.
subject: Original Research
  topic: section
subject: Airway Management
  topic: keywords
subject: Education, Medical
  topic: keywords
subject: Simulation Training
  topic: keywords
subject: Students, Medical
  topic: keywords
subject: Airway Management
  topic: subjects
subject: Students, Medical
  topic: subjects
subject: Education, Medical, Undergraduate
  topic: subjects
subject: Clinical Competence
  topic: subjects
subject: Simulation Training
  topic: subjects
creator: Tin Plaftak
creator: Renata Curić Radivojević
creator: Kristina Jurakić
creator: Daniela Bandić Pavlović
creator: Dinko Tonković
rights: Copyright (c) 2026 Tin Plaftak, Renata Curić Radivojević, Kristina Jurakić, Daniela Bandić Pavlović, Dinko Tonković (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-06
publication date: 2026-07-06
starting page: 6
ending page: 13
doi: 10.66166/cjaim.2.1.1

Tackling Infections in Intensive care unit setting
type: item
description: Infections within the intensive care unit (ICU) continue to be a major contributor to morbidity and mortality throughout Europe. Critically ill patients, oftentimes presenting with organ failure, having frequent interactions with invasive medical devices, and by receiving multiple antimicrobial agents are particularly susceptible to infections. Having knowledge of pathogen-specific epidemiology in ICUs across Europe and their antimicrobial resistance patterns is of utmost importance to choosing the right empirical therapy. Challenge posed by multidrug-resistant organisms, especially Gram-negative bacteria, is easier to tackle with infection prevention strategies, antimicrobial stewardship initiatives, and collaborative multidisciplinary care in place within the ICU setting.
subject: Review Articles
  topic: section
subject: icu
  topic: keywords
subject: mdro
  topic: keywords
subject: infections
  topic: keywords
subject: infectious disease
  topic: subjects
subject: Intensive Medicine
  topic: subjects
creator: Željko Đurić
creator: Mia Slade-Vitković
creator: Iva Ćosić
creator: Marko Siroglavić
rights: Copyright (c) 2026 Željko Đurić, Mia Slade-Vitković, Iva Ćosić, Marko Siroglavić (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-06
publication date: 2026-07-06
starting page: 34
ending page: 39
doi: 10.66166/cjaim.2.1.4

Ketamine and Spine Surgery – Review
type: item
description: Introduction: Various multimodal analgesic approaches have been proposed for spine surgery. This article aims to review the evidence regarding the effect of perioperative ketamine on postoperative opioid consumption, pain scores, and side effects. Materials and Methods: We included clinical trials in the adult population. Our primary outcome was pain management. Randomized controlled trials published in the English language from the January 1995 to September 2005 assessing postoperative pain after spine surgery were identified from the MEDLINE database. Results: A total of 16 clinical trials were selected for inclusion in the Review. Conclusion: Perioperative low doses of ketamine demonstrated analgesic and opioid-sparing effects with no increased adverse events after spine surgery. Further studies of qualitative randomized controlled trials are required to assess the optimal protocol of ketamine administration for postoperative pain relief.
subject: Review Articles
  topic: section
subject: ketamine
  topic: keywords
subject: spine surgery
  topic: keywords
subject: opioids
  topic: keywords
subject: pain management
  topic: keywords
subject: ketamine
  topic: subjects
subject: spine surgery
  topic: subjects
subject: opioids
  topic: subjects
subject: pain management
  topic: subjects
creator: Ivan Krezić
creator: Marin Lozic
creator: Marijana Matas
creator: Niksa Peric
creator: Vasilije Stambolija
creator: Miroslav Scap
rights: Copyright (c) 2026 Ivan Krezić, Marin Lozic, Marijana Matas, Niksa Peric, Vasilije Stambolija, Miroslav Scap (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-06
publication date: 2026-07-06
starting page: 14
ending page: 22
doi: 10.66166/cjaim.2.1.2

A knotted central venous catheter discovered at removal: when resistance should prompt imaging, not traction
type: item
description: Dear Editor, Central venous catheter (CVC) placement is routine in acute care, yet mechanical complications remain clinically important. Most attention rightly focuses on arterial puncture, pneumothorax, infection, and thrombosis. Knot formation at the distal end of a standard multilumen CVC is uncommon and easily missed when the line functions normally during use. We wish to report a case that illustrates this hazard. We hope this report encourages colleagues to stop, image, and seek specialist input when catheter removal is unexpectedly difficult.
subject: Letters to the Editor
  topic: section
subject: Central Venous Catheter
  topic: keywords
subject: Complications
  topic: keywords
subject: knot
  topic: keywords
subject: central venous chateter
  topic: subjects
creator: Tina Tomić Mahečić
creator: Anđela Babić
creator: Igor Balenović
creator: Dora Karmelić
creator: Lucija Biličić
creator: Antonia Vukšić
creator: Ivana Janja Bošnjak
creator: Robert Baronica
creator: Andrea Crkvenac Gregorek
rights: Copyright (c) 2026 Tina Tomić Mahečić, Anđela Babić, Igor Balenović, Dora Karmelić, Lucija Biličić, Antonia Vukšić, Ivana Janja Bošnjak, Robert Baronica, Andrea Crkvenac Gregorek (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-06
publication date: 2026-07-06
starting page: 65
ending page: 67

Managing Anaesthesia in GLUT1 Deficiency Syndrome: Case Report
type: item
description: Glucose Transporter Type 1 Deficiency Syndrome (GLUT1-DS) is a rare genetic disorder caused by mutations in the SLC2A1 gene, leading to impaired glucose transport across the blood–brain barrier. Those patients are susceptible to neurologic decompensation, particularly during periods of stress such as surgery. The ketogenic diet, which provides ketones as an alternative energy source, is the cornerstone of treatment. Anaesthetic management in these patients requires careful planning to maintain metabolic stability and preserve neurologic function. Unfortunately, no formal guidelines exist for anaesthetic management. We present the case of a 26-year-old female with confirmed GLUT1-DS undergoing elective septoplasty and inferior turbinate reduction under general anaesthesia. The patient was on a strict ketogenic diet and had a history of dystonia, epilepsy, and dyskinesia. Perioperative strategies focused on maintaining ketosis, preventing hypoglycaemia, and avoiding agents that could lower the seizure threshold. Fasting was limited to 8 hours, fluids were restricted to 0.9% NaCl and blood glucose was closely monitored (range 4.6–4.8 mmol/L). Anaesthesia was induced with propofol and sufentanil, maintained with sevoflurane and remifentanil, and supported by multimodal non-opioid analgesia. The procedure was uneventful, with no signs of neurologic deterioration postoperatively. The ketogenic diet was resumed the same day. This case highlights the importance of individualised perioperative management in GLUT1-DS. Elaborate planning and multidisciplinary collaboration that includes maintenance of ketosis, avoidance of glucose-containing solutions, and careful selection of anaesthetic agents is essential to prevent neurologic decompensation. Further studies are warranted to establish evidence-based guidelines.
subject: Case Reports
  topic: section
subject: GLUT1 deficiency syndrome
  topic: keywords
subject: ketogenic diet
  topic: keywords
subject: anaesthesia
  topic: keywords
subject: perioperative management
  topic: keywords
subject: Anaesthesia
  topic: subjects
creator: Ana Jozepović
creator: Nevena Mumelaš
creator: Renata Curić Radivojević
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 82
ending page: 90
doi: 10.66166/cjaim.1.1.10

Acute Kidney Injury in a Patient with Aneurysmatic Subarachnoid Haemorrhage: A Case Report
type: item
description: Aneurysmatic SAH (aSAH) is a life-threatening condition, with an incidence of 6–10 cases per 100,000 patients annually. It can present with an intense headache described as "the worst headache of your life", nausea and vomiting, epileptic seizures, and an altered level of consciousness. Sympathetic activation due to complex pathophysiological processes may lead to extracerebral organ injury, including cardiac pathology, neurogenic pulmonary oedema, and acute kidney injury (AKI). The incidence of AKI in a SAH patients ranges from 16.3% to 25%. SAH patients who develop AKI have a poorer outcome and higher mortality. Uremic encephalopathy is a cerebral dysfunction caused by acute kidney injury and the accumulation of uremic toxins, resulting in an impaired level of consciousness and uremic coma. Therefore, AKI may mimic or worsen patients' neurological status. The diagnosis of uremic encephalopathy or coma is established after neurological improvement following dialysis.
subject: Case Reports
  topic: section
subject: acute kidney injury (AKI)
  topic: keywords
subject: aneurysmatic subarachnoid haemorrhage
  topic: keywords
subject: uremic coma
  topic: keywords
subject: renal replacement therapy
  topic: keywords
subject: Intensive Medicine
  topic: subjects
creator: Martina Miklić Bublić
creator: Dinko Tonković
creator: Alka Makovšek
creator: Marijana Matas
creator: Ivan Paripović
creator: Marin Mandić
creator: Dijana Kukin
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 77
ending page: 81
doi: 10.66166/cjaim.1.1.9

Anesthetic Management of a Patient with Chiari Malformation Type I and Syringomyelia Undergoing Total Hip Replacement
type: item
description: Syringomyelia associated with Chiari malformation type I presents significant anesthetic challenges due to risks related to altered cerebrospinal fluid dynamics, autonomic dysfunction, impaired respiratory function, and potential for increased intracranial pressure. Evidence-based recommendations remain limited, particularly for non-obstetric procedures. We report the successful anesthetic management of a 52-year-old male with Chiari malformation type I and cervicothoracic syringomyelia undergoing elective total hip arthroplasty. Given prior posterior fossa decompression, thoracic kyphoscoliosis, and concern for increased intracranial pressure during airway manipulation, spinal anesthesia was selected. The procedure and postoperative recovery were uneventful, with stable hemodynamics and no neurological deterioration. This case supports the growing view that neuraxial anesthesia can be safely performed in selected patients with syringomyelia and Chiari malformation type I when there is no radiological evidence of elevated intracranial pressure or syrinx extension at the puncture site. Individualized anesthetic planning, multidisciplinary collaboration, and meticulous intraoperative monitoring are key to optimizing outcomes in non-obstetric surgery.
subject: Case Reports
  topic: section
subject: acute kidney injury (AKI)
  topic: keywords
subject: aneurysmatic subarachnoid haemorrhage
  topic: keywords
subject: uremic coma
  topic: keywords
subject: renal replacement therapy
  topic: keywords
subject: Anaesthesia
  topic: subjects
creator: Matea Lončar
creator: Tihana Magdić Turković
creator: Goran Sabo
creator: Filip Juroš
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 68
ending page: 76
doi: 10.66166/cjaim.1.1.8

Prolonged postoperative urinary retention following spinal anesthesia for knee arthroscopy - a case report
type: item
description: Postoperative urinary retention (POUR) is one of the most common complications of spinal anesthesia. Although common, prolonged cases of POUR that were associated with spinal anesthesia are sporadic. This article represents a case report of a patient who suffered from prolonged POUR attributed to the spinal anesthesia for knee arthroscopy which was assumed to be caused by intrathecal bupivacaine neurotoxicity. It reports an unexpectedly long duration of POUR that has not been recovered after 14 months, with no additional complications. According to our knowledge, no case of permanent POUR after spinal anesthesia has been reported nor has it been mentioned as a complication of intrathecal bupivacaine administration so far. Therefore, we emphasize the importance of awareness of unexpected complications after medical procedures because it is the provider's responsibility to recognize them and treat them accordingly.
subject: Case Reports
  topic: section
subject: urinary retention
  topic: keywords
subject: spinal anesthesia
  topic: keywords
subject: bupivacaine
  topic: keywords
subject: postoperative complication
  topic: keywords
subject: Anaesthesia
  topic: subjects
creator: Mirta Ciglar
creator: Tihana Magdić Turković
creator: Agata Škunca
creator: Goran Jaić
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 60
ending page: 67
doi: 10.66166/cjaim.1.1.7

Should We Use Sugammadex in Rocuronium-Induced Anaphylaxis?
type: item
description: Intraoperative anaphylaxis is a rare but potentially life-threatening complication of anaesthesia, with neuromuscular blocking drugs (NMBDs) being the most frequent cause. Published reports indicate that the incidence of anaphylaxis is higher for rocuronium compared to other non-depolarising NMBDs. Sugammadex is a novel reversal agent with a unique mechanism of action, specifically designed to encapsulate aminosteroid NMBDs and antagonise their pharmacological effects. Due to this mechanism, sugammadex has been suggested as a potential treatment option for rocuronium-induced anaphylaxis. Several case reports have described reversal or mitigation of rocuronium-induced anaphylaxis following sugammadex administration. In contrast, both in vitro and in vivo immunological studies suggest that sugammadex is unable to modify a type I hypersensitivity reaction. The small number of available case reports and limited prospective non-clinical immunological studies do not fully explain the underlying pathophysiological mechanisms. The role of sugammadex in rocuronium-induced anaphylaxis therefore remains unclear. Despite the reported clinical benefits, there are currently no recommendations to include sugammadex in standard anaphylaxis management algorithms.
subject: Review Articles
  topic: section
subject: anaphylaxis
  topic: keywords
subject: sugammadex
  topic: keywords
subject: rocuronium
  topic: keywords
subject: Anaesthesia
  topic: subjects
creator: Eleonora Goluža
creator: Marina Nakić Pranjić
creator: Nataša Margaretić
creator: Sandra Šprajc Nenadić
creator: Ante Erceg
creator: Karlo Uroda
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 52
ending page: 59
doi: 10.66166/cjaim.1.1.6

Conflicting Strategies in the Management of an ARDS Patient with Airway Leak
type: item
description: Acute Respiratory Distress Syndrome is a complex medical condition which, despite variability in its presentation and clinical manifestations, typically necessitates positive pressure mechanical ventilation in affected patients. Advances in clinical practice have significantly improved patient management and reduced mortality. Nevertheless, complications arising from barotrauma, more specifically airway leak, most notably pneumothorax and pneumomediastinum, continue to pose a serious threat to patient outcomes and represent a significant clinical challenge in intensive care management.
subject: Review Articles
  topic: section
subject: acute respiratory distress syndrome
  topic: keywords
subject: barotrauma
  topic: keywords
subject: airway leak
  topic: keywords
subject: pneumothorax
  topic: keywords
subject: pneumomediastinum
  topic: keywords
subject: Ventilation
  topic: subjects
creator: Ivan Bandić Bandić
creator: Jasminka Peršec
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 40
ending page: 51
doi: 10.66166/cjaim.1.1.5

Perioperative Management of Patients with Durable Left Ventricular Assist Devices Undergoing Non-Cardiac Surgery
type: item
description: Patients receiving durable left ventricular assist devices (LVADs) for advanced heart failure present growing perioperative challenges, with nearly one-third undergoing non-cardiac procedures most often in emergent or urgent contexts. This article reviews critical management strategies, emphasizing the importance of multidisciplinary collaboration. Device characteristics and operating principles are detailed, focusing on pump types, control parameters, and unique physiological responses in LVAD-supported patients. Preoperative assessment entails comprehensive echocardiographic evaluation, management of coexisting implantable cardioverter defibrillators (ICDs), and tailored anticoagulation regimens. Warfarin discontinuation and perioperative heparin bridging, consideration of acquired von Willebrand syndrome, and preemptive transfusion planning are highlighted to address bleeding risks. Infection prevention includes strict sterile technique and timely administration of prophylactic antibiotics targeting skin flora and device-specific pathogens. Intraoperatively, vigilant monitoring of device parameters and hemodynamics, invasive arterial blood pressure assessment, and selection of anesthesia approaches are outlined. Special attention is given to LVAD preload and afterload dependencies, right ventricular support, positioning, and arrhythmia management. Acute complications, including suction events, device malfunction, and modified cardiopulmonary resuscitation protocols are addressed, underscoring differences from standard cardiac arrest care. The postoperative phase demands careful ICU management, prompt resumption of anticoagulation, and restoration of ICD settings. As LVAD utilization increases, non-cardiac anesthesiologists are required basic understanding in device physiology, monitoring, anticoagulation, and infection prevention to optimize outcomes for this complex patient population.
subject: Review Articles
  topic: section
subject: left ventricular assist device
  topic: keywords
subject: perioperative
  topic: keywords
subject: non-cardiac surgery
  topic: keywords
subject: Perioperative Management
  topic: subjects
creator: Karlo Vidović
creator: Mirabel Mažar
creator: Ivona Vučić
creator: Željko Čolak
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 31
ending page: 39
doi: 10.66166/cjaim.1.1.4

Maternal Care Under Pressure: Providing Obstetric Anesthesia During Disasters and Low-Resource Settings
type: item
description: This article is a narrative review of obstetric anesthesia in low-resource and disaster-affected settings, employing a comprehensive synthesis of experiences from natural disasters and low- and middle-income countries. The methodology involved a search of recent literature and organizational guidelines to identify challenges, ethical dilemmas, and strategic approaches. The review categorizes deficiencies in infrastructure, workforce, and equipment, examining feasible anesthesia and analgesia techniques during crises and outlining ethical considerations relevant to resource allocation and triage. Disaster conditions frequently result in loss of electricity, oxygen supplies, monitoring equipment, sterile facilities, and trained personnel. Spinal anesthesia remains the preferred technique for cesarean section, while ketamine-based total intravenous anesthesia provides a safe alternative when monitoring is limited. Epidural analgesia may be unavailable, necessitating reliance on systemic or non-pharmacologic pain management strategies. Early risk triage, simplified protocols, and multidisciplinary teamwork are essential for safe care. Strategies such as simulation training, telemedicine supervision, and resilient infrastructure can mitigate risks, but ethical dilemmas---such as prioritizing high-risk patients and resource allocation---must be addressed within predefined frameworks. Overall, obstetric anesthesia in these settings requires adaptability, preparedness, and ethical awareness. Through context-specific protocols, task shifting, and interprofessional collaboration, anesthesiologists can sustain safety and improve maternal and neonatal outcomes despite severe constraints. Strengthening disaster readiness and resilience within maternity anesthesia services is increasingly vital in light of global instability.
subject: Review Articles
  topic: section
subject: obstetric anesthesia
  topic: keywords
subject: disaster
  topic: keywords
subject: low-resource setting
  topic: keywords
subject: Obstetric Anesthesia
  topic: subjects
creator: Nikolina Džaja
creator: Krešimir Reiner
creator: Matej Cindrić
creator: Slobodan Mihaljević
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 21
ending page: 30
doi: 10.66166/cjaim.1.1.3

When to Let Go: Physician Ethical Dilemmas in CPR Initiation During In-Hospital Arrests
type: item
description: Objective: To examine physicians' attitudes on initiating and terminating cardiopulmonary resuscitation (CPR) in terminally ill patients and to explore how these attitudes vary by demographic and professional characteristics. Methods: This cross-sectional study included 129 medical specialists from 14 departments of the University Hospital Centre Osijek, Croatia (2021). Data were collected using a 31-item questionnaire covering demographics, professional experience, attitudes toward CPR, knowledge of survival outcomes, and responses to six clinical scenarios. Results: More than half of respondents (55.1% and 69.8%, respectively) supported withholding or early termination of CPR in patients with incurable illness, primarily citing false hope, prolonged suffering, and resource overuse. Despite these views, over half indicated they would initiate CPR in all six hypothetical scenarios, including patients with advanced malignancy and multiple comorbidities. ICU admission following successful CPR was favoured by 52% of respondents, even in terminal cases, although knowledge of outcomes and resources was limited: only 45% correctly identified survival rates after in-hospital cardiac arrest, and fewer than 40% knew ICU bed capacity. Surgeons were less likely than non-surgeons to regard CPR in terminal patients as futile (P<0.05). Conclusion: Our findings indicate that structured ethics education and clear institutional guidelines are essential to improve decision-making in end-of-life care in Croatia.
subject: Original Research
  topic: section
subject: cardiopulmonary resuscitation
  topic: keywords
subject: terminally ill
  topic: keywords
subject: attitude of health personnel
  topic: keywords
subject: linical decision-making
  topic: keywords
subject: ethics
  topic: keywords
subject: medical
  topic: keywords
subject: Croatia
  topic: keywords
subject: Resuscitation
  topic: subjects
creator: Davor Klepo
creator: Tamara Janošević
creator: Vjeran Leventić
creator: Ivana Haršanji Drenjančević
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 12
ending page: 20
doi: 10.66166/cjaim.1.1.2

Sources of Preoperative Information and Satisfaction of Pregnant Women Undergoing Cesarean Section
type: item
description: Introduction: Patient satisfaction with preoperative counselling is increasingly recognized as a relevant indicator of the quality of perioperative care in obstetrics, particularly in the context of elective caesarean section. Objective: To evaluate the primary sources of information and the level of satisfaction among pregnant women regarding preoperative counselling for caesarean section. Materials and Methods: A total of 60 pregnant women with a medical indication for elective caesarean section, hospitalized at the Clinic for Gynecology and Obstetrics Petrova, University Hospital Centre Zagreb, participated in this cross-sectional study. Data were collected using a structured, anonymous questionnaire administered prior to the procedure. Results: Out of 60 distributed questionnaires, 54 (90.0%) were fully completed. The majority of respondents (83.02%; N=44) indicated the operating gynecologist as the most informative and satisfactory source of preoperative counselling, emphasizing their key role in preparing patients for the surgical procedure. Furthermore, the participants rated the anesthesiologists' preoperative consultations highly, with a mean score of M=4.60 (SD=0.76), highlighting both the clarity and adequacy of the information provided. Nursing staff also received favourable evaluations, with a mean score of M=4.55 (SD=0.78), indicating their significant contribution to the overall preoperative preparation process. Conclusion: Pregnant women undergoing elective caesarean section due to medical indications expressed a high level of satisfaction with the preoperative counselling provided by medical personnel, particularly valuing the contributions of the operating gynecologists, anesthesiologists, and nursing staff. These findings underscore the importance of multidisciplinary communication in enhancing the quality of obstetric care.
subject: Original Research
  topic: section
subject: elective caesarean section
  topic: keywords
subject: preoperative counselling
  topic: keywords
subject: patient satisfaction
  topic: keywords
subject: quality of care
  topic: keywords
subject: obstetric anesthesia
  topic: keywords
subject: Perioperative care
  topic: subjects
creator: Slobodan Mihaljević
creator: Mateja Briševac
creator: Vesna Bratić
creator: Ivan Šklebar
creator: Pavao Planinić
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-12-26
publication date: 2025-12-26
starting page: 3
ending page: 11
doi: 10.66166/cjaim.1.1.1