Anesteziologie a intenzivní medicína, 2001 (vol. 12), issue 4
Hepatorenal Dysfunction after Caesarean SectionArticles
M. Fořtová
Anest. intenziv. Med. 2001;12(4):159-161
HELLP syndrom is one of the forms of late gestosis. It is characterized by H (hemolysis), EL (elevated liver enzymes) and LP (low plateled count).This syndrom is a severe complication of pregnancy with high mortality. Maternal mortality amounts to 50 %. HELLP syndrom occurs as a rule fromthe 17th week of the pregnancy to the 6th day of the postpartum. (70 % before delivery, 30 % postpartum). Pathophysiology is not known exactly, perhapsit is caused by vascular lesion with multiple organ failure (above all of the liver) and by activation of coagulation. What most authors also consideras this syndrom are the cases without hemolysis (ELLP) or without...
Intrathecal Administration of Morphine for Postoperative Pain Control after Caesarean SectionArticles
J. Frdlík, J. Vondráček, I. Chytra, E. Kasal
Anest. intenziv. Med. 2001;12(4):162-164
The authors present the results of two-year prospective study comparing spinal anaesthesia with hyperbaric bupivacaine 0.5% with morphine togeneral anaesthesia or spinal anaesthesia with hyperbaric bupivacaine only. Spinal anaesthesia with hyperbaric bupivacaine combined with intrathecalmorphine provided excellent postoperative analgesia with statistically lower suppleme ntal analgesia requirements in the postoperative period. Theadverse effects are not severe. Their frequency is comparable with other types of anaesthesia. Financial costs associated with that type of anaesthesiado not increase above the financial costs associated with general anaesthesia....
Post Dural Puncture Headache in Parturients Following Spinal Anaesthesia for Caesarean Section.Articles
V. Bárta, V. Čermáková, P. Jiránek
Anest. intenziv. Med. 2001;12(4):165-166
The aim of the study was to follow the association between post dural puncture headache (PDPH) and the type of needle tip used and diameter ofthe needle used to spinal anaesthesia in parturients scheduled for Caesarean section. This type of anaesthesia is the first choice for the procedure.Puncture of the subarachnoidal space was performed in a seated patient in thirty seven per cent of cases, in lateral recumbent position in sixty-threeper cent of cases. Medial approach was attempted in ninety-seven per cent of cases, using G20 needle. The use of pencil point needles G27 significantlydecreased the occurrence of adverse post dural puncture headaches.
Comparison of Remifentanil and Sufentanil in Anaesthesia of Patients Operated on for Intracranial DiseaseArticles
M. Lopourová, J. Málek, P. Mizner, J. Pachl
Anest. intenziv. Med. 2001;12(4):167-170
The aim of the study was to compare currently used perioperative analgesia with sufentanil to new opioid remifentanil in a set of neurosurgicalpatients operated on due to intracranial lesion. In a prospective open clinical study we randomized 20 patients in two groups. Ten patients in groupS received sufentanil perioperatively (initial rate 0.5 mcg/kg/hr), ten patients in group R received remifentanil (initial rate 0.1 mcg/kg/hr). The doseswere adjusted as requested by the patient. Anaesthesiologic management was equal and standard in both groups. We monitored hemodynamic changesperioperatively and postoperatively, time to extubation and adverse effects....
Anaesthesia for Neurosurgical Operation and Perioperative Contact with PatientArticles
J. Rajciová, I. Schroederová, T. Bartošík, R. Hřib, R. Kraus
Anest. intenziv. Med. 2001;12(4):171-172
The article presents a technique of anaesthesia for a specific neurosurgical operations of epilepsy, for surgeries, performed next to central area,speech center and functionally exposed brain areas. We use a laryngeal mask to enable a verbal contact with the patient or memory test making duringthe operation. Difficulties of this procedure, possible complications and risks of the second phase of the operation are emphasized.
Rocuronium as an Alternative to Suxamethonium for Endotracheal IntubationArticles
P. Michálek, J. Cihlář, H. Paříková, M. Moravec
Anest. intenziv. Med. 2001;12(4):173-175
Rocuronium bromide is a steroid-structure non-depolarizing muscle relaxant agent, characterized by selective affinity to laryngeal muscles, fastonset and medium-term duration of action. It could be seen as a suitable alternative to suxamethonium for "rapid sequence" intubation, without the latter's adverse effects. The prospective study evaluated intubation conditions in fifty patients following administration of rocuronium bromide 0.6 mg/kg. The speed of onset of action after rocuronium administration is comparable to suxamethonium. The effect on hemodynamics is negligible.There was not observed significantly prolonged duration of action even in chronic...
Acute Normovolemic Hemodilution for Management of Blood Loss during Radical Cystectomy - Case ReportArticles
R. Gál, I. Čundrle, B. Stibor
Anest. intenziv. Med. 2001;12(4):176-177
Blood loss is an inevitable consequence of surgery. We refer a case report of patient with high cardiac risk (ASA classification III), in which weused acute normovolemic hemodilution as a solely method for avoiding of allogenic blood transfusions. After starting general anaesthesia we removed2 500 g of whole blood from patient with restoration of circulation volume by 1 500 ml of colloids and 2 000 ml of crystalloids. Retransfusion we startedafter 800 ml blood loss (transfusion trigger - Hct 0,20). The general blood loss was 3 500 ml during 6 hour and 40 minutes of operation time and next880 ml in 48 hours postoperatively. The patient was the whole...
Obstetric Epidural Analgesia in a District Hospital EnvironmentArticles
J. Karaš, J. Fedorko, J. Pružinský, E. Korba
Anest. intenziv. Med. 2001;12(4):178-186
The authors have implemented obstetric epidural analgesia as a standard method in a district hospital. Between January 1998 and June 2000 theyperformed epidural analgesia in 231 deliveries. This represents 11.0% of 2091 total deliveries. They created standard guidelines for anesthesiologicand obstetric teams. These guidelines included steps in informing and preparing parturients for labor and delivery. By completing a questionnaire,parturients commented on their satisfaction with the epidural analgesia. The authors emphasize that the most important goal in implementing theirmethod is maintaining good cooperation between the anesthesiologic and obstetric...
Top Role of Anaesthesiologist in Treatment of Neuropathic PainArticles
P. Cvrček
Anest. intenziv. Med. 2001;12(4):187-190
Many patients suffering from intensive neuropathic pain cannot find adequate treatment neither in GP office nor in hospital. Tricyclic antidepressants, antiseizures, antiarrhythmics and other usual drugs haven't any considered effect or this effect become very late. Nevertheless there is one verypotent drug, which can offer the relief from the neuropathic pain in some seconds and provide this analgesia until definitive resolution of this problemis obtained. This drug is ketamine.
Postoperative analgesia in Cardiac SurgeryArticles
J. Kunstýř, M. Stříteský, J. Krištof, B. Škrovina, T. Kotulák
Anest. intenziv. Med. 2001;12(4):191-194
Introduction:Prospective study comparing four methods of postoperative analgesia with regard to the following criteria: pain relief during bed-restand rehabilitation; the effect on ventilation and the occurrence of side effects.Study population and types of intervention: Ninety-two patients scheduled for cardiac surgery via sternotomy were enrolled in the study during theperiod from autumn 1998 to spring 1999. The patients were randomized into four groups. Balanced general anaesthesia was administered. Withinfirst 48 hours after the completion of surgery, patients were periodically assessed in 6-12 hours intervals and also during rehabilitation....
Is it Possible to Develop an Addiction to Opioids in Oncology Patients Suffering from Pain?Articles
Z. Toman
Anest. intenziv. Med. 2001;12(4):195-197
An addiction to opioids in oncology patients suffering from severe pain is developing in a different way compared to street-drug addicts. Itsdevelopment is possible according to the regimen of their application: 1. Treatment strategy based on a fixed-interval schedule provides the patient with a time-constant pain relief. This strategy preventively suppressesemerging pain. with application of this regimen, drug addiction is suppressed to a minimum. 2. Analgetic strategy "on demand" is a practical presentation of opioid-phobia of a physician.Opioids are administered irregularly. Pain relief is repeatedly replaced with pain emergence. Frequent changing...
Cancer Patient Admitted to ICUArticles
Z. Kos
Anest. intenziv. Med. 2001;12(4):198-200
The purpose of this study was to evaluate demographic data, length of stay, severity of illness and outcome of patients with cancer admitted to ICU.During a 3-year period 479 patients were hospitalised. All admissions were reviewed and 38 cancer patients were identified. All suffered malignantsolid tumors and the most of them were surgical patients (36 vs. 2). The most frequent admission was due to severe sepsis or septic shock, others wereadmitted because of prolonged perioperative management, left heart failure, COPD exacerbation, ARDS. At first 24 hours the mean TISS value was30 and SOFA score was 7, all patients were mechanically ventilated. ICU...
Bronchopleural Phistula Treated by Selective Ventilation of the Lungs with High Frequency Jet VentilationArticles
J. Langer
Anest. intenziv. Med. 2001;12(4):201-204
The case report describes a patient with pneumonia with abscess formation who developed a bronchopleural phistula leading to pyopneumothorax.The patient was intubated with biluminaltube. The affected lung was ventilated with high frequency jet ventilation, the healthy lung was ventilated involume control BIPAP mode. Antibiotic treatment is discussed with proper bronchial tree toilette using targeted bronchial lavage and suction.
Lactulose and Impact on Microbial Colonization in Critically Ill PatientsArticles
V. Zvoníček, P. Ševčík, V. Šrámek, M. Votava, P. Ondrovčík, S. Zábranská
Anest. intenziv. Med. 2001;12(4):205-208
Lactulose decreases pH of colon contents and can thus inhibit the overgrowth of pathogenic strains. In our study the impact of lactulose on microbialcolonisation of critically ill patients was investigated. Forty-eight mechanically ventilated patients with no signs of pneumonia on admission wererecruited into the prospective double-blind randomised study (15 ml lactulose versus saline q.i. d administered into the stomach). Gastric andoropharyngeal contents, tracheal aspirate and rectal swab were taken on admission and then at 3 day intervals. The concentration of pathogens> 105/ml was considered significant. Thirty-eight patients (15 given lactulose...
Diffuse Axonal InjuryArticles
B. Drugová, T. Hyánek, R. Druga, J. Pokorný, A. Cypriánová, I. Procházka
Anest. intenziv. Med. 2001;12(4):209-212
Diffuse axonal injury (DAI) is widespread damage to axons in the white matter of the hemispheres and brain stem. Axonal damage was producedby mechanical forces shearing the fibers at the moment of impact. The paper present four patients. Of these three were injured in a road traffic accident.The true extent of brain involvement is better appreciated with MR imaging. MR imaging in our patients demonstrated multiple focal lesions of thewhite matter of the cerebral hemisphere (centrum semiovale, corpus callosum) and the brain stem (midbrain and pontine tegmentum, substantia nigra,cerebral peduncles and the dorsolateral quadrant of the pontomesencephalic...
Fate of Recipients of Cadaveric Organ from Donors with a CNS TumorArticles
E. Pokorná, Š. Vítko
Anest. intenziv. Med. 2001;12(4):213-215
Introduction:We conducted a retrospective study designed to monitor the fate of recipients of organs from donors with a CNS tumor to establishwhether or not the malignancy got transferred.Material and methods: A total of 2,048 cadaveric organ donors were indicated for organ harvesting in the Czech Republic in the 1986-1998 period;in 42 (2.1%), the cause of the brain death was a CNS tumor. In one case, autopsy showed metastasis of bronchogenic carcinoma so the diagnosis ofa CNS tumor was erroneous! A total of 92 organs (79 kidneys, 4 hearts, 5 livers, 3 pancreases, and 1 lung) were transplanted to 89 recipients.Results: Six recipients died...