Anesteziologie a intenzivní medicína, 2001 (vol. 12), issue 6
Sevoflurane in Cardiac Surgery: a Haemodynamic StudyArticles
R. Wagner
Anest. intenziv. Med. 2001;12(6):275-279
In cardiac anaesthesia, there is observed an increasing interest in new inhalational agents. One of the recently introduced agents is represented bysevoflurane, which appears to be as suitable as isoflurane for balanced anaesthesia for cardiac surgery. The goal of the study was to compare theeffect of sevoflurane (n = 20) to isoflurane (n = 11) on haemodynamics of patients operated on for valvular heart disease. The data were compared tothe group treated with vasodilator agent nitroglycerine (n = 11) instead of inhalational agent. Haemodynamic data were obtained from thermodilutioncatheter technique and transesophageal echocardiography. Based on the...
Automatic Control of Neuromuscular Block during General AnaesthesiaArticles
M. Adamus, P. Adamus
Anest. intenziv. Med. 2001;12(6):280-287
The provision of neuromuscular block is a fundamental part of balanced anaesthesia. It is important that the degree of neuromuscular block issufficient to provide adequate surgical conditions, while not so excessive as to make it difficult to antagonize at the end of surgery. Developed systemfor automatic delivery of neuromuscular blockers (RelaxA) comprised a general purpose IBM-compatible computer (PC) interfaced to a Datex AS/3™NMT (neuromuscular transmission) monitor and Graseby Medical 3400 infusion pump. Datex AS/3™ was used to measure NMT every 20 sec whilethe PC was programmed to instruct the infusion pump to administer an atracurium...
Moxonidine (Cynt) in Premedication and Laparoscopic CholecystectomyArticles
J. Málek, M. Starec, M. Štefan, H. Vokounová
Anest. intenziv. Med. 2001;12(6):288-290
We evaluated the effect of moxonidine (Cynt) 0,3 mg (n = 22) and 0,4 mg (n = 25) p.o. on the attenuation of haemodynamic response duringlaparoscopic cholecystectomy in comparison with clonidine (Catapresan) 150 mg i.v. (n = 23) and control group (n = 22). Compared to clonidine,moxonidine was not able to attenuate the rise in blood pressure during capnoperitoneum; however, both groups of moxonidine and clonidine shownless frequent occurrence of blood pressure readings over 175/105 compared to control group (p < 0.001). Other followed parameters (consumptionof fentanyl, postoperative sedation, hypotension, bradycardia, nausea and vomiting) did not...
Time Constant Tau (t) during Mechanical Ventilation: Theoretical and Physical ModelArticles
P. Török, M. Májek, J. Kolník
Anest. intenziv. Med. 2001;12(6):291-294
The authors describe methodic approach and clinical results of mathematical and physical model, measurements and calculations of time constantsof respiratory organs (t) during mechanical ventilation of the lungs. During modelling they found out that theoretically calculated time constant tstatas outcome of multiplication of compliance (Cst ) and respiratory tract resistance (Taw) does not equal the measured values. Detailed analysis ofinspiratory phase and especially expiratory phase revealed that static time constant tstat derived from static components changes during one ventilationcycle in inspiratory and expiratory phases, and that t1 > t2 >...
Time Constant Tau (t) during Mechanical Ventilation: Clinical ResultsArticles
P. Török, M. Májek, J. Kolník
Anest. intenziv. Med. 2001;12(6):295-297
In the study there are compared calculated (tstat ) and measured time constant (tdyn) in two groups of patients with long-term mechanical ventilationin CMV, PCV and PSV modes. Patients were randomized into two groups: one groups consisted of five COPD patients, the other group consisted ofpatients with no lung injury.During the expiratory phase, there were monitored first, second and third time constant (tEdyn1,2,3), as well as calculated time constant as the resultof R . C i.e. tstat.They found no significant correlation between computed and measured time constant.The analysis of measured time constant revealed differences between time constants irrespectively...
Possible Risk of Prolonged Mechanical Ventilation in Pressure-support ModeArticles
P. Török, M. Májek
Anest. intenziv. Med. 2001;12(6):298-303
The authors describe the possible risk of inpulsion effect arising during conventional ventilation if TI:TE ratio is less than 0.5 (Ti% < 33%).They analyze changes of expiratory time constant, pressure support, TI:TE ratio, ventilation frequency, FiO2, SpO2, static compliance and respiratoryresistance which were monitored during ventilation in pressure support mode (pressure support PS). The authors have found that during prolongeddecrease of Ti < 33% (28 ± 3) there could be observed a decrease of static compliance and increase of respiratory tract resistance, evolving graduallyduring several tens of hours.To maintain the gas exchange...
New Possibilities of Diagnosis of Perifocal Cerebral Lesions - a Pilot StudyArticles
J. Pachl, P. Haninec, L. Houšťava, M. Šidák, B. Bakalář, P. Mizner, M. Lopourová
Anest. intenziv. Med. 2001;12(6):304-306
The aim of the prospective study was to set the basic characteristics of values of respiratory parameters (pCO2ti, pO2ti) and pH (pHti) in perifocalzone of focal brain lesions of different etiology in the setting of intraparenchymatous monitoring.The study in patients with focal brain lesions (n = 9: trauma, tumors, vessel malformations) showed severe metabolic changes in perifocal regions.Those are characterized by combined respiratory and metabolic acidosis (pHti 6,97 SD 0,14 and pCO2ti 8,38 SD 1,32). The correction of followedparameters was associated with different cerebral perfusion pressures or oxygen fraction in inspired gas mixture. Optimal...
Hyperhomocysteinemia in Critically Ill PatientsArticles
T. Hyánek, J. Hyánek, H. Pejznochová, M. Macek jun.
Anest. intenziv. Med. 2001;12(6):307-310
Homocysteine is a part of metabolic pathway changes and remethylation of methionine, the important source of methyl groups for all anabolicpathways of an organism. Hyperhomocysteinemia (HHC) is defined as increased plasma level of total homocysteine (tHcy) above reference level.Pathophysiologic effects of elevated Hcy are represented by direct injury of endothel, changes in oxidoregulation balance, oxidative stress, changesin antithrombogenic balance leading to increase of thrombogenic activity, and to increase in atherogenic activity. All those actions result in worseningof clinical and metabolic state of critically ill patient. In our pilot study...
Acute Renal Failure during Sepsis Caused by Mucor spp. - a Case ReportArticles
J. Čupera, H. Řihová, I. Čundrle, P. Brychta, D. Seidlová
Anest. intenziv. Med. 2001;12(6):311-313
Severely burned patient developed a septic state during the in-hospital treatment; the causative agent was identified as Mucor spp. During thetherapy with intravenous immunoglobulines, possibly in combination with amphotericine B, the patient developed an acute renal failure. In the paperthere are reviewed the mechanisms of renal impairment during the treatment with drugs outlined above, and the protective measures targeted againstthose adverse effects.
Skeletal Muscle Amino Acid Metabolism in Septic Patients - a Pilot StudyArticles
P. Živný, V. Černý, H. Živná, J. Bureš, V. Palička, J. Vávrová
Anest. intenziv. Med. 2001;12(6):314-319
Microdialysis of skeletal muscle in patients with and/or without sepsis was performed to assess changes in their interstitial metabolism. Afterinstitutional approval 7 critically ill patients were divided into two groups: group I. (n = 3) patient without sepsis and group II. (n = 4) patients withsepsis. Microdialysis probe CMA 60 (CMA, Microdialysis, Sweden, cut-off approx. 20 kDa) was inserted into musculus quadriceps femoris.Microdialysis with Ringer's solution (flow rate 0.6 ml/min) was started. Sixty minutes samples were collected within 24 hours. Venous blood sampleswere taken in 4 hours intervals. Selected amino acids (AA) concentration in microdialysate...
Immunoparalysis and Infectious Complications in Critically Ill PatientsArticles
M. Průcha, R. Zazula, B. Kavka, J. Hyánek
Anest. intenziv. Med. 2001;12(6):320-323
Immunoparalysis is a relatively frequent finding in critically ill patients treated in the i ntensive care unit. It is characterized by reduced monocyteHLA-DR expression below 30% and decreased production of tumor necrosis factor-a after stimulation with lipopolysaccharid ex vivo lower than 300pg/ml. For the function of the immune system it means inadequate antigen presentation with subsequent defect in the nonspecific and specific immuneresponse. It means also inadequate activity of the proinflammatory reactions which provide homeostasis. In this situation there is a prevalence of theantiinflammatory processes associated with adverse clinical prognosis....