• MeSH
• Androstanols MeSH
• Anesthesiology trends   MeSH
• Anesthesia, Epidural MeSH
• Factor VII therapeutic use   MeSH
• gamma-Cyclodextrins therapeutic use   MeSH
• Anesthesia, Inhalation methods   utilization   MeSH
• Humans MeSH
• Off-Label Use MeSH
• Nitrous Oxide therapeutic use   MeSH
• Anesthesia, Obstetrical * trends   MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Introductory Journal Article MeSH

Myasthenia gravis postihuje nervosvalový přenos. Léčí se farmakologicky, imunologicky a thymektomií. Exacerbovat ji mohou operace, anestezie a další faktory. Nejbezpečnější technika znecitlivění není dosud stanovena. Doporučuje se anestezie pokud možno bez svalové relaxace – hluboká inhalační, nebo propofol a opioidy, či svodná anestezie. Jsou-li svalová relaxancia nutná k zajištění klidného operačního pole, hlavní problém představuje ovlivnění nervosvalového přenosu. Myastenici na relaxancia reagují nepředvídatelně kvůli změnám nervosvalové ploténky. Nejobávanější komplikací je prodloužený účinek znemožňující spontánní ventilaci spolu se zvýšeným rizikem aspirace a sníženou reakcí na hypoxii. Pak je možné pokračovat v umělé ventilaci do zotavení, klasická dekurarizace bývá omezeně účinná, může vyvolat cholinergní krizi. Novou možností je použít k relaxaci výhradně rokuronium a na konci sugammadex. Rokuronium a sugammadex představují nový, účinný a bezpečný přístup k celkové anestezii u myasteniků.

Myasthenia gravis impairs neuromuscular transmission. Its therapy is pharmacological, immunological and surgical by thymectomy. Surgery, anaesthesia and other factors can induce exacerbation of myasthenia. The safest technique of anaesthesia has not been determined. Anaesthesia without muscle relaxation recommended, either deep inhalational anaesthesia, or propofol with opioids, or regional anaesthesia. If neuromuscular blocking agents are needed to create a motionless surgical field, the main problem is neuromuscular transmission impairment. Myasthenic patients react on these agents unpredictably. The most feared complication is a prolonged effect preventing spontaneous ventilation with an increased risk of aspiration and a decreased reaction to hypoxia. In these circumstances mechanical ventilation can be continued. Pharmacological reversal can be attempted but it can induce a cholinergic crisis and its effect is usually limited. A new possibility is the use of rocuronium for muscle relaxation with reversal by sugammadex. Rocuronium and sugammadex could offer a new, effective and safe approach to general anaesthesia in myasthenic patients.

• MeSH
• Androstanols adverse effects   therapeutic use   MeSH
• Anesthetics, General adverse effects   MeSH
• Anesthesia adverse effects   MeSH
• Anesthesia, General * methods   adverse effects   MeSH
• Surgical Procedures, Operative * adverse effects   MeSH
• Neuromuscular Depolarizing Agents adverse effects   therapeutic use   MeSH
• gamma-Cyclodextrins adverse effects   therapeutic use   MeSH
• Anesthesia, Inhalation methods   adverse effects   utilization   MeSH
• Humans MeSH
• Myasthenia Gravis * surgery   physiopathology   MeSH
• Neuromuscular Nondepolarizing Agents adverse effects   therapeutic use   MeSH
• Neuromuscular Blockade adverse effects   MeSH
• Motor Endplate physiopathology   drug effects   MeSH
• Anesthesia Recovery Period MeSH
• Respiratory Insufficiency chemically induced   complications   MeSH
• Rocuronium MeSH
• Sugammadex MeSH
• Thymectomy MeSH
• Respiration, Artificial MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

• Keywords
• operační čepice,
• MeSH
• Antisepsis history   methods   standards   instrumentation   MeSH
• Asepsis * history   methods   standards   instrumentation   MeSH
• Anesthesia, General * MeSH
• Surgical Instruments history   utilization   MeSH
• Surgical Attire * history   standards   utilization   MeSH
• Surgical Procedures, Operative * methods   nursing   adverse effects   utilization   MeSH
• General Surgery MeSH
• Disinfection * history   methods   instrumentation   utilization   MeSH
• Anesthesia, Inhalation utilization   MeSH
• Humans MeSH
• Gloves, Protective utilization   MeSH
• Operating Rooms * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Biography MeSH
• Historical Article MeSH

• MeSH
• Patient Compliance MeSH
• Child MeSH
• Anesthesia, Inhalation methods   utilization   MeSH
• Humans MeSH
• Adolescent MeSH
• Nitrous Oxide therapeutic use   MeSH
• Pediatrics MeSH
• Child, Preschool MeSH
• Oral Medicine MeSH
• Dental Anxiety therapy   MeSH
• Treatment Outcome MeSH
• Anesthesia, Dental methods   utilization   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Child, Preschool MeSH

• MeSH
• Anesthesia, Inhalation methods   utilization   MeSH
• Humans MeSH
• Nitrous Oxide administration & dosage   adverse effects   therapeutic use   MeSH
• Anesthesia, Dental methods   instrumentation   utilization   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Comment MeSH

• MeSH
• Child MeSH
• Anesthesia, Inhalation economics   utilization   MeSH
• Humans MeSH
• Adolescent MeSH
• Nitrous Oxide therapeutic use   MeSH
• Child, Preschool MeSH
• Practice Guidelines as Topic MeSH
• Anesthesia, Dental economics   utilization   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Child, Preschool MeSH
• Publication type
• Comment MeSH

Pneumatic tourniquets are widely used in pediatric extremity surgery to provide a bloodless field and facilitate dissection. This prospective study was carried out to examine possible effect of different anesthesia techniques on oxidative stress and endothelial dysfunction connected with ischemia-reperfusion injury during extremity operations at children's age. Patients were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples for determination of the malondialdehyde in plasma and erythrocytes, protein carbonyl groups concentration as well as plasma nitrites and nitrates level and xanthine oxidase activity were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release, 5 and 20 min after tourniquet release. This study demonstrates that total intravenous anesthesia with propofol and regional anesthesia techniques provide better antioxidant defense and reduce endothelial dysfunction than general inhalational anesthesia with sevoflurane during tourniquet application in pediatric extremity surgery.

• MeSH
• Anesthesia, General methods   adverse effects   utilization   MeSH
• Child MeSH
• Endothelial Cells physiology   pathology   drug effects   MeSH
• Anesthesia, Inhalation methods   adverse effects   utilization   MeSH
• Anesthesia, Intravenous methods   adverse effects   utilization   MeSH
• Humans MeSH
• Anesthesia, Local methods   adverse effects   MeSH
• Methyl Ethers administration & dosage   adverse effects   therapeutic use   MeSH
• Orthopedic Procedures methods   utilization   MeSH
• Oxidative Stress physiology   drug effects   MeSH
• Propofol administration & dosage   adverse effects   therapeutic use   MeSH
• Prospective Studies MeSH
• Statistics as Topic MeSH
• Tourniquets adverse effects   utilization   MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Child MeSH
• Humans MeSH

• Keywords
• péče o dýchací cesty,
• MeSH
• Conscious Sedation MeSH
• Benzodiazepines administration & dosage   therapeutic use   MeSH
• Anesthesia, Inhalation utilization   MeSH
• Intubation, Intratracheal MeSH
• Humans MeSH
• Airway Obstruction prevention & control   MeSH
• Analgesics, Opioid administration & dosage   therapeutic use   MeSH
• Check Tag
• Humans MeSH

Prvým cieľom práce bola experimentálna aplikácia krátkodobej inhalačnej anestézie xenónom a zvládnutie techniky a technológie jej podávania. Druhým cieľom bolo sledovanie objektívnych fyziologických a laboratórnych parametrov, ako aj subjektívnych pocitov experimentálnych subjektov – anestéziológov, ktorí sa podrobili anestézii. Autori v práci opisujú prvé experimentálne podanie xenónovej inhalačnej anestézie na dobrovoľníkoch. Pracovisko: Oddelenie anestéziológie a intenzívnej medicíny. Dizajn: Klinický experiment (Súhlas etickej komisie č. 21082009). Materiál a metodika: Na skupine 5 dobrovoľníkov sme sledovali účinky xenónovej anestézie, jej objektívnych účinkov na fyziologické premenné, laboratórne výsledky a subjektívne prežívanie anestézie do štádia, kedy dôjde k strate vedomia. Dva experimentálne subjekty voviedli do prvých dvoch štádií hĺbky anestézie, ďalšie 3 subjekty do 3–4. štádia xenónovej anestézie. Pacienti boli štandardne monitorovaní a zabezpečení. Výsledky:V parametroch laboratórnych biochemických a hematologických vyšetrení, porovnávali výsledky odberov pred anestéziou a cca 15 min po anestézii. Rozdiely medzi výsledkami pred anestéziou a po anestézii nezistili. Výsledky boli v tolerancii fyziologických hodnôt. Počas anestézie boli sledované parametre obehu (TK a P) stabilné a nedošlo k významným zmenám pulzu a TK. Ventilačné parametre sa v úvode do anestézie mierne menili, dýchanie sa spomalilo a prehĺbilo, ale po nástupe III a IV štádia anestézie „spánku“ sa parametre prakticky vrátili na pôvodné hodnoty. Monitorovaná SpO2 bola stabilná, okolo 97–100 %. ETCO2 sa pohybovalo od 5,2 do 4,6 %. Autori hodnotia subjektívne pocity anestézovaných subjektov, a to v momente dosiahnutia relatívne stabilnej koncentrácie xenónu v dýchacom okruhu pri 10, 20, 30, 40 a 50%. Záver: Autori konštatujú, že pre získanie určitej skúsenosti s aplikáciou xenónu, ako aj technologických zručností bol tento experiment veľkým prínosom. Z pohľadu experimentálnych osôb – anestéziológov, to bola nenahraditeľná skúsenosť. Autori predpokladajú skoré zavedenie xenónu do anestéziologickej praxe v indikovaných prípadoch na vlastnom oddelení.

Objective:We describe the first experimental administration of xenon inhalational anaesthesia in volunteers. The primary aim was administering a short inhalational xenon anaesthesia and learning the technique and technology of its administration. The secondary aim was observing objective physiological and laboratory parameters and the subjective feelings of the subjects who had undergone the anaesthesia. Setting: Department of Anaesthesia and Intensive Medicine. Design: Clinical experiment (Approval No. 21082009 of the Ethical Committee). Materials and methods:The objective effects of xenon anaesthesia on the physiological variables and laboratory tests and its subjective perception until the loss of consciousness by the subjects were tested in a group of 5 volunteers. Two subjects reached the first two depth levels of anaesthesia and the remaining subjects reached levels 3 and 4 of xenon anaesthesia. All the subjects were monitored and managed in a standard fashion. Results: The laboratory tests were performed prior to and 15 minutes after the anaesthesia. There were no significant differences found in the results before and after the anaesthesia. No result exceeded the normal range. Blood pressure and heart rate were stable, without significant changes, during the course of anaesthesia. Ventilatory parameters showed minor changes, the heart rate decreased and breathing became temporarily deeper but after reaching anaesthesia depth-levels 3 and 4, all the parameters became normal again. SpO2 was stable, oscillating between 97 and 100%, ETCO2 reached 4.6–5.2 kPa. The authors evaluated the subjective perception by the anaesthetized persons at the moments when xenon concentration in the airways reached a relatively stable concentration at 10, 20, 30, 40 and 50%. Conclusion: This experiment is one of the first ones in the field of gaining technical skills and experience in performing xenon anaesthesia. For the volunteers, all of whom are anaesthetists, this was a unique personal experience. The authors expect early implementation of xenon anaesthesia into their clinical anae - sthetic practice in indicated cases.

• MeSH
• Anesthesia, General methods   utilization   MeSH
• Human Experimentation ethics   standards   legislation & jurisprudence   MeSH
• Drug Evaluation MeSH
• Anesthesia, Inhalation history   methods   utilization   MeSH
• Humans MeSH
• Monitoring, Intraoperative methods   utilization   MeSH
• Anesthesia Recovery Period MeSH
• Statistics as Topic MeSH
• Outcome and Process Assessment, Health Care MeSH
• Xenon administration & dosage   adverse effects   therapeutic use   MeSH
• Check Tag
• Humans MeSH

Autoři popisují začátky a vývoj dětské anesteziologie, resuscitace a intenzivního léčení ve fakultních nemocnicích 2. a 3. lékařské fakulty Karlovy univerzity v Praze ve druhé polovině 20. století. V roce 1965 bylo zřízeno v Dětské fakultní nemocnici (DFN) anesteziologické oddělení vedené primářem Miloslavem Drapkou (1911–2000). Zajišťovalo anesteziologickou a perioperační péči nemocným dětské chirurgické kliniky, dětské ortopedické kliniky, gynekologicko-porodnické kliniky, dětské otorinolaryngologické kliniky, dětem při náročných diagnostických vyšetřeních a při výkonech na ambulancích klinik. Drapka upravil soudobé anesteziologické postupy pro nemocné všech dětských věkových kategorií. Velkou pozornost věnoval premedikaci. Díky vysoké odborné úrovni anesteziologické péče byl možný v DFN specializovaný vývoj dětských operačních oborů. V roce 1972 zahájilo ve Fakultní nemocnici v Motole (FNM) činnost desetilůžkové dětské resuscitační oddělení. V. Kyncl, jeho zakladatel a vedoucí lékař, vypracoval vysoké standardy léčebných postupů a organizační řád tohoto celostátně jedinečného pracoviště. V roce 1973 byla ministerstvem zdravotnictví zřízena ve FNM a na 2. LF UK klinika anesteziologie a resuscitace jako klinická základna katedry AR ILF pro specializační vzdělávání lékařů. Vznikla sloučením anesteziologických a resuscitačních pracovišť v DFN ve FNM. V roce 1956 zahájila ve Fakultní nemocnici na Královských Vinohradech odborná anestezioložka L. Čvančarová spolupráci s klinikou plastické chirurgie akademika Buriana. S ní spolupracovali odborníci později zřízeného anesteziologického pracoviště. Byly vypracovány specializované anesteziologické postupy pro děti všech věkových skupin umožňující rozsáhlé chirurgické léčení vrozených vad a léčení těžkých popálenin.

The authors describe the beginnings and the development of paediatric anaesthesia, resuscitation and intensive therapy in two Charles University Hospitals in Prague in the second half of the 20th century. The Department of Anaesthesiology was founded at the Paediatric University Hospital and headed by Miloslav Drapka (1911–2000) in 1965. The department provided anaesthetics and perioperative care for patients from the clinics of Paediatric Surgery, Orthopaedics, ENT, Gynaecology and Obstetrics, and for children indicated for diagnostic imaging procedures. Drapka adapted contemporary methods of anaesthesiology to paediatric patients. He implemented premedication with neuroplegics. The high standard of anaesthetic care as achieved by Drapka and his co-workers was the prerequisite for the specialized development of paediatric surgical specialities. In 1972, the Department of Paediatric Resuscitation in the paediatric section of the University Hospital Motol in Prague was opened with 10 intensive therapy beds for children in a critical condition. V. Kyncl, the head of the unit, set the high standards of treatment as well as the operating procedures of this nationally unique unit. The department has been achieving outstanding results. In 1973, the Department of Paediatric Anaesthesiology and the Department of Paediatric Resuscitation were incorporated in the Clinic of Anaesthesiology and Resuscitation at the University Hospital Motol in Prague. As such they formed the clinical basis for postgraduate medical education of specialists in anaesthesiology and resuscitation. In 1956 L. Čvančarová, a specialist anaesthetist at the University Hospital of the 3rd Medical Faculty, started professional cooperation with the Department of Plastic Surgery headed by the Science Academy member F. Burian. She worked together with specialists from the later established Department of Anaesthesiology. Specialized techniques and methods of anaesthesia and analgesic sedation for children of all age groups were developed in order to facilitate extensive surgical treatment of innate defects and severe burns.

• MeSH
• Anesthesiology history   organization & administration   statistics & numerical data   MeSH
• History, 19th Century MeSH
• History, 20th Century MeSH
• History of Medicine MeSH
• Hospitals, Pediatric history   organization & administration   MeSH
• Child MeSH
• Anesthesia, Inhalation methods   utilization   MeSH
• Anesthesia, Intravenous methods   utilization   MeSH
• Humans MeSH
• Hospitals, Teaching history   organization & administration   MeSH
• Pediatrics history   organization & administration   statistics & numerical data   MeSH
• Premedication history   methods   utilization   MeSH
• Resuscitation history   methods   MeSH
• Life Support Care history   methods   organization & administration   MeSH
• Check Tag
• History, 19th Century MeSH
• History, 20th Century MeSH
• Child MeSH
• Humans MeSH
• Geographicals
• Czechoslovakia MeSH