Anesteziologie a intenzivní medicína, 2002 (vol. 13), issue 5
Fast-track Anaesthesia with Alfentanil in Heart Valves SurgeryArticles
T. Vaněk, P. Brůček, Z. Straka, M. Jareš
Anest. intenziv. Med. 2002;13(5):203-205
The authors describe their experience with 22 patients who underwent the fast-tract anaesthesia with alfentanil for the lesion of aortic valve,ascending aorta or mitral valve. 8 patients had moderate risk for the surgery (EuroSCORE 3-5) and 11 patients had high risk for the surgery(EuroSCORE>6). 8 patients (36.3%) were extubated 10 minutes after the end of the procedure in the operating room. The average time of mechanicalventilation in other patients was 51±45 minutes. No patient was reintubated for the respiratory or cardiac failure. Average length of stay in the intensivecare unit was 2.2±1.4 days. No patient died in 30 postoperative...
Nimbex (cis-atracurium) in Patients with Facial FracturesArticles
J. Mannová, J. Čupera, I. Čundrle, H. Ondrášková
Anest. intenziv. Med. 2002;13(5):206-209
The authors evaluated cis-atracurium (Nimbex) in 21 patients who underwent general anaesthesia due to facial (mandibular and maxillary) fractures.In 13 patients cis-atracurium was used for intubation and after 120 sec the intubation conditions were evaluated. The conditions were sufficient andalmost excellent in all cases. For maintance of anaesthesia cis-atracurium was used in half of the patients in continuous infusion of 1 µg/kg/min. Thisway was superior for short procedures (60 minutes). In the other half of the patients cis-atracurium was supplemented by boluses of 0.025-0.030 mg/kgat interval of 30-40 minutes. The conditions for extubation...
First Experience with New Analgesic Neodolpasse RArticles
T. Grosmanová, J. Klein, T. Bohanes
Anest. intenziv. Med. 2002;13(5):210-214
Treatment of a pain after thoracic surgery procedures remains a chalenge. Thoracotomy is very painful but excessively sedated patients in thepostoperative period do not cooperate, hypoventilate and do not cough enough. Postoperative complications can seriously worsen patient's status.At Dept. of Surgery I in Olomouc in period between April-August 2001 we used a new intravenous analgetic agent Neodolpasse R (produced byFresenius Kabi) for treatment of a pain after thoracic surgery procedures.Neodolpasse R consists of two effective substances - Diclofenacum natricum and Orphenadrini citras (NSAID and central myorelaxans). Weadministered Neodolpasse R...
Effects of Intraoperative Ventilation Strategy on Pulmonary Functions and Postoperative Course in the Patients Undergoing Large SurgicalProcedureArticles
P. Dostál, V. Dostálová, P. Navrátil, M. Broďák, V. Černý
Anest. intenziv. Med. 2002;13(5):215-219
During general anaesthesia there is a decrease of functional residual capacity (FRC) and changes of pulmonary gas exchange. The goal of the studywas to evaluate the influence of ventilation strategy during general anaesthesia on chosen pulmonary function parameters and postoperative coursein the patients who underwent large surgical procedure. The prospective randomized study enrolled 67 patients. The patients of control group (groupK, n=34) were ventilated during anaesthesia in VCV ventilation mode with low PEEP (3 cmH2O). In the second group of patients (group RMP, n=33)modified recruitment maneuver was performed after 15 min from the induction of...
Prediction of Impact of End-expiratory Pressure Changes on Pulmonary Shunt Fraction in Patients with ARDS - the Significance of EstimatedPulmonary RecruitmentArticles
P. Dostál, R. Pařízková, V. Černý
Anest. intenziv. Med. 2002;13(5):220-226
The use of PEEP is the integral part of ventilatory strategy in patients with ARDS. Optimization technique of PEEP setting is controversial. Thegoal of the study was to find the algorithm which can predict the value of PEEP with the smallest pulmonary shunt fraction Qs/Qt based on the evalutionof the mechanical properties of respiratory system. The prospective observational study enrolled 7 patients with pulmonary artery catheter who metAmerican-European consensual criteria for ARDS. During data recording the patients were ventilated in CMV ventilation mode with constantinspiration flow, tidal volume of 5-7 ml.kg-1, inspiration pause of 0.5-1 sec;...
Treatment Algorithm for Severe Necrotic Pancreatitis from the Point of View of Interdisciplinary CollaborationArticles
J. Bober, J. Firment, M. Grochová, M. Steranková, P. Harbuľák
Anest. intenziv. Med. 2002;13(5):227-230
The authors highlight the increased incidence of acute pancreatitis with the part of severe forms which still have high mortality.In the chapter "Methods" they present their treatment algorithm for acute pancreatitis with emphasis on its severe forms. The authors particularlyaccent the medical collaboration with intensivists and other specialists (from the area of nephrology, haematology, gastroenterology and cardiology).The condition for the achievement of good treatment results in severe forms of acute pancreatitis is strong interdisciplinary collaboration and the useof advanced treatment methods.The authors gained their experience during 3.5 years...
Risk of the Interpretation of Phenytoin Plasma Levels in the Intensive Care - Case ReportArticles
J. Tichá, M. Halačová, H. Pejznochová, B. Kavka, D. Vondráčková, J. Hyánek, R. Průša
Anest. intenziv. Med. 2002;13(5):231-234
Phenytoin is a commonly prescribed antiepileptic drug in medical practice. As it is a drug which has a non-linear saturable pharmacokinetics,a relatively narrow therapeutic range and a large number of reported pharmacokinetic interactions, plasma phenytoin concentration is inevitable tomonitor. Our aim is to emphasize, one of serious interactions of phenytoin with enteral feeding formulas administered together with phenytoin bynasogastric tube. This interaction decreases bioavailability of phenytoin resulting often in detection of subtherapeutic concentrations, thoughrecommended daily doses (recommended daily dose 5-7 mg/kg/day, RDD 300 mg) are administered....
Death on Generalized Mucormycosis - Case ReportArticles
P. Smetana, M. Šulc
Anest. intenziv. Med. 2002;13(5):235-236
A 56-years-old man with diabetes and polytrauma died under the picture of septic shock. At necropsy, generalised mucormycosis has been diagnosed.Early recognition is necessary for successfull treatment. Biopsy of necropsy skin is a key to this in our country unusual diagnosis.
Continuous Venovenous Hemodiafiltration (CVVHDF): Effects on Global Hemodynamics and Gastric Mucosal Energy BalanceArticles
R. Rokyta, jun., V. Šrámek, M. Matějovič, P. Hora, I. Novák
Anest. intenziv. Med. 2002;13(5):237-240
Objective:To assess the impact of continuous venovenous hemodiafiltration (CVVHDF) initiation on central hemodynamics, oxygen transport andgastric mucosal energy metabolismDesign: Prospective clinical study.Setting: University Hospital medical intensive care unit.Subjects: Fourteen critically ill patients with acute renal failure.Methods: Gastric mucosal PCO2 (pgmCO2) was measured using gastric tonometry at baseline and then at 1,2,3 and 6 hours after starting CVVHDFand gastric mucosal to arterialPCO2 gradient (PCO2gap) was calculated. Whole body hemodynamics was measured invasively (arterial and pulmonaryarterial catheters).Results: PCO2gap...
Posttraumatic Stress Disorder in Intensive CareArticles
B. Šestáková, I. Chytra, H. Skalková, E. Kasal, R. Pradl, V. Fessl
Anest. intenziv. Med. 2002;13(5):241-243
The aim of our work was to specify in detail mental trauma experienced by the critically ill patients during the treatment in intensive care unit.Physical deprivation, fear of death and pharmacological sedation in patients who survive intensive care lead to biopsychosocial process which has allthe attributes of posttraumatic stress disorder (PTSD). We analyzed the group of 26 patients who had returned from the intensive care unit to everydaylife. For the diagnosis of PTSD we used standard patient exploration guided by the psychologist, STAI (State-Trait Anxiety Inventory) and MHQ(Middlesex Hospital Questionnaire) questionnaires, and drawing projection...
Constitution of Postgraduate Training Centre for Basic and Advanced Life SupportArticles
B. Klementa, O. Marek, E. Sovová, V. Rýznar
Anest. intenziv. Med. 2002;13(5):244-246
The cardiopulmonary resuscitation (CPR) in the hospital is basic knowledge and duty for every physician. Because of intensive advancement in thisarea the physicians can't do without regular renewal of their knowledge. Unfortunately there is no system of regular cyclic training in CPR in the mostof our hospitals. Technical equipment of hospitals is outdated and hospital staff uses old methods. The University Hospital Olomouc has started regularcompulsoryCPRtraining in 2000. The training courses run in theCPRpostgraduate training centre in the Department of Anaesthesiology and IntensiveCare. The test in the beginning of the courses showed insufficient...
Temporary Possibilities of Cardiac PacingArticles
R. Škulec, J. Bělohlávek, J. Kolář, M. Pšenička, M. Aschermann
Anest. intenziv. Med. 2002;13(5):247-254
Hemodynamicaly significant bradyarrhythmias (sinus bradycardia, sinoatrial block, atrioventricular block, cardiac arrest) are emergencies whichneed urgent solutions.We offer the review of farmacologic and nonfarmacologic procedures with focusing on their application in prehospital care. Fortemporary cardiac pacing, transcutaneous cardiac pacing we conclude as first line procedure because of its safety, non-invasivity and quick applicability.For the future, perspective method is esothoracic pacing.