BACKGROUND: To test the hypothesis that Hypotension probability indicator (HPI) driven hemodynamic protocol use may decrease the exposition to hypotension (mean arterial pressure below 65 mmHg) during supratentorial intracranial procedures. METHODS: Patients undergoing supratentorial tumor resection under general anesthesia (ASA 1-3) were included into this randomized single center-controlled pilot trial. Patients in the control group (COV, N.=20) were managed based on the institutional standard to avoid hypotension. Patients in the intervention (INT, N.=20) group were managed using a protocol triggered by the HPI above 85 based on the stroke volume variation, dynamic elastance, and cardiac index parameters. The number of patients experiencing hypotension (mean arterial pressure below 65 mmHg) during the whole procedure and anesthesia maintenance phase was the primary outcome variable. The number of hypotensive periods, time spent in hypotension, and hypotension dose served as secondary outcome variables. Other clinically relevant parameters and postsurgical outcomes were screened. RESULTS: The number of patients who never experienced hypotension was significantly lower in the INT group during the anesthesia maintenance phase (10 (50%) vs. 16 (80%); P=0.049). In several other hemodynamic outcomes, a distinct numerical, but statistically non-significant trend towards lower hypotension exposition was observed. There were no significant differences in clinically relevant parameters. CONCLUSIONS: In this pilot trial, the HPI-based protocol decreased the incidence of hypotension during the anesthesia maintenance but non-significant trends among secondary outcomes were also documented. Larger trials are needed to confirm our findings.
- MeSH
- hypotenze * prevence a kontrola epidemiologie MeSH
- lidé MeSH
- mozek MeSH
- pilotní projekty MeSH
- pravděpodobnost MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- protokol klinické studie MeSH
- Publikační typ
- abstrakt z konference MeSH
Salt stress is one of the most damaging plant stressors, whereas hypoosmotic stress is not considered to be a dangerous type of stress in plants and has been less extensively studied. This study was performed to compare the metabolism of cucumber plants grown in soil with plants transferred to distilled water and to a 100 mM NaCl solution. Even though hypoosmotic stress caused by distilled water did not cause such significant changes in the relative water content, Na+/K+ ratio and Rubisco content as those caused by salt stress, it was accompanied by more pronounced changes in the specific activities of NADP-dependent enzymes. After 3 days, the specific activities of NADP-isocitrate dehydrogenase, glucose-6-phosphate dehydrogenase, NADP-malic enzyme and non-phosphorylating glyceraldehyde-3-phosphate dehydrogenase in leaves were highest under hypoosmotic stress, and lowest in plants grown in soil. In roots, salt stress caused a decrease in the specific activities of major NADP-enzymes. However, at the beginning of salt stress, NADP-galactose-1-dehydrogenase and ribose-1-dehydrogenase were involved in a plant defense response in both roots and leaves. Therefore, the enhanced demands of NADPH in stress can be replenished by a wide range of NADP-dependent enzymes.
- MeSH
- chlorid sodný aplikace a dávkování MeSH
- Cucumis sativus fyziologie MeSH
- fyziologický stres účinky léků fyziologie MeSH
- multienzymové komplexy metabolismus MeSH
- NADP metabolismus MeSH
- osmotický tlak účinky léků fyziologie MeSH
- semenáček účinky léků fyziologie MeSH
- tolerance k soli účinky léků fyziologie MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Východisko: Primárním cílem práce bylo zhodnotit dopady neuroprotekce podané při karotické endarterektomii na metabolické mozkové parametry. Sekundárním cílem bylo zjistit zda eventuální změny mozkového metabolismu mají vliv na výsledný klinický stav. Materiál a metoda: Sledovaný soubor obsahuje 35 nemocných, kteří podstoupili karotickou endarterektomii s preventivním podáním kombinované neuroprotekce (Sendai koktejl: Manitol, Phenhydan, Solumedrol, Tokoferol; Cerebrolysin; 100% O2, střední arteriální tlak 100 mm Hg, celková anestezie). Zhodnocen byl vliv neuroprotekce na tyto mozkové metabolické parametry: S100B protein, glykémie, laktát, pH, saturace jugulárního bulbu – SvjO2. Parametry mozkového metabolismu byly nabírány z homolaterální vena jugularis interna v průběhu operace před uvolněním cévních svorek. Výsledný klinický stav byl hodnocen prostřednictvím NIHSS (National Institutes of Health Stroke Scale). Kontrolním souborem bylo 35 nemocných operovaných bez neuroprotekce. Výsledky sledovaných parametrů v obou souborech byly zhodnoceny, porovnány a statisticky zpracovány. Výsledky: Ve sledovaném souboru byly zjištěny signifikantně vyšší hladiny S100B proteinu (medián 0,117 vs. 0,088; p < 0,0182), laktátu (medián 1,92 vs. 1,020; p < 0,0006), glykémie (medián 9,5 vs. 8,2; p < 0,0243) a SvjO2 (medián 0,79 vs. 0,65; p < 0,0001). Hodnoty pH se v obou souborech signifikantně nelišily. NIHSS se v obou souborech po operaci nezměnilo. Závěr: Podání neuroprotekce před karotickou endarterektomií ovlivnilo některé parametry mozkového metabolismu, a to jak pozitivně tak i negativně, avšak bez dopadu na výsledný klinický stav.
Objectives: The primary objective of this study was to evaluate the impact of neuroprotection, administered during carotid endarterectomy, on brain metabolism. The secondary objective was to assess the impact of resulting changes in brain metabolism on the clinical outcome. Methods: A total of 35 patients underwent carotid endarterectomy with prophylactic combined neuroprotection (Sendai cocktail: Manitol, Phenhydan, Solumedrol, Tokoferol; Cerebrolysin; fraction of inspired oxygen (FiO2) =1, middle arterial pressure (MAP) = 100 mmHg, total intravenous anesthesia - TIVA). The influence of neuroprotection on brain metabolism (S100B, glycaemia, lactate, pH, jugular vein bulb oxygen saturation - SvjO2) was evaluated. Metabolic parameters were acquired from the jugular bulb during surgery, just before unclamping of the vessel. The clinical outcome was evaluated by NIHSS (National Institutes of Health Stroke Scale). There were 35 patients in the control group who where operated on without any neuroprotection. The results from both groups of patients were compared and statistically analyzed. Results: Postoperative NIHSS did not change in any patient in either group. An intraoperative shunt was not inserted in any patient in either group. In the group with neuroprotection there were significantly higher levels of S100B (median 0.117 vs. 0.088; p<0.0182), lactate (median 1.92 vs. 1.020; p<0.0006), glycaemia (median 9.5 vs. 8.2; p<0.0243), and SvjO2 (median 0.79 vs. 0.65; p<0.0001). There were no postoperative changes to NIHSS in either group. Conclusions: Neuroprotection administered before carotid endarterectomy influences some parameters of brain metabolism both positively and negatively, but with no impact on clinical outcome.
- Klíčová slova
- mozkový metabolismus,
- MeSH
- celková anestezie MeSH
- dospělí MeSH
- karotická endarterektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mozek metabolismus MeSH
- neuroprotektivní látky aplikace a dávkování MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
The aim of this study was to develop a method of Se and As determination in drinking water by electrochemical hydride generation coupled with AAS. Three types of electrolytic cells were constructed and optimized for the determination. Two cells (thin-layer and tubular) were finally chosen for their low inner volume and a high hydride generation efficiency (ca. 90 %). The limits of detection of As(III) and Se(IV) were 0.07 and 0.37 ng ml–1, respectively. The accuracy of the method was verified using reference materials.
Autoři se v článku zabývají epidemiologií kraniocerebrálních poranění, morbiditou a mortalitou. Kladou důraz na prevenci sekundárních inzultů jako jediné cesty vedoucí ke zlepšení výsledku nemocných s vážným kraniocerebrálním traumatem. Zabývají se prioritami v ošetření traumatizovaného nemocného a základními vyšetřeními před úvodem do celkové anestezie, stejně jako požadavky na monitoraci těchto nemocných. Za stěžejní patofyziologický parametr považují mozkový perfuzní tlak (CPP) a znalosti faktorů, které ho ovlivňují, pokládají za zásadní při volbě adekvátního anesteziologického postupu.
In this article, the authors are engaged with the epidemiology, mortality and morbidity of craniocerebral injuries. They stress the prevention of secondary insult affecting the brain as the correct way of improving the outcome in patients undergoing serious craniocerebral injury. They describe priorities in treatment of traumatised patients, basic examinations before induction to general anaesthesia and the specific monitoring necessary during general anaesthesia in this sort of patients. The authors emphasise cerebral perfusion pressure (CPP) as the main pathophysiologic parameter; the knowledge of factors changing CPP is considered basic in choice of adequate anaesthesiologic management.
