Vesna Marjanović

University of Nis

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Ivana Budić

University of Nis

Dušica Simić

University Children's Hospital, Belgrade

Marija Stević

University Children's Hospital, Belgrade

Mlađjan Golubović

Klinički centar Niš

Goran Marjanović

University of Nis

Milan Lazarević

University of Nis

Velimir Perić

University of Nis

Biljana Stošić

University of Nis

Irena Simić

University of Belgrade

Christian Breschan

Klinikum Klagenfurt

Cooperative Institutions

University of Nis

Klinički centar Niš

Boston Children's Hospital

Istituti di Ricovero e Cura a Carattere Scientifico

Inserm

University of Belgrade

University College London

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Istituto Giannina Gaslini

European Society of Anaesthesiology

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USE OF BISPECTRAL INDEX (BIS) FOR MONITORING OF SEDATION AND TOTAL INTRAVENOUS ANESTHESIA (TIVA) IN PEDIATRIC PATIENTS UNDERGOING COLONOSCOPY

Facta Universitatis Series Medicine and Biology (2022)

Ivana Budić Zlatko Djurić Vesna Marjanović Ivona Djordjević Marija Stević

The objectives of this study were to determine whether there was a correlation between bispectral index (BIS) and Ramsey Sedation Scale (RSS) in regard to the type of sedation and total intravenous anesthesia (TIVA) during colonoscopy procedures in children, and to assess the utility of ketamine and propofol combination (ketofol) for this kind of procedures at children’s age. In our prospective study, 40 ASA I-II patients, 3 to 17 years of age, were randomly divided into two groups of 20 patients each. After premedication with atropine and midazolam, sedation was induced with propofol and fentanyl in Group PF, whereas in Group PK propofol and ketamine were used for induction. Both groups were further divided into two subgroups depending on whether anesthesia was maintained with intermittent doses or continuous infusion of propofol. Ketamine and/or fentanyl were administered as bolus doses. Heart rate (HR), peripheral oxygen saturation (SpO2), RSS and BIS values of all patients were recorded every 5 minutes throughout the colonoscopy procedures. The strongest degree of correlation between RSS and BIS existed when sedation or TIVA was maintained by the boluses of propofol and fentanyl. The use of ketamine significantly reduced the doses of propofol and fentanyl. BIS can be monitored in all pediatric patients in whom sedation and TIVA are administered during colonoscopy, but the effect of different anesthetics on the EEG signal should be considered in order to adequately assess the depth of sedation and anesthesia.Key words: awareness, monitoring, child, anesthetics, endoscopy

Bispectral index

Midazolam

Premedication

Bolus (digestion)

10.22190/fumb220413003b

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Expression of regulatory proteins and proliferative activity in relation to phenotypic characteristics of upper urothelial carcinoma

Vojnosanitetski pregled (2011)

Zana Dolićanin Ljubinka Janković Veličković Biljana Djordjević Milan Višnjić Ivana Pešić

Background/Aim. Deregulation of the normal cell cycle is common in upper urothelial carcinoma (UUC). The aim of this study was to investigate the expression of regulatory proteins of the cell cycle (p53, p16, cyclin D1, HER-2) and proliferative Ki-67 activity in UUC, and to determine their interaction and influence on the phenotypic characteristics of UUC. Methods. In 44 patients with UUC, histopathological and immunohistochemical analyses (p53, p16, cyclin D1, HER-2, and Ki-67) of tumors were done. Results. Overexpression/ altered expression of p53, p16, cyclin D1 or HER-2 was detected in 20%, 57%, 64%, and 57% of tumors, respectively. Eleven (25%) UUC had a high proliferative Ki-67 index. Forty patients (91%) had at least one marker altered, while four (9%) tumors had a wild-type status. Analysis of relationship between expressions of molecular markers showed that only high expression of p53 was significantly associated with altered p16 activity (p < 0.05). High Ki-67 index was associated with the high stage (p < 0.005), solid growth (p < 0.01), high grade (p < 0.05), and multifocality p < 0.05) of UUC, while high expression of p53 was associated with the solid growth (p < 0.05). In regression models that included all molecular markers and phenotypic characteristics, only Ki-67 correlated with the growth (p < 0.0001), stage (p < 0.01), grade (p < 0.05) and multifocality (p < 0.05) of UUC; Ki-67 and HER-2 expression correlated with the lymphovascular invasion (p < 0.05). Conclusions. This investigation showed that only negative regulatory proteins of the cell cycle, p53 and p16, were significantly associated in UUC, while proliferative marker Ki-67 was in relation to the key phenotypic characteristics of UUC in the best way.

Ki-67

10.2298/vsp1107567d

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The Effect of UGT1A9, CYP2B6 and CYP2C9 Genes Polymorphism on Propofol Pharmacokinetics in Children

DOAJ (DOAJ: Directory of Open Access Journals) (2020)

Dušica Pavlović Ivana Budić Jiangtao Ma Dragana Stokanović Vesna Marjanović

CYP2B6

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Penile block and inhalation anesthetics as a combined anesthesia in surgery of the penis in children

Regional Anesthesia & Pain Medicine (2004)

Ivana Budić Vesna Marjanović Dejan Novaković

10.1016/j.rapm.2004.07.066

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Clinical prognostic factors in patients with unspecified peripheral t-cell lymphoma

Acta Facultatis Medicae Naissensis (2003)

Goran Marjanović Vesna Marjanović Lana Mačukanović-Golubović Mladen Milenović Bojan Marjanović

In order to asses the predictive capacity of various prognostic models in patients with Peripheral T-cell Lymphoma-Unspecified (PTCL-U), we retrospectively analyzed 36 cases fulfilling the criteria defined by the WHO classification. All patients were diagnosed and treated at The Clinic of Hematology, Clinical Center in Nis, from January 1991 until December 2003 with median follow up of 50 months. During the first 24 months of follow up 80.55 % of the patients, with 28.5% of cumulative probability survived during the period of 5 years. The factors significantly associated with reduced survival in multivariate analysis were: performance status (p=0.014), elevated LDH (p=0.0383), elevated sedimentation rate (ESR) (p=0.045) and complete response vs. no response vs. partial response to therapy (p=0.00395). Univariate analysis showed that age over 60 (p=0.042) adversely influenced survival. International prognostic index (IPI) was able to identify subsets of patients with different prognosis (p=0,047). Prognostic model designed especially for PTCL-U called PIT was able to identify the risk group patients (Log Rank p= 0.041350), while simplified two-class PIT proved to be superior over the simplified two class IPI. (Log Rank p=0.010973 versus p=0.041350). ILI prognostic model, designed for indolent lymphoma (Inter Gruppo Italiano Lymphoma), is not useful in aggressive lymphomas like PTCL-U. (Log Rank p=0.4). In conclusion, a new therapeutic strategy should be explored for high risk groups of patients identified in PIT model due to their dismal prognosis and a very low 5 year survival.

Univariate analysis

International Prognostic Index

Peripheral T-cell lymphoma

Hematology

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Prediction of a Difficult Airway Using the ARNE Score and Flexible Laryngoscopy in Patients with Laryngeal Pathology

Medicina (2024)

Danica Marković Maja Šurbatović Dušan Milisavljević Vesna Marjanović Biljana Stošić

Background and Objectives: The ARNE score was developed for the prediction of a difficult airway for both general and ear, nose and throat (ENT) surgery with a universal cut-off value. We tested the accuracy of this score in the case of laryngeal surgery and provided an insight into its effects in combination with flexible laryngoscopy. Materials and Methods: This prospective pilot clinical study included 100 patients who were being scheduled for microscopic laryngeal surgery. We calculated the ARNE score for every patient, and flexible laryngoscopy was provided preoperative. Difficult intubation was assessed according to the intubation difficulty score (IDS). Results: A total of 33% patients had difficult intubation according to the IDS. The ARNE score showed limited accuracy for the prediction of difficult intubation in laryngology with p < 0.0001 and an AUC of 0.784. Flexible laryngoscopy also showed limitations when used as an independent parameter with p < 0.0001 and an AUC of 0.766. We defined a new cut-off value of 15.50 for laryngology, according to the AUC. After the patients were divided into two groups, according to the new cut-off value and provided cut-off value, the AUC improved to 0.707 from 0.619, respectively. Flexible laryngoscopy improved the prediction model of the ARNE score to an AUC of 0.882 and of the new cut-off value to an AUC of 0.833. Conclusions: It is recommended to use flexible laryngoscopy together with the ARNE score in difficult airway prediction in patients with laryngeal pathology. Also, the universally recommended cut-off value of 11 cannot be effectively used in laryngology, and a new cut-off value of 15.50 is recommended.

Laryngology

Throat

Elective surgery

10.3390/medicina60040619

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Procedural sedation and analgesia in the pediatric intensive care unit

Signa Vitae (2023)

Ivana Budić Vesna Marjanović Ivona Djordjević Marija Stević Dragoljub Živanović

Children frequently experience more painful, stressful, and traumatic medical procedures and treatments in the pediatric intensive care unit (PICU) than when they are hospitalized in general wards. An essential part of care in the PICU is providing critically ill children with appropriate sedation and analgesia. Finding the perfect combination of adequate analgesia and sufficient sedation in a patient group with a wide range of ages, sizes, and developmental stages can be challenging. Administration of sedatives and analgesics to critically ill patients may be challenging and complicated by unpredictable pharmacokinetics (PK) and pharmacodynamics (PD). It is important to keep in mind that optimal agents for procedural sedation and analgesia (PSA) differ from those used for long-term sedation in the PICU. In addition to pharmacological measures, different non-pharmacological methods can be applied and have been shown to be effective for pain relief in children. Efforts are being made to improve PSA management with the use of national surveys, recommendations, and guidelines.

Pharmacodynamics

10.22514/sv.2023.007

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Efficasy of different anesthetics for achieving deep sedation during magnetic resonance imaging in children: Anesthetics for a deep sedation during magnetic resonance imaging

Serbian Journal of Anesthesia and Intensive Therapy (2016)

Vesna Marjanović Ivana Budić

Introduction: During magnetic resonance imaging (MRI) in children, safe, fast and effective anesthetics should be chosen for achieving deep sedation. Until now, no single anesthetic had this qualities, and only with a combination of different anesthetics the desired level of sedation could be obtained. Methods: In this prospective study 90 children that were scheduled for MRI, ages 6 month to 7 years ASA status I-II, were investigated. According to the anesthetic that was used for deep sedation, patients were divided into three groups: group 1 (ketamine), group 2 (propofol) and group 3 (ketofol = ketamine + propofol). The following parameters were analyzed: gender, age and body weight, length of MRI, the time from the beginning of anesthetics administration to the start of MRI procedure, the number of repeated doses of anesthetics, the total amount of anesthetic per kilogram body weight, recovery time and side effects. Results: Analyzing the time from the start of administration of anesthetic until the conditions for performing MRI were achieved, a statistically significant shorter period of time in ketofol group (p <0.001) was observed in comparison with ketamine and propofol groups. The smallest number of repeated single bolus doses of anesthetics was in ketofol group with statistical significance of p ˂ 0.05 compared to ketamine and propofol groups. The shortest period of recovery after performing deep sedation was registered in propofol group (p <0.001). The total amount of anesthetic was significantly reduced in ketofol group (p <0.05) as compared to the single administration of drugs. Conclusion: Deep sedation during MRI in children is best achieved by simultaneous application of ketamine and propofol as compared to single administration, as it speeds up the start of MRI procedure, decrises the number of repeated doses and total amount of anesthetic, thus reducing side effects of anesthetics.

Bolus (digestion)

10.5937/sjait1608219m

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The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury

Medicinski pregled (2011)

Vesna Marjanović Vesna Novak Ljubinka Janković Veličković Goran Marjanović

Introduction. Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator- associated pneumonia and outcome in patients with severe traumatic brain injury. Material and Methods. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Results. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p<0.001), longer stay at intensive care unit (17 vs 5 days, p<0.001) and chest injury (51.61 vs 19.51%, p< 0.009) compared to patients without ventilator-associated pneumonia.. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p= 0.12). Conclusion. The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.

Ventilator-associated Pneumonia

10.2298/mpns1108403m

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Citations (4)

Unrecognized acute lithium toxicity: a case report

Open Medicine (2012)

Dragana Ignjatović Ristić Marianna Siapera Jelena Jović Vesna Marjanović Milan Radovanović

Abstract We report a case of a 63-year-old male who has been admitted to the Emergency department with nonspecific symptoms. Lithium toxicity was not at first recognized. When we obtained sufficient information about previous medication and medical history, we measured lithium levels found to be 1.46 mmol/L. Although the value of lithium was mildly elevated, nephrotoxicity was produced leading to severe renal insufficiency and neurological symptoms. Hemodialysis was started, and we succeed to treat the patient without squeals. This case illustrates some of the factors that lead to lithium toxicity as well as the need to consider lithium toxicity to the differential diagnosis of a patient presenting with renal insufficiency with or without change in mental status and neurologic symptom.

Nephrotoxicity

Altered Mental Status

10.2478/s11536-012-0058-0

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Citations (5)