Anesteziologie a intenzivní medicína, 2000 (vol. 11), issue 4
The Role of an Anesthesiologic Ambulance in Preoperative Preparation for AnesthesiaArticles
V. Dostálová, E. Odrážková, K. Kulda, V. Černý
Anest. intenziv. Med. 2000;11(4):138-140
Careful and targeted preanesthetic evaluation of patients scheduled for anesthesia presents an important step in the prevention of severeperioperative complications. The basic goal of anesthesiologic ambulance is the improvement of preoperative assessment while decreasing the needfor complementary examination and laboratory tests, that could be effectively done in the out-hospital setting. The working of the ambulance contributesto the decrease of the number of re-scheduled cases due to incomplete preanesthetic examination or suboptimal compensation just prior to a surgicalprocedure. The indications for a visit in the anesthesiologic ambulance are...
Oral Premedication with Depot Morphine FormulaArticles
V. Špatenková, J. Holub
Anest. intenziv. Med. 2000;11(4):141-143
In a retrospective study we evaluated morphine hydrochloride (Vendal retard) in premedication for spinal surgery or peripheral nerve surgery. 250patients were enrolled. We also monitored its combination with other pharmacological agents - non-steroidal anti-inflammatory drug ketoprofen andbenzodiazepines. We evaluated adverse effects of depot morphine formula, the need for atropine or naloxone administration, opioid dose duringanesthesia, the effects of premedication and postoperative analgesia. Oral premedication with depot formula of morphine hydrochloride, 10 mg or20 mg, in combination with non-steroidal anti-inflammatory drug ketoprofen, 100 mg,...
Cesarean Section in Patient with Uncorrected Tetralogy of Fallot in Epidural AnaesthesiaArticles
R. Gál, I. Čundrle, I. Zimová, J. Hrubá
Anest. intenziv. Med. 2000;11(4):144-145
We report an anaesthesia management a patient without surgical correction a tetralogy of Fallot scheduled for cesarean section. The patient wasseverely cyanotic with high pulmonary hypertension. During epidural anaesthesia we had not record any significant complication. This casedemonstrate usefulness of regional anaesthesia techniques for cesarean section in spite of cardiac risk patient.
Treatment of Different Types of Cancer PainArticles
Z. Toman
Anest. intenziv. Med. 2000;11(4):146-148
Cancer pain in patients with malignant disease can be effectively treated only after evaluation of the exact type of pain. History and clinical evaluationwill help to differentiate between various types of pain. However, patient can suffer from several types of pain concurrently. Every type of pain can bealleviated with appropriate measures, finally bringing it under control as a whole process.There are several types of cancer pain: nociceptive pain (effectively treated according to well known three-step ladder with non-steroidalanti-inflammatory drugs - NSAIDs and opioids). Visceral pain is a part of nociceptive pain; however, selected subtypes can...
Analgosedation for Endovascular Embolization of Intracranial Arteriovenous MalformationsArticles
J. Schreiberová, V. Bašta, A. Krajina
Anest. intenziv. Med. 2000;11(4):149-151
The introductory part of the paper reviews the characteristics of intracranial arteriovenous malformations (AVM), current treatment options andspecific features of anesthesia and analgosedation for their treatment with endovascular embolization The sedation must be very flexible, since itsdepth has to be changed rapidly to allow for contact and cooperation with a patient to perform function tests before embolization procedure isaccomplished, discarding AVM from circulation. The other part of the paper reviews the authors' own experience with analgosedation in 75 cases ofendovascular embolization. Analgosedation is preferentially achieved by combination...
Positive End-exspiratory Pressure during Mechanical Ventilation - State-of-the-artArticles
P. Dostál, V. Černý
Anest. intenziv. Med. 2000;11(4):152-158
Application of positive end-exspiratory pressure (PEEP) represents an integral part of ventilatory strategy. Application of PEEP addresses severalpathophysiologic targets: functional residual capacity, ventilation/perfusion distribution, decrease of intrinsic PEEP in patients with limited respiratorytract flow. Clinical aspects of PEEP application are evident in improvement of oxygenation, improvement of patient/ventilator synchrony, decrease ofwork of breathing, limiting of ventilator-induced lung injury. PEEP increases end-exspiratory lung volume (EELV) and also influences distribution ofventilation and perfusion, pulmonary shunt and alveolar ventilation....
The Complement System: A Two Edged SwordArticles
A. Heller, M. Kirschfink, T. Koch
Anest. intenziv. Med. 2000;11(4):159-164
The complement system is a multifactorial protein cascade system which is essentially involved in the early unspecific immune response. Activationof the complement system is achieved by a variety of stimuli e.g. trauma, infection or immunologic reactions. Its major function is the activation ofcellular defense mechanisms, opsonisation of foreign particles and the destruction of target cells. While the impact of the different complementcomponents for bacterial elimination still remains controversial, overwhelming activation of the complement cascade, however, can induce lifethreatening tissue damage due to the effective cytotoxic properties. In the...
The Use of Procalcitonin as a Marker of Sepsis in Postoperative and Intensive CareArticles
D. Setvák, R. Záhorec, J. Mišianik
Anest. intenziv. Med. 2000;11(4):165-169
The plasmatic levels of procalcitonin is now considered as an objective parameter of severe systemic infection, SIRS and sepsis. We have observedthe dynamics of serum procalcitonin in longitudinal prospective study of 40 oncological patients 3 days after abdominal surgery. We have found outthat the peak values of procalcitonin were on the 1 st postoperative day and in uncomplicated course did not exceed the value 1.44 - 2 ng/ml. We haveobserved 3 cases of severe systemic infection (2 cases of peritonitis 9.9 - 15.5 ng/ml) and 1 case of proven catheter sepsis with gram/positivehemocultures (peak value 54.4 ng/ml). We also observed 3 cases of circulatory...
Paracetamol IntoxicationArticles
E. Kieslichová, R. Zazula, T. Tyll
Anest. intenziv. Med. 2000;11(4):170-173
The authors describe the possibility of acetaminophen intoxication that is becoming more and more frequent due to an easy availability of the drugand extending awareness of its toxicityAfter an overdose serious hepatic impairment, even fulminant hepatic failure may occur. Acetaminophen toxicity also affects the kidney, pancreasand heart muscle. The treatment is based on the reduction of acetaminophen absorption with t he aid of gastric lavage and active coal administration,and on the use of a specific antidote, N-acetylcystein. Liver transplantation should be considered in patient population with fulminant hepatic failure.
Deliberate Hypothermia for Patients with Severe Brain InjuryArticles
R. Gál, I. Čundrle, I. Zimová
Anest. intenziv. Med. 2000;11(4):174-175
Effect of mild and moderate hypothermia on neuronal protection have been reported in numerous experimental settings. Furthermore, clinical datasuggest, that brain injured patients may benefit from mild hypothermia. We present a group of patients in which we used mild hypothermia asa component of intensive care management for severe brain injury patients. Our data showed, that therapeutic hypothermia is useful procedure toprevent ischemia related brain damage. With full monitoring is safety also for polytrauma patients. However, the optimal temperature managementregarding minimal side effects and maximal cerebral protection has not yet been defined.
Our Experience with Patient Stratification in Critically Ill PatientsArticles
R. Pařízková, V. Černý, P. Dostál
Anest. intenziv. Med. 2000;11(4):176-180
The goal of patient stratification in critical care setting can be seen in effective resource allocation to patients in whom real improvement in medicalstatus or restoration of acceptable quality of life could be expected; this must be done with respect to basic ethical principles. On the other hand, theextent of health care could be restricted in patients not benefiting from it, i.e. in patients in whom the level of care would just prolong the irreversiblestate and could not even possibly change the unfavourable outcome. The paper summarizes the experience with patient stratification in the Departmentof Anesthesia and Intensive Care, Charles University...
Any Notes to the Pathophysiology of Secondary Cerebral InjuryArticles
P. Sklienka, I. Petrašovičová, L. Kolář, J. Jahoda, R. Hrdlička, R. Kula
Anest. intenziv. Med. 2000;11(4):180-183
Authors retrospectively analysed morphologic (CT scan) and multimodal monitoring data in a group of 31 patients with cerebral injury. On theinitial CT scan cerebral edema was apparent in 79 % cases. In contrast with this observation, in course of 48 hours from injury ICP value over 20mmHg was found in 5 % and SjO2 value below 60 % was found in 59 % measurements. In SjO2 < 60 % data set significantly lower values of paCO2and significantly higher occurrence of CPP values below CPPcrit were found comparing to SjO2 > 60 % data set. Analysing causes of CPP fall belowCPPcrit 8 % participation of isolated ICP rise over ICPcrit and 67 % participation...
Nitric Oxide and Treatment of Respiratory Failure in ChildrenArticles
M. Filaun, I. Lišková, P. Pavlíček
Anest. intenziv. Med. 2000;11(4):184-186
In years 1997 - 1998 there was treated in our PICU 521 children with mechanical ventilation, in 6 children failed conventional respiratory treatmentand led to increasing of hypoxemia with no response on treatment. Nitric oxide was in these cases used as a method for treatment of supposed pulmonaryhypertension. Indication for use of NO were SaO2 saturation below 85 %, paO2 below 10 kPa, hypoxemic index under 80, pulmonary shunts above40 % with application FiO2 1,0. Positive effect was minimum 10 % increased SaO2 saturation with improvement of other parameters as above. NOwas used in 6 children in age bracket 3 month to 14 years. Treatment continued...