- Klíčová slova
- anesteziologické riziko, chronická medikace, prokrvení, periferní bloky,
- MeSH
- analgetika aplikace a dávkování farmakologie klasifikace MeSH
- analgezie MeSH
- anestezie * klasifikace metody škodlivé účinky MeSH
- celková anestezie metody MeSH
- klinické rozhodování MeSH
- lidé MeSH
- opioidní analgetika aplikace a dávkování farmakologie klasifikace MeSH
- ortopedické výkony MeSH
- perioperační péče metody MeSH
- předoperační péče * MeSH
- premedikace anestezie klasifikace metody MeSH
- riziko MeSH
- svodná anestezie metody škodlivé účinky MeSH
- vysazování léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes. METHODS: In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension. RESULTS: Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective. CONCLUSION: GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.
- MeSH
- anestetika intravenózní aplikace a dávkování škodlivé účinky MeSH
- arteriální tlak účinky léků MeSH
- celková anestezie škodlivé účinky metody MeSH
- dospělí MeSH
- hypertenze epidemiologie MeSH
- hypotenze epidemiologie MeSH
- intratracheální intubace MeSH
- krevní tlak účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- propofol aplikace a dávkování farmakologie MeSH
- prospektivní studie MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- sufentanil aplikace a dávkování farmakologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
The dysregulation of inflammatory response to surgical injury affects outcomes. Alarmins, the earliest bioactive substances from damaged cells, play a crucial role in initiating the inflammation. We analyzed serum levels of alarmins (S100A8, S100A12, high mobility group box, and heat shock protein 70) after major abdominal surgery (MAS) in surgical (S) (n = 82) and nonsurgical (NS) groups (n = 35). The main objective was determining a role of selected alarmins in host response to MAS. The secondary objectives were (i) evaluation of the relationship among alarmins and selected biomarkers (C-reactive protein, interleukin-6), (ii) influence of the place of gastrointestinal resection, and (iii) role of alarmins in MAS for cancer. Except for HMGB1, the levels of all alarmins were higher in the S group compared with the NS group. In the S group, positive correlations were found between S100A8 and both IL-6 and CRP. Additionally, the S100A8 level was higher (p < 0.01) in patients who underwent upper gastrointestinal tract (GIT) surgery compared to middle and lower GIT resections. Alarmins levels did not differ between cancer and noncancer patients. MAS is able to elicit increase in alarmin levels. S100A8 can be considered a potential biomarker of surgical injury, especially in the upper part of the GIT.
- MeSH
- alarminy krev MeSH
- biologické markery krev MeSH
- C-reaktivní protein analýza MeSH
- chirurgie trávicího traktu * MeSH
- dospělí MeSH
- kalgranulin A krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- prospektivní studie MeSH
- protein HMGB1 krev MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Background: Major abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins. Patients and methods: Patients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT). Serum levels of alarmins (S100A8, S100A12, HMGB1, and HSP70) and biomarkers (leukocytes, C-reactive protein [CRP], and interleukin-6 [IL-6]) were analyzed between the groups. The secondary objectives were to compare LPT and LPS cancer subgroups and to find the relationship between procedure and outcome (intensive care unit length of stay [ICU-LOS] and hospital length of stay [H-LOS]). Results: A total of 82 patients were analyzed. No significant difference was found in alarmin levels between the mixed LPS and LPT groups. IL-6 was higher in the LPS group on day 2 (p=0.03) and day 3 (p=0.04). Significantly higher S100A8 protein levels on day 1 (p=0.02) and day 2 (p=0.01) and higher S100A12 protein levels on day 2 (p=0.03) were obtained in the LPS cancer subgroup. ICU-LOS and H-LOS were longer in the LPS cancer subgroup. Conclusion: The degree of surgical injury elicited by open MAS as reflected by alarmins is similar to that of laparoscopic procedures. Nevertheless, an early biomarker of inflammation (IL-6) was higher in the laparoscopy group, suggesting a greater inflammatory response. Moreover, the levels of S100A8 and S100A12 were higher with a longer ICU-LOS and H-LOS in the LPS cancer subgroup.
- Publikační typ
- časopisecké články MeSH
Sepse je život ohrožující stav vznikající na podkladě dysregulované odpovědi hostitelského organismu na infekci. Pohled na problematiku sepse se v posledních desetiletích dramaticky vyvíjí, což je dáno rychlým nárůstem nových poznatků o její epidemiologii, patofyziologii i léčbě. Z tohoto důvodu byla v roce 2016 představena nová mezinárodní kritéria a definice sepse a septického šoku „The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)“, která vznikla na podkladě konsenzuálního stanoviska mezinárodního panelu expertů (The Society of Critical Care Medicine a The European Society of Intensive Care Medicine). Hlavním cílem zavedení nových kritérií a definice sepse bylo rozšířit povědomí odborné veřejnosti o sepsi jako onemocnění s vysokou mortalitou, a to především v situacích, kdy není včas diagnostikována a léčena. Sepsis-3 má být východiskem pro preklinický i klinický výzkum, ale také pro rozvoj nových diagnostických metod a pro léčbu pacientů se sepsí a septickým šokem.
Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Over the last decades, the approach to sepsis is evolving dramatically, mainly as a result of a rapid increase in the knowledge of its epidemiology, physiopathology, and management. In this context, the new international criteria and definition for sepsis, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), were introduced in 2016. The criteria were established consensually by the Task Force which consisted of experts from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. The main goal is the expansion of awareness of the professional public about this medical condition with a high fatality rate, particularly when not diagnosed and treated early. Sepsis-3 should also serve as a benchmark for future preclinical and clinical research, development of new diagnostic methods, and the terapy of patients with sepsis and septic shock.
- Klíčová slova
- SEPSIS-3,
- MeSH
- lidé MeSH
- multiorgánové selhání komplikace patofyziologie MeSH
- sepse * dějiny diagnóza klasifikace MeSH
- septický šok diagnóza patofyziologie MeSH
- terminologie jako téma MeSH
- vyhodnocení orgánové dysfunkce MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- souhrny MeSH
Cíl studie: Kolorektální resekce významně ovlivňují homeostázu organismu. Cílem práce bylo zjistit, zda předoperačně měřená variabilita srdeční frekvence (heart rate variability – HRV) může identifikovat pacienty s vysokou prozánětlivou odpovědí na operační inzult objektivizovanou koncentracemi C-reaktivního proteinu (CRP), interleukinu-6 (IL-6) a leukocytů (Leu) do 48 hodin od začátku operace. Typ studie: Prospektivní observační studie. Typ pracoviště: Klinika anesteziologie, resuscitace a intenzivní medicíny, fakultní nemocnice. Materiál a metoda: HRV byla měřena během ortostatické zkoušky den před operací. Pacienti byli rozděleni dle HRV do dvou skupin: KAR (s kardiální autonomní reaktivitou, n = 23) a NKAR (bez kardiální autonomní reaktivity, n = 30). Sérové koncentrace CRP, IL-6 a Leu byly vyšetřeny v časových intervalech 0, 12 (pouze IL-6), 24 a 48 hodin od začátku operace. Výsledky: KAR a NKAR se lišily v koncentracích CRP v T0 (6,5 ± 5,1 vs. 16,4 ± 23,2 mg/l, p <0,05), T24 (70,5 ± 33,6 vs. 95,7 ± 49,1 mg/l, p < 0,05), T48 (103,1 ± 42,4 vs. 159,0 ± 63,4 mg/l, p < 0,001) a IL-6 v T12 (79,3 ± 42,2 vs. 248,2 ± 285,2 pg/ml, p < 0,05), T24 (68,0 ± 28,0 vs. 239,6 ± 245,8 pg/ml, p < 0,001) a T48 (39,5 ± 18,4 vs. 195,5 ± 162,9 pg/ml, p < 0,0001). KAR a NKAR se signifikantně nelišily v počtu leukocytů. Závěr: HRV je metoda k identifikaci pacientů, kteří vykazují perioperačně vysokou prozánětlivou odpověď. Statistická rozdílnost koncentrací CRP a IL-6 mezi skupinami narůstala s časem. IL-6 byl statisticky významně rozdílný již v T24, tedy časněji identifikoval pacienty s vyšší prozánětlivou odpovědí v porovnání s CRP.
Objective: Colorectal surgery significantly affects homeostasis. The aim of the study was to identify patients with high inflammatory response to surgical injury, objectivized by the levels of C-reactive protein (CRP), interleukin-6 (IL-6) and white cell count (WCC) measured within 48 hours after the beginning of surgery by pre-operative measurement of heart rate variability (HRV). Design: Prospective, observational study. Setting: Department of Anesthesiology and Intensive Care Medicine, University Hospital Materials and methods: HRV was measured during orthostatic load one day before surgery. The patients were divided according to the HRV results into two groups: CAR (with cardiac autonomic reactivity, n=23), and NCAR (without cardiac autonomic reactivity, n=30). Serum levels of CRP, IL-6 and WCC were obtained at 0, 12 (only IL-6), 24 and 48 hours after the beginning of surgery. Results: The observed CAR and NCAR were significantly different at the levels of CRP at T0 (6.5 ± 5.1 mg/L vs. 16.4 ± 23.2 mg/L, p<0.05), T24 (70.5 ± 33.6 mg/L vs. 95.7 ± 49.1 mg/L, p<0.05), T48 (103.1 ± 42.4 mg/L vs. 159.0 ± 63.4 mg/L, p<0.001), and IL-6 at T12 (79.3 ± 42.2 pg/mL vs. 248.2 ± 285.2 pg/mL, p<0.05), T24 (68.0 ± 28.0 pg/mL vs. 239.6 ± 245.8 pg/mL, p<0.001), and T48 (39.5 ± 18.4 pg/mL vs. 195.5 ± 162.9 pg/mL, p<0.0001). There was no significant difference in WCC between CAR and NCAR patients. Conclusion: HRV is a method for identifying patients with high perioperative pro-inflammatory response. Statistical differences in CRP and IL-6 levels between the studied groups increased over time. IL-6 was statistically significantly different already at T24, thus enabled earlier identification of patients with higher pro-inflammatory response when compared to CRP.
- Klíčová slova
- variabilita srdeční frekvence,
- MeSH
- anestetika aplikace a dávkování terapeutické užití MeSH
- C-reaktivní protein analýza MeSH
- homeostáza MeSH
- interleukin-6 krev MeSH
- interpretace statistických dat MeSH
- kolorektální chirurgie MeSH
- komorbidita MeSH
- leukocyty MeSH
- lidé MeSH
- pozorovací studie jako téma MeSH
- předoperační péče MeSH
- prospektivní studie MeSH
- srdeční frekvence * MeSH
- syndrom systémové zánětlivé reakce * MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Major abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS). PATIENTS AND METHODS: Sixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30). RESULTS: The final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p<0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p<0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p<0.01). Furthermore, the NCAR group had more serious complications (Clavien-Dindo ≥ Grade III n=6 vs n=0; p<0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p<0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p<0.01) and ileus (NCAR: n=11 vs CAR: n=2; p<0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p<0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p<0.0001). CONCLUSION: Preoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor post-operative course.
- Publikační typ
- časopisecké články MeSH
Autonomní nervový systém (ANS) hraje zásadní roli v udržování homeostázy organismu. Vyšetření funkce autonomního nervového systému se provádí měřením variability srdeční frekvence (HRV – heart rate variability). Dysfunkce autonomního nervového systému může komplikovat perioperační průběh u pacientů podstupujících operační výkon, a tudíž by měla být považována za další rizikový faktor v rámci předoperačního zhodnocení stavu pacienta. V dnešní době není zhodnocení funkce autonomního nervového systému, jakožto možného nástroje pro predikci perioperačního průběhu, zahrnuto do běžné anesteziologické praxe.
The autonomic nervous system (ANS) plays an important role in the maintenance of systemic homeostasis. Measurement of heart rate variability (HRV) is a method for assessment of the autonomic nervous system. Dysfunction of the autonomic nervous system could complicate the perioperative course in the pacient undergoing surgery, therefore it should be considered as another risk factor during preoperative assessment. Nowadays the assessment of the autonomic nervous system function as a predictive tool of the perioperative outcome is not considered in daily anaesthetic practice.
- MeSH
- autonomní nervový systém * fyziologie účinky léků MeSH
- celková anestezie MeSH
- hypotenze prevence a kontrola MeSH
- krevní tlak účinky léků MeSH
- lidé MeSH
- měření krevního tlaku metody MeSH
- pooperační komplikace prevence a kontrola MeSH
- předoperační péče metody MeSH
- spektrální analýza * využití MeSH
- spinální anestezie škodlivé účinky MeSH
- srdeční frekvence * fyziologie účinky léků MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
