Anesteziologie a intenzivní medicína, 1999 (vol. 10), issue 6
Anaesthesia in craniocerebral injuriesArticles
V. Červený, J. Šrogl
Anest. intenziv. Med. 1999;10(6):231-236
In this article, the authors are engaged with the epidemiology, mortality and morbidity of craniocerebral injuries. They stress the prevention ofsecondary insult affecting the brain as the correct way of improving the outcome in patients undergoing serious craniocerebral injury. They describepriorities in treatment of traumatised patients, basic examinations before induction to general anaesthesia and the specific monitoring necessary duringgeneral anaesthesia in this sort of patients. The authors emphasise cerebral perfusion pressure (CPP) as the main pathophysiologic parameter; theknowledge of factors changing CPP is considered basic in choice of...
Cerebrovascular Neurosurgery - Review and the Role of Anaesthesiologist in the Interdisciplinary TeamArticles
V. Beneš ml., M. Mohapl, V. Trávníček
Anest. intenziv. Med. 1999;10(6):237-243
The authors are presenting the review of cerebrovascular neurosurgery. In particular areas, namely aneurysm and AVM surgery and in the surgeryfor cerebral ischemia, recent advancements and trends in the medical, surgical, neuroradiological and radiosurgical treatment alternatives arediscussed. Authors are comparing their results with the results published in the international literature. Interdisciplinary team approach and importanceof neuroanesthesiologist as an integral member of a team are stressed.
Caudal epidural anesthesia in newborn ageArticles
V. Mixa
Anest. intenziv. Med. 1999;10(6):244-246
Local anesthesia is becoming more and more popular even for pediatric patients. Caudal epidural anesthesia in combination with low-doseconcentration of inhaled anesthetic agent proved to be effective in hernia repairs in patients of the lowest age and weight groups.The identification of epidural space in a newborn is easy. Bupivacaine 0,25% is applicated in the dose 0,5 ml/kg, using G23 needle advanced circa5 mm behind sacrococcygeal membrane. The withdrawal reactions of a patient can be attenuated by inhalational administration of halothane inconcentration 0,4-0,8%.We sought to determine the optimal regimen of caudal anesthesia in 30 children (21...
Bronchoscopic intubation as a method of choice for difficult-to-intubate pediatric patientsArticles
D. Hechtová, D. Blažek, V. Mixa
Anest. intenziv. Med. 1999;10(6):247-248
The authors present their experience with the use of fiberoptic bronchoscope for intubation of pediatric patients. There are presented indicationsfor this technique, preoperative management and the differences according to the age of patients. Fiberoptic bronchoscope (BFS) of external diameter3,5 mm was used. This device allows to pass over ETT 4,5 mm. The most frequent complication of that procedure was nasal mucosa bleeding. Withthat technique, all 22 patients were successfully intubated. The mean duration of intubation was 6 minutes, the longest intubation took 13 minutes. Thepossibility of fiberoptic intubation of pediatric patients is a great...
Selective intubation and ventilation of the lungs in pediatric anesthesiaArticles
V. Mixa, D. Hechtová, D. Blažek
Anest. intenziv. Med. 1999;10(6):249-251
The paper present two methods of selective intubation and ventilation of pediatric lungs during anesthesia for thoracoscopic or surgical proceduresin thoracic cavity. One method is a combination of endobronchial and endotracheal intubation with two tubes; the other one implements obturationof bronchus of operated lung with angioplastic catheter balloon. Both methods meet the expectations i.e. the lung collapsed and could be eventuallyisolated. Parameters of selective pediatric lung ventilation are derived from the values for common ventilation, needs for correction are minimal. Thepaper shows that the method implementing bronchus obturation is more...
The priorities of analgesia in prehospital careArticles
E. Kasal, J. Lejčko, I. Chytra
Anest. intenziv. Med. 1999;10(6):252-253
Analgesia ranks among the basic priorities of the prehospital care for patients with multiple trauma. This presentation presents a complex surveyof pharmacologic and non-pharmacologic possibilities of the pain management, their advantages and risks. Because pain is symptom, not diagnosisand is very important for the diagnostic process, it is necessary to provide complex examination during pain relief to exclude injuries which can becovered by effective analgesia or analgosedation.
Subarachnoidal application of morphine as a method of postoperative analgesia for Cesarian sectionArticles
J. Frdlík, J. Vondráček, E. Kasal
Anest. intenziv. Med. 1999;10(6):254-256
The authors present their experience with subarachnoideal anesthesia with 0,5% hyperbaric bupivacaine with morphine supplement, comparing itwith general anesthesia and subarachnoideal anesthesia with hyperbaric bupivacaine only. This method resulted in excellent postoperative analgesiawith statistically proven decreased need for analgesics in the postoperative period. The adverse effects are not severe and are not more frequentcompared to other types of anesthesia. According to financial aspects, the expenditures associated with this type of anesthesia do not raise aboveexpenditures on general anesthesia. Preservative-free morphine only can be used,...
The analgesia and sedation in patients with polytrauma on clinic of anaesthesic and intensive care medicine in University hospital in PlzeňArticles
J. Lejčko, I. Chytra, E. Kasal, R. Kovařík, J. Vidunová, S. Machart, P. Chlebo
Anest. intenziv. Med. 1999;10(6):257-260
The overview of analgosedation regimens used presently in the authors department is presented. The basic aspects of current opinion on this partof intensive care with possible risks and hazards are analysed. The ideal sedation regimen does not exist and it is important to emphasise that optimumdosage must be tailored to the individual's response. Role of nurse is essential, especially in the time of weaning from analgosedation and mechanicalventilation. Very often problem in ICU is withdrawal syndrome. Weaning strategy is demonstrated. Cost effectiveness is one of the important factorsobserved in the field of intensive care at present. As well for...
The problems of airway management in patients with neck injuriesArticles
E. Kasal, K. Svoboda, P. Havel, I. Chytra
Anest. intenziv. Med. 1999;10(6):261-264
Neck injuries can become life-treating disease mainly thanks to a probable airways obstruction. Airway management in such cases ranks in thecategory of the "difficult airways". This presentation deals with kinds of the neck injury, their typical symptoms, especially with regard to possibleairways injury. Adequate airway management in patients with the neck injury remains the first priority. We present a survey of kinds of the airwaysmanagement, their benefit and risk. Three case presentations of patients with severe neck injury are presented, including the diagnostic process andthe therapy description. Necessity of a complex diagnostic process even...
The intraoperative blood salvage, problematic and posibilitiesArticles
S. Machart, P. Lavička, P. Altman, P. Jeníčková
Anest. intenziv. Med. 1999;10(6):265-267
This work summarized common indications for blood transfusion, facilities of autologous blood transfusion and our experiences with intraoperativeblood salvage used in 97 patients in 1995 - 1998.
Cytokine balance and its modulation in patients undergoing cardiopulmonarybypass surgeryArticles
S. Kleinschmidt
Anest. intenziv. Med. 1999;10(6):268-272
An adequate balance of homeostasis, represented by various pro- and anti-inflammatory cytokines, is important for the maintenance of health.Deviation of the normal balance of pro- and anti-inflammatory cytokines will lead to severe restrictions of immune response. Cardiopulmonary bypass(CPB) is regarded as a reproducible model of inflammatory response and constitutes a major challenge to the patient's ability to maintain this balance.Recent research has focused on the pro- and inflammatory cytokine balance, immune-modulating therapies and techniques to characterize the patient'sindividual immune status. The importance of cytokine balance and the various...
The use of intraosseal infusion in childrenArticles
M. Uher, M. Pisarčíková, J. Filka, M. Kurák
Anest. intenziv. Med. 1999;10(6):273-275
The review of intraosseal access as alternative and suitable vascular access in the urgent situation is presented. This access was successfully used21 times in 14 children in the PICU department (in 2 cases during cardiopulmonary resuscitation in infants).