Ze všech prací publikovaných za posledních 12 měsíců z oblasti anesteziologie přináší tento článek publikační přehled ze tří tematických oblastí, které autoři tohoto textu považují za významné – srovnání vlivu celkové a regionální anestezie, srovnání vhodnosti inhalační a totální intravenózní anestezie a srovnání účinků remimazolamu versus propofolu.
Out of all the papers published in the last 12 months in anaesthesiology, this article presents a publication overview of three topic areas that the authors of this text consider significant - a comparison of the effects of general and regional anesthesia, a comparison of the suitability of inhalational and total intravenous anesthesia, and comparison of the effects of remimazolam versus propofol.
INTRODUCTION: Corticobasal syndrome (CBS) is a specific clinical manifestation shared by multiple pathologies. The exact mechanism of this phenomenon remains unclear. Differential diagnosis of CBS in everyday clinical practice is challenging, as this syndrome can overlap with other entities, especially progressive supranuclear palsy Richardson-Steele phenotype (PSP-RS). Several papers have suggested a possible role of vascular pathology as a linking factor in the pathogenesis of CBS based on different neuropathologies. This paper analyses differences in the occurrence of the most common vascular risk factors such as hypertension and lipid profile with respect to dietary habits among patients who fulfill the diagnostic criteria for probable/possible CBS and PSP-RS. MATERIAL AND METHODS: Seventy (70) patients in total were included in the study. Exclusion criteria comprised hydrocephalus, stroke in the past, the presence of marked vascular changes in white matter defined as the presence of vascular change ≥ 1 mm in 3T MRI, medical history of hyperlipidemia or the use of drugs that could impact upon lipid metabolism before the initiation of the neurodegenerative disease, and neoplastic focuses in the central nervous system. Patients with diabetes, or with BMI exceeding 18-25, or who were smokers, or who were affected by chronic stress were also excluded. Data was analysed statistically using the Shapiro-Wilk test, the U Mann-Whitney test for group comparison, and a Bonferroni correction to control the false discovery rate (FDR). RESULTS: Our obtained results indicated a statistically significantly higher level of total cholesterol in the CBS group (p = 0.0039) without a correlation with dietary habits. CONCLUSIONS AND CLINICAL IMPLICATIONS: The results obtained in our study may suggest a possible role of vascular pathology in CBS development. This issue requires further research.
Multiple system atrophy (MSA) is generally a sporadic neurodegenerative disease which ranks among atypical Parkinson's syndromes. The main clinical manifestation is a combination of autonomic dysfunction and parkinsonism and/or cerebellar disability. The disease may resemble other Parkinsonian syndromes, such as Parkinson's disease (PD) or progressive supranuclear palsy (PSP), from which MSA could be hardly distinguishable during the first years of progression. Due to the lack of a reliable and easily accessible biomarker, the diagnosis is still based primarily on the clinical picture. Recently, reduced levels of coenzyme Q10 (CoQ10) were described in MSA in various tissues, including the central nervous system. The aim of our study was to verify whether the level of CoQ10 in plasma and lymphocytes could serve as an easily available diagnostic biomarker of MSA. The study reported significantly lower levels of CoQ10 in the lymphocytes of patients with MSA compared to patients with PD and controls. The reduction in CoQ10 levels in lymphocytes correlated with the increasing degree of clinical involvement of patients with MSA. CoQ10 levels in lymphocytes seem to be a potential biomarker of disease progression.
- Publikační typ
- časopisecké články MeSH
PURPOSE: The objective of our study was to evaluate the diagnostic accuracy of internal jugular vein (IJV) collapsibility as a predictor of fluid responsiveness in spontaneously breathing patients after cardiac surgery. METHODS: In this prospective observational study, spontaneously breathing patients were enrolled on the first postoperative day after coronary artery bypass grafting. Hemodynamic data coupled with simultaneous ultrasound assessment of the IJV were collected at baseline and after passive leg raising test (PLR). Continuous cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV) were assessed with FloTracTM/EV1000TM. Fluid responsiveness was defined as an increase in CI ≥ 10% after PLR. We compared the differences in measured variables between fluid responders and non-responders and tested the ability of ultrasonographic IJV indices to predict fluid responsiveness. RESULTS: Fifty-four patients were included in the study. Seventeen (31.5%) were fluid responders. The responders demonstrated significantly lower inspiratory and expiratory diameters of the IJV at baseline, but IJV collapsibility was comparable (P = 0.7). Using the cut-off point of 20%, IJV collapsibility predicted fluid responsiveness with a sensitivity of 76.5% and specificity of 38.9%, ROC AUC 0.55. CONCLUSION: In spontaneously breathing patients after surgical coronary revascularisation, collapsibility of the internal jugular vein did not predict fluid responsiveness.
- MeSH
- dýchání MeSH
- hemodynamika MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- tekutinová terapie MeSH
- tepový objem MeSH
- venae jugulares * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: The effects of expiratory muscle strength training (EMST) has not yet been investigated in MSA patients. OBJECTIVE: The primary objective was to test the effects of EMST on expiratory muscle strength and voluntary peak cough flow (vPCF) in patients with multiple system atrophy (MSA). The secondary objective was to assess the suitability of the pulmonary dysfunction index as a tool for identifying MSA patients with expiratory muscle weakness and reduced voluntary peak cough flow. METHODS: This was an open label, non-controlled study, with an 8-week intensive home-based EMST protocol. The outcome measures included: maximal expiratory pressure (MEP) and vPCF. The sensitivity and specificity of the index of pulmonary dysfunction in the respiratory diagnostic process were assessed using receiver operating characteristic (ROC) analysis. RESULTS: Fifteen MSA patients were enrolled in the study. Twelve MSA patients completed the training period. After the training period, MEP significantly increased (P = 0.006). Differences in vPCF were not significant (P = 0.845). ROC analysis indicated that the overall respiratory diagnostic accuracy of the index of pulmonary dysfunction had an outstanding capability to detect patients at risk of less effective coughing and an acceptable capability of detecting patients with decreased expiratory muscle strength. CONCLUSIONS: These findings indicate non-significant differences in vPCF after 8 weeks of EMST. The index of pulmonary dysfunction appears to be a promising prognostic screening tool for identifying altered cough efficacy in MSA patients. Test cut-offs may be used to select an appropriate respiratory physiotherapy technique.
- Publikační typ
- časopisecké články MeSH
Postpartum/peripartum hemorrhage (PPH) is an obstetric emergency complicating 1-10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. However, the incidence of PPH differs widely according to the definition and criteria used, the way of measuring postpartum blood loss, and the population being studied with the highest numbers in developing countries. Despite all the significant progress in healthcare, the incidence of PPH is rising due to an incomplete implementation of guidelines, resulting in treatment delays and suboptimal care. A consensus clinical definition of PPH is needed to enable awareness, early recognition, and initiation of appropriate intensive treatment. Unfortunately, the most used definition of PPH based on blood loss ≥500 ml after delivery suffers from inaccuracies in blood loss quantification and is not clinically relevant in most cases, as the amount of blood loss does not fully reflect the severity of bleeding.
Epidurální porodnická analgezie (EPA) se řadí k nejúčinnějším a nejbezpečnějším metodám využívaných k tlumení porodních bolestí. V posledních letech je ale spojována s vyšší incidencí horečky matky, tzv. epidurální horečkou, a to až u 34 % rodiček s EPA. Její etiologie není plně objasněna, předpokládá se vliv neinfekčního zánětu vyvolaného zavedeným epidurálním katétrem. Někteří autoři tuto asociaci popírají. Jsou názoru, že jde pouze o výběrové bias v tom smyslu, že EPA požadují více rodičky s déletrvajícím, bolestivějším či komplikovaným porodem, a tudíž je vzestup teploty dán jinými příčinami. Případně poukazují na skutečnost, že horečka byla v některých studiích s EPA vyvolána současně probíhající chorioamniitidou. Maternální horečka, ať už infekčního, nebo neinfekčního původu, má velký klinický dopad na léčbu matky a novorozence. Je s otázkou, zda jí můžeme předcházet, a tím snížit celosvětově se zvyšující nežádoucí spotřebu antibiotik.
Epidural analgesia (EPA) is the most effective method of intrapartum pain relief and is considered to be very safe. Recently, it has been used in up to 34% of parturients with EPA and is also associated with maternal temperature elevations during labor. The mechanism of this epidural-associated fever remains incompletely understood. The most likely etiology seems to be non-infectious inflammation caused by an epidural catheter. However, some authors deny this association. They theorize it is caused by selection bias only, as EPA is more often required by women with more painful and prolonged or more complicated labor, where temperature elevation is due to other causes. They point out that in some studies, fever was correlated to EPA only with concurrent placental inflammation. Maternal fever, despite the cause, either infectious or non-infectious origin, carries important clinical and public health implications. Further research that evaluates maternal epidural status and its influence on maternal or neonatal fever could improve sepsis evaluation and lead to worldwide decrease of unnecessary antibiotic exposure.
- Klíčová slova
- epidurální horečka,
- MeSH
- epidurální analgezie * škodlivé účinky MeSH
- horečka etiologie MeSH
- lidé MeSH
- porodní bolesti terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Progresivní supranukleární obrna je onemocnění z okruhu atypických parkinsonských syndromů řadící se mezi tauopatie. Mezi jeho hlavní příznaky patří poruchy okulomotoriky, časná posturální instabilita, symetrický hypokineticko-rigidní syndrom s axiální převahou a kognitivní deficit. Spektrum příznaků a rychlost progrese se liší v závislosti na konkrétní variantě onemocnění. Diagnostika se opírá především o klinický nález a z podpůrných metod zůstává na prvním místě MR. Text je zaměřen především na klinický obraz a současný pohled na diagnostiku, reflektující nově vznikající doporučení. Kauzální terapie neexistuje, proto je třeba maximálně využít možnosti symptomatické terapie.
Progressive supranuclear palsy is a tauopathy belonging to atypical Parkinsonian syndromes. The main clinical symptoms include oculomotor dysfunctions, early postural instability, symmetrical hypokinetic-rigid syndrome with axial predominance and cognitive decline. The symptom variability and rate of progression depend on disease subtype. Diagnostics are based on clinical symptoms; MRI remains the most useful auxiliary method. The article is focused mainly on clinical perspectives and recent diagnostic approaches considering the latest recommendations. Symptomatic therapy remains of great importance as causal treatment is still lacking.
- Klíčová slova
- paréza vertikálního pohledu, posturální instabilita,
- MeSH
- amantadin terapeutické užití MeSH
- kognitivní dysfunkce MeSH
- levodopa terapeutické užití MeSH
- lidé MeSH
- parkinsonské poruchy MeSH
- posturální rovnováha MeSH
- progresivní supranukleární obrna * diagnóza patofyziologie terapie MeSH
- tauopatie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Onset times and conditions for intubation after rocuronium versus suxamethonium at cesarean section have been evaluated, but no study thus far has examined the influence of these neuromuscular blocking drugs on the surgical conditions or their effect on the duration of surgery and the ease of fetal delivery. We aimed to compare the surgical conditions for delivery in parturients who received deep neuromuscular block with rocuronium with those who had induction with suxamethonium. METHODS: Ninety patients undergoing cesarean section under general anesthesia were randomized to receive either rocuronium 0.6 mg/kg or suxamethonium 1 mg/kg for tracheal intubation and delivery. Times to delivery and the quality of surgical conditions, using a five-point Surgical Rating Scale for Delivery (SRSD) ranging from 1 (poor) to 5 (excellent), were evaluated. RESULTS: The median SRSD (range) was found to be significantly better in the rocuronium group [4 (3-5) points vs 3 (2-4) points with suxamethonium (P <0.001)]. Whereas the mean (SD) induction-to-intubation interval was longer with rocuronium [106 (34) s vs 68 (32) s with suxamethonium (95% CI of the difference 24 to 52 s, P <0.001)], the incision-to-delivery interval was shorter in the rocuronium group [147 (68) s vs 196 (51) s with suxamethonium (95% CI of the difference -75 to -24 s, P <0.001)]. The mean induction-to-delivery intervals were similar [268 (73) s vs 276 (63) s, respectively]. CONCLUSIONS: Whereas the induction-to-delivery intervals were comparable, we found rocuronium superior to suxamethonium in allowing better surgical conditions for fetal delivery, which enabled an easier delivery and a shorter incision-to-delivery interval.
- MeSH
- časové faktory MeSH
- císařský řez * MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- lidé MeSH
- prospektivní studie MeSH
- rokuronium farmakologie MeSH
- sukcinylcholin farmakologie MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Multisystémová atrofie (MSA) je relativně vzácné neurodegenerativní onemocnění středního a vyššího věku s fatální prognózou. U MSA se kombinují různé motorické i nonmotorické příznaky. Kauzální léčba neexistuje a účinky symptomatické léčby jsou neuspokojivé. Článek stručně pojednává o patofyziologii a genetice MSA. Detailně se zaměřuje na klinický obraz, praktické aspekty diagnostiky a aktuální terapeutické možnosti MSA v ČR.
Multiple system atrophy (MSA) is relatively rare neurodegenerative disease with fatal prognosis affecting middle-aged and elderly individuals. There is combination of several motor and nonmotor symptoms in MSA. Causal treatment does not exist and symptomatic treatment effect is unsatisfactory. The article briefly discus ses genetics and pathophysiology of MSA with special focus on the clinical picture, practical aspects of diagnostics and cur rent therapeutic options of MSA in the Czech Republic.
- Klíčová slova
- abnormní chování v REM spánku, autonomní dysfunkce, inspirační stridor,
- MeSH
- lidé MeSH
- multisystémová atrofie * diagnóza terapie MeSH
- ortostatická hypotenze MeSH
- parkinsonské poruchy MeSH
- synukleiny MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
