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- Keywords
- simulační centra, lektoři,
- MeSH
- Anesthesiology * education MeSH
- Communication MeSH
- Humans MeSH
- Critical Care * MeSH
- Education, Medical methods MeSH
- Simulation Training * methods MeSH
- Check Tag
- Humans MeSH
Jak se mohou kliničtí lékaři dobře naučit léčbu komplikovaných zdravotních stavů pacientů, aniž by je vystavili nepřiměřenému riziku? Jak můžeme posoudit schopnosti lékařů i celých týmů, když každý pacient i lékař je jiný, stavů je mnoho a ještě více jejich kombinací? Podobné otázky vedly v posledních letech k rozvoji simulační medicíny. Inspirace pro vznik tohoto odvětví medicíny přišla z leteckého průmyslu, vojenství a kosmonautiky. Cílem simulací je rozvoj hlavně netechnických dovedností (např. komunikace) jednotlivců i celého týmu. Jedinečná možnost bezpečné (simulátor neumře) sebereflexe je příležitostí ke zlepšení dovedností každého z nás.
How can clinicians master the treatment of complicated medical conditions without exposing patients to risk? How can we assess the ability of physicians and teams when each patient and doctor is different, when there are many conditions and yet more combinations? These and similar issues have led to the development of medical simulation. The inspiration for the creation of this part of medicine has come from the airline, military and aerospace industry. The aim of simulation is the development of non-technical skills (e.g. communication) of individuals and the team. A unique opportunity for self-reflection (the simulator does not die) is an opportunity to improve the skills of each of us.
- Keywords
- simulační medicína, simulační centra,
- MeSH
- Anesthesiology education MeSH
- Patient Safety MeSH
- Medical Errors prevention & control MeSH
- Crew Resource Management, Healthcare * methods organization & administration utilization MeSH
- Communication MeSH
- Education, Medical, Continuing * MeSH
- Crisis Intervention MeSH
- Humans MeSH
- Critical Care MeSH
- Risk Management MeSH
- Decision Making MeSH
- Self-Assessment MeSH
- Simulation Training * methods MeSH
- Patient Care Team MeSH
- Educational Technology MeSH
- Check Tag
- Humans MeSH
- Keywords
- vegetativní nervový systém, barevné mapování průtoku,
- MeSH
- Anesthetics, Local administration & dosage MeSH
- Autonomic Nerve Block methods instrumentation MeSH
- Doppler Effect MeSH
- Stellate Ganglion physiopathology drug effects ultrasonography MeSH
- Humans MeSH
- Nerve Block methods instrumentation MeSH
- Ultrasonography, Doppler, Color utilization MeSH
- Ultrasonics MeSH
- Check Tag
- Humans MeSH
- Publication type
- Case Reports MeSH
Endarterektomie krčních tepen je jedním z nejčastějších výkonů cévní chirurgie. Pooperační průběh je obvykle nekomplikovaný. U pacientů může v období po výkonu dojít k neurologickým komplikacím, které se manifestují jako cévní mozková příhoda, hyperperfuzní syndrom a řídce se vyskytující křečové stavy. Oběhová nestabilita po operaci zahrnuje hypertenzi, méně často hypotenzi a poruchy srdečního rytmu. Akutní ischémie myokardu se může vyskytnout u nemocných s ischemickou chorobou srdeční. K dalším komplikacím patří krvácení v operační ráně, které může vést k obstrukci dýchacích cest a poškození funkce nervů, které se nacházejí v operované oblasti.
Carotid endarterectomy is one of the most frequent vascular surgery procedures worldwide. The postoperative course is mostly uncomplicated. Neurological complications may manifest as a cerebral stroke, hyperperfusion syndrome or, rarely, as convulsions. Postoperative cardiovascular instability that may occur includes hypertension or less often hypotension and cardiac dysrhythmias. Acute myocardial ischaemia is seen mostly in patients with ischaemic heart disease. Other complications include postoperative wound haematoma potentially leading to airway obstruction and damage to the nerves adjacent to the surgical incision.
- Keywords
- hyperperfuzní syndrom, akutní infarkt myokardu,
- MeSH
- Stroke etiology complications MeSH
- Hypertension complications MeSH
- Myocardial Infarction epidemiology complications MeSH
- Intracranial Hemorrhages epidemiology etiology complications MeSH
- Endarterectomy, Carotid methods adverse effects MeSH
- Humans MeSH
- Cranial Nerve Diseases etiology complications MeSH
- Airway Obstruction etiology MeSH
- Postoperative Complications MeSH
- Postoperative Hemorrhage epidemiology etiology MeSH
- Postoperative Care MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: The aim of this retrospective study was to compare the failure rates and the frequency of anaesthesia-related complications of two different methods of regional anaesthesia used for carotid endarterectomy--cervical epidural (CE) anaesthesia and cervical plexus block (CPB). METHODS: The study included 1828 carotid endarterectomies performed in 1455 patients between 1996 and 2006. A combination of deep and superficial CPB was used for 1166 procedures, whereas in 662 cases surgery was performed under CE anaesthesia. RESULTS: The failure rate of CPB was 3% compared with 6.9% for CE anaesthesia (P < 0.0001). The reasons for failure of the anaesthetic techniques were (1) technical failure, (2) insufficient analgesia, (3) non-compliant patients, and (4) anaesthetic complications. The incidence of complications resulting from CE anaesthesia was significantly higher than with CPB; life-threatening complications--2% compared with 0.3% (P < 0.0001); other anaesthesia-related complications 5.7 vs 4.7%. Serious complications included inadvertant injection into the subarachnoid space or vertebral artery. The frequency of shunt insertion, perioperative stroke, and death from any cause was similar in both groups of patients. CONCLUSIONS: Both methods of regional anaesthesia are acceptable for carotid artery surgery. CPB is associated with a significantly lower frequency of anaesthesia-related complications and should therefore be considered the anaesthetic of choice. CE anaesthesia should not be performed except in extenuating circumstances such as variant anatomy or the requirement for more extensive surgery.
- MeSH
- Patient Compliance MeSH
- Anesthesia, General MeSH
- Anesthesia, Epidural adverse effects MeSH
- Endarterectomy, Carotid MeSH
- Humans MeSH
- Nerve Block adverse effects MeSH
- Treatment Failure MeSH
- Cervical Plexus MeSH
- Movement drug effects MeSH
- Retrospective Studies MeSH
- Medical Audit MeSH
- Check Tag
- Humans MeSH
- Publication type
- Multicenter Study MeSH
- Comparative Study MeSH
