Renata Curić Radivojević

Background/Objectives: Endotracheal intubation can cause postoperative voice disturbances, even after short procedures. These effects have been documented in head and neck surgery, but direct comparisons between head/neck and abdominal surgeries are lacking. We sought to compare short-term postoperative voice changes in patients undergoing head/neck and abdominal surgery and to evaluate their association with intubation parameters and patient factors. Methods: We prospectively studied 80 adults (mean age X ± SD) undergoing either head–neck surgery (parotidectomy or total thyroidectomy) or abdominal surgery. Voice acoustic parameters (fundamental frequency (F₀), jitter, shimmer, intensity, maximum phonation time (MFT)) were measured preoperatively and on postoperative days 2, 14, and 30. Anesthetic parameters were recorded during the perioperative period. Anesthesiologists were blinded to the ongoing investigation. We used repeated-measures ANCOVA (with sex as a covariate) to test for group-by-time interactions and main effects. Effect sizes were calculated. Results: Eighty patients were included. All acoustic parameters showed significant postoperative changes (p < 0.001). The most pronounced alterations occurred in the early postoperative period, with decreased F₀, intensity, and MFT, and increased jitter and shimmer. Significant interaction effects between time and type of surgery were observed for F₀ (ηp² = 0.445), shimmer (ηp² = 0.210), intensity (ηp² = 0.267), and MFT (ηp² = 0.149), indicating distinct recovery patterns across groups. Patients undergoing abdominal surgery showed less pronounced and more rapidly resolving changes, whereas head and neck surgery was associated with greater and more persistent impairment. Among all parameters, shimmer demonstrated the largest overall effect size (ηp² = 0.338), suggesting high sensitivity to short-term voice changes. Perioperative factors, including duration of surgery, endotracheal tube size, and BMI, were significantly associated with the extent of voice changes. Conclusions: Short-duration endotracheal intubation can lead to measurable short-term voice changes, which are more pronounced after head/neck surgery (particularly total thyroidectomy). Objective acoustic analysis detected these subclinical alterations even when patients were asymptomatic. These findings underscore the importance of monitoring voice outcomes and optimizing intubation techniques, although future work is needed to correlate acoustic changes with laryngeal exam findings.

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.

Background and Objectives: Elderly patients with head and neck tumours frequently present with multiple comorbidities and a potentially difficult airway, making general anaesthesia high-risk. Dexmedetomidine, a selective alpha-2 adrenoceptor agonist, provides conscious sedation without clinically significant respiratory depression, offering a compelling locoregional alternative. This study evaluated the haemodynamic profile, sedation kinetics, and satisfaction outcomes of a standardised dexmedetomidine-based protocol for head and neck surgery under local infiltration anaesthesia. Materials and Methods: A prospective, single-centre observational study was conducted at the University Hospital Centre Zagreb. Twenty-three consecutive adult patients received a continuous dexmedetomidine infusion at 0.5 μg/kg/h, initiated preoperatively in the post-anaesthesia care unit without a loading dose. Haemodynamic parameters, sedation-to-incision interval, cumulative dose, and postoperative patient and surgeon satisfaction (NRS 1–10) were recorded. Spearman rank-order correlation and the Mann–Whitney U test were used for statistical analysis. Results: The primary outcome of haemodynamic stability—defined as the absence of vasoactive or inotropic rescue—was achieved in all 23 patients (100%). The median cumulative dexmedetomidine dose was 52 μg (IQR 44–68 μg). Controlled hypotension was achieved in all patients, with a median nadir systolic blood pressure of 98 mmHg. Supplemental oxygen was required in only 2 of 23 patients (8.7%). Patient and surgeon satisfaction reached a median NRS score of 10 in both groups. The sedation-to-incision interval correlated with total drug dose (ρ = 0.74, p < 0.001), consistent with fixed-rate infusion pharmacokinetics. Hypertensive patients exhibited a greater reduction in systolic blood pressure (median 45 vs. 28 mmHg; p = 0.015). Conclusions: A fixed-rate dexmedetomidine infusion initiated in the post-anaesthesia care unit provides a feasible and potentially effective conscious sedation strategy for head and neck surgery under local infiltration anaesthesia in selected elderly and comorbid patients. In this pilot series, the protocol was associated with haemodynamic stability in all cases, low supplemental oxygen requirements, and high procedural satisfaction among both patients and surgeons. These findings are preliminary and require confirmation in larger, controlled studies.

Introduction: More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking. Methods and analysis: The International ob S ervational s T udy on A i R way mana G ement in oper A ting room and non-opera T ing room ana E sthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients’ characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients. Ethics and dissemination: The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals. Trial registration number: NCT05759299 .

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.

Background and purpose: Retrosternal goiter refers to thyroid enlargement in which the lower pole of the thyroid is not palpable with the neck in a hyperextended position. The presence of a mass in the anterior mediastinum and displacement of the trachea are the risk factors for a difficult airway. The aim of this study was to present our experience with airway management in patients with retrosternal goiter. Materials and methods: We conducted a retrospective observational study of patients undergoing elective retrosternal goiter surgery in a tertiary center over one year. We analyzed the preoperative evaluation data and the planning, techniques and outcome of airway management. Results: From January 1st to December 31st, 2024, a total of 349 patients underwent thyroid surgery at our center. Among 72 patients admitted for goiter surgery, 26 patients were diagnosed with retrosternal goiter. A preoperative computerized tomography scan was performed in most patients and revealed 11 patients with massive retrosternal goiter. Intravenous induction to anesthesia with direct or video laryngoscopy was the preferred method of intubation. No significant complications were recorded. Conclusion: If there are no additional risk factors, intravenous induction of anesthesia and intubation with direct or video laryngoscopy are acceptable methods of airway management in patients with retrosternal goiter. Flexible nasendoscopy and virtual bronchoscopy are valuable methods for airway assessment and may reduce the need for awake fiberoptic intubation in complex cases. However, multicentric studies with larger sample sizes are needed to confirm our findings.

Background and purpose: Thyroidectomies are one of the most common elective surgical procedures in modern medicine. Performed under general anesthesia, thyroidectomies are associated with a high incidence of postoperative nausea and vomiting. Other common complications that increase anxiety among the surgical population are pain, postoperative voice dysfunction, and hypocalcemia. Dexamethasone, as a common adjuvant in anesthesia, is recommended as standard of care for prophylaxis of postoperative nausea and vomiting, as well as in the management of postoperative pain. Recent studies recommended the prophylactic use of dexamethasone in order to prevent hypocalcemia, and voice changes after thyroid surgery. Materials and methods: A literature review with 35 studies included was done to investigate and evaluate the effect of dexamethasone on the postoperative nausea and vomiting, pain, and voice dysfunction in patients undergoing thyroid surgery. Results: Dexamethasone seems to be effective for postoperative nausea and vomiting prophylaxis in patients undergoing thyroid surgery in a preoperative single dose of 8-10 mg intravenously. Dexamethasone may have potential in alleviating pain, but the correct dose needs to be determined. Studies supported the prophylaxis with dexamethasone for voice changes and hypocalcemia, but further research is required. Conclusion: A preoperative single intravenous dose of dexamethasone is a safe and effective method for preventing postoperative nausea and vomiting. Further meta-analyses and high-quality trials are needed to determine the optimal dose for pain relief and to assess its impact on voice changes and hypocalcemia.

Background: Reuse of sterile textiles could potentially reduce the carbon footprint of operating theatres. The aim of this mixed-methods study is to gain a deeper understanding of the implementation of reusable drapes and gowns across different contexts through applying the Consolidated Framework for Implementation Research (CFIR). Methods: A mixed-methods analysis was performed of cross-sectional data from a survey distributed by snowball sampling across a global research network. A five-point Likert scale assessed perspectives on safety and feasibility of implementation of reusable textiles. An open-ended question asked about the implementation of reusables. Inductive and deductive coding was used, informed by the CFIR. Results: A total of 5734 responses were collected, of which 5230 were eligible for inclusion. Most respondents believed that the intervention was unlikely or very unlikely to affect safety (3266/5230, 62.4%) or have detrimental consequences on environment or patient care (2990/5230, 57.2%), and that its introduction was likely or very likely to be successful (2888/5230, 55.2%). From a total of 1514 free-text entries, nine unique implementation factors were identified. Financial constraints were important across all settings. Whilst sterilisation-related issues were commonly reported in low and middle-income countries, institutional challenges were prominent in high-income countries. Mapping these factors to CFIR, the ‘setting’ of the intervention was the most relevant for effective implementation, along with the ‘individuals’ within the setting, rather than the intervention itself or the implementation process. A strategy identification tool and programme theory were developed, providing a starting point for institutions considering implementation of reusables and basis for future research. Conclusion: Implementation of this carbon-reducing intervention varied across resource settings. Recognising the unique implementation context, and developing tailored strategies, could aid implementation of this innovation through both research and wider scale rollout.