Anesteziologie a intenzivní medicína, 2003 (vol. 14), issue 2
Levobupivacaine - a Safer Variant of 30-year-old SubjectArticles
P. Ševčík
Anest. intenziv. Med. 2003;14(2):69-72
Levobupivacaine is a long acting, amide-type local anaesthetic and is the S(-)-enantiomer of racemic bupivacaine. Themajority of in vitro, in vivo and human pharmacodynamic studies indicate that levobupivacaine has a similar potency tobupivacaine in various types of nerve blocks. However, levobupivacaine has a lower risk of cardiovascular and CNS toxicitythan bupivacaine. Randomised, double blind clinical studies established that the anaesthetic and/or analgesic effects oflevobupivacaine were very similar to those of bupivacaine of thesame dose.The sensory block tended to be a little bit longerwith levobupivacaine than bupivacaine. Levobupivacaine...
Epidural Anaesthesiawith Levobupivacaine for Surgery of Herniated Lumbar Intervertebral DiscArticles
M. Votýpka, T. Bartošík
Anest. intenziv. Med. 2003;14(2):74-76
Objective:To evaluate the quality of epidural anaesthesia and occurrence of adverse reactions of levobupivacaine 0.5% foroperation of herniated lumbar intervertebral disc.Design: clinical study.Setting: Department of Anaesthesia and Intensive Care, St. Ann's University Hospital, Brno.Material and methods: 30 randomly selected patients undergoing operation of herniated lumbar intervertebral disc. Afteroral premedication a peripheral venous line was inserted and crystalloids (Ringer solution) were administered.ECG,arterialblood pressure and pulse oximetry were used for monitoring. After detection of the epidural space levobupivacaine 0.5%was...
Subarachnoid Anaesthesia with 0,5% Levobupivacaine (Chirocaine) for Lower Limb in ElectiveOrthopaedic and Trauma SurgeryArticles
I. Herold, J. Nováček, M. Trnovský, M. Rosický, J. Pečenková, V. Kňourek, L. Piskač, L. Piskačová, J. Sedláček
Anest. intenziv. Med. 2003;14(2):77-81
Objective:New chiral local anaesthetic levobupivacaine has been used until now mostly for epidural anaesthesia/analgesia,plexus and major nerve blocks. There are only a few reports of its use for subarachnoid anaesthesia (SA). The study aimedto evaluate the efficacy and safety of intrathecal administration of 0.5% levobupivacaine, where previously racemicbupivacaine was used almost exclusively.Setting: Department of Anaesthesiology and Intensive Care, Department of Orthopaedic Surgery and Traumatology ofRegional Klaudian's Hospital, Mladá Boleslav.Material and methods: The authors enrolled 30 patients (ASA I-III, age 15-80, height ≥ '...
Ketamine Suppresses Morphine Tolerance - Old Dog Learns New TricksArticles
J. Málek, M. Šejdová
Anest. intenziv. Med. 2003;14(2):82-84
Low-dose ketamine prevents opioid tolerance during long-term pain therapy or abuse of opioids by NMDA receptor blockand improves morphine analgesia. Two cases are presented, where this effect was used. The first case was a young woman(24 years) dependent on heroin (daily dose approx. 1 g intranasally). She was admitted for surgery and operated for bilateralgluteal abscesses. After surgery she suffered a severe pain at rest, pain at visual analogue scale (VAS 0-10) was 8 in spiteof three days therapy with slow release morphine (MST Continus) 2x60 mg p.o. per day and intramuscular morphine 10 mgevery 4 hours. Ketamine 40 mg p.o. every 4 hours was started...
Diagnosis of Myocardial Contusion?Articles
R. Šplechtna, L. Pokorný, E. Hušková, P. Obruba, J. Fialka, D. Nalos
Anest. intenziv. Med. 2003;14(2):85-89
Objective:Myocardial contusion can result from blunt thoracic trauma and is commonly suspected in deceleration injuries(after a traffic accident or a fall from great height etc.). Unfortunately, traumatic heart disease is frequently overlooked andthe diagnosis ofmyocardial contusion is often unrecognized. The diagnosis of cardiac injury in patients with blunt thoracictrauma is controversial. Non-invasive tests including ECG, cardiac enzymes, radionuclide studies and echocardiography(transthoracic echocardiography - TTE and especially transaesophageal echocardiography TEE) can be used.Many articlesconcerning methods of diagnosis of heart...
Regional and General Anaesthesia - Rivals or Partners?Articles
D. Nalos
Anest. intenziv. Med. 2003;14(2):90-93
The author demonstrates possible advantages in combining methods of general and regional anaesthesia. Methods ofgeneral anaesthesia, such as analgesia and sedation, are often used in peripheral and neuroaxial blocks. The advantagesof general and regional anaesthesia remarkably increase number of profiting patients. On the other hand, methods ofregional anaesthesia lower the risk and an amount of complications during and after extensive surgical procedures undergeneral anaesthesia. In many patients combination of general and regional anaesthesia represents the most rational andsimple approach to increase operiperative safety and optimal care in the...
Hypoxic Pulmonary VasoconstrictionArticles
V. Lachmanová
Anest. intenziv. Med. 2003;14(2):94-97
Hypoxic pulmonary vasoconstriction reduces perfusion in poorly ventilated regions of the lungs and redistributes perfusionto the well-ventilated areas. It therefore decreases venous admixture and optimizes the oxygenation of arterial blood. It isalready present in the foetal period when it contributes to the decrease of the overall pulmonary blood flow. It is acceptedtoday that all mechanism of hypoxic pulmonary vasoconstriction are localized in the pulmonary vascular smooth musclecells. The mechanisms of cellular oxygen sensing are still obscure. Hypoxia inhibits the potassium channels leading tomembrane depolarisation of smooth muscle cells and to...
Glutamine in Critically Ill PatientsArticles
I. Novák, M. Matějovič, R. Rokyta, jun., A. Kroužecký
Anest. intenziv. Med. 2003;14(2):98-102
Glutamine is the most abundant amino acid in the body, and is the preferred energy substrate for lymphocytes, enterocytesand neutrophils. This amino acid plays also a central role in amino acid and carbohydrate metabolism. Glutamine deficiencyis common in those who remain critically ill for more than a few days and may result in impaired immune function, thusincreasing susceptibility to infection. There is growing evidence that glutamine, alone or in combination, exerts beneficialeffects on the clinical outcome and infectious complications in critically ill patients. Glutamine enriched nutritional supportmay not reduce the overall incidence of acquired...
Cardiac Failure in Intensive CareArticles
R. Pařízková
Anest. intenziv. Med. 2003;14(2):103-110
Heart failure represents almost 5 % of all hospital admissions and both mortality and health care cost on account of thosepatients are high. The proportion of patients on ICU with heart failure of various origin (mostly as a results either of primaryheart damage or as a result of secondary heart damage due to multiple organ failure) has increased rapidly during the lasttwo decades. Heart failure occurs mostly as a result of ischaemic heart disease and the prevalence of heart failure increasesin those with both ischaemic heart disease and hypertension.Increased sympathetic activity, renin-angiotensin-aldosterone axis, vasopressin, endothelin and atrial...