Ve skupině 49 pacientů jsme sledovali hemodynamickou stabilitu při úvodu do anestezie. Pro usnadnění intubace bylo použito nedepolarizující relaxans cisatracurium, které nemá vést k uvolnění histaminu. K vlastnímu úvodu jsme podali kombinaci intravenózního hypnotika etomidátu a opiátu sufentanilu. Srovnávali jsme dva soubory pacientů, rozdělené podle závažnosti přidružených kardiovaskulárních onemocnění, především ICHS. Podání cisatracuria nevedlo k významnému zhoršení sledovaných hemodynamických parametrů. Jiné projevy uvolnění histaminu nebyly zaznamenány. Cisatracurium představuje bezpečné relaxans pro hemodynamicky stabilní úvod do anestezie.

We evaluated haemodynamic stability during the induction of general anaesthesia in the group od 49 patients. For the orotracheal intubation we used nondepolarizing muscle relaxant cisatrcurium which is told not to make a release of histamin. For the induction of general anaesthesia we used etomidate (intravenous induction agent) with sufentanil (opioid). We compared two groups ofpatients who were divided by the severity of cardiovascular conditions, especially coronary heart disease. The application of cisatracurium did not impair followed haemodynamic parameters significantly. Other signs of release of histamin were not noted. Cisatracurium is the Bafe muscle relaxant for the induction of general anaesthesia with haemodynamic stability.

• MeSH
• atrakurium analogy a deriváty   terapeutické užití   MeSH
• etomidát terapeutické užití   MeSH
• hemodynamika účinky léků   MeSH
• lidé MeSH
• premedikace anestezie metody   MeSH
• sufentanil terapeutické užití   MeSH
• Check Tag
• lidé MeSH

The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure <70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%. Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.

• MeSH
• fixace fraktury MeSH
• fraktury kostí komplikace   terapie   MeSH
• hemoragický šok diagnóza   terapie   MeSH
• hemostatické techniky MeSH
• krvácení etiologie   terapie   MeSH
• lidé MeSH
• pánevní kosti zranění   MeSH
• poranění měkkých tkání komplikace   terapie   MeSH
• terapeutická embolizace MeSH
• urgentní služby nemocnice MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• hemodynamika fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň MeSH
• papilární svaly zranění   MeSH
• poinfarktová ruptura srdce terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Cíl: Alfa-2 sympatomimetika se stále častěji používají v premedikaci k zlepšení perioperačního průběhu. Cílem práce bylo zhodnotit účinnost nového preparátu dexmedetomidinu v premedikaci před laparoskopickou cholecystektomií (LACHE) v porovnání s dosavadním postupem. Materiál a metodika: Po souhlasu etické komise a pacientů byl zaslepeně a randomizovaně podán 15 min. před úvodem do anestezie do m. deltoideus atropin 0,5 mg + jedna ze 3 premedikací, a to skupina FNT: dexmedetomidin 1,0 µg.kg-1 + ketamin 0,5 mg.kg-1 + fentanyl 1,0 µg.kg-1, skupina Dolsin: petidin 1,5 mg.kg-1 a skupina ALFNT: dexmedetomidin 1,0 µg.kg-1 + ketamin 0,5 mg.kg-1 + alfentanil 5,0 µg.kg-1. Úvod a vedení anestezie byly standardní. Byly zaznamenávány hodnoty vitálních funkcí, nežádoucí reakce pacienta a doba do podání prvního analgetika po operaci. Výsledky byly zhodnoceny Kruskalovým-Wallisovým a Fisherovým testem. Výsledky: Ve FNT a Dolsin bylo 16 a ALFNT 15 pacientů. Mezi skupinami nebyly s výjimkou nižšího věku v ALFNT rozdíly v demografii a trvání operace. Hlavní rozdíly byly ve výskytu hypertenzní reakce na kapnoperitoneum: 0/16 FNT a 1/15 ALFNT vs. 11/16 Dolsin, oboje p < 0,001, v peroperační spotřebě fentanylu: FNT 31,5 µg vs. Dolsin 165,0 µg, p < 0,001 a ALFNT 50,0 µg, p < 0,05 (ALFNT vs. Dolsin, p < 0,01) a době do žádosti o analgetikum: FNT 1,3 hod. vs. Dolsin 0,45 hod., p < 0,05 vs. ALFNT 0,8 hod., p < 0,01. Nežádoucí reakce se nelišily s výjimkou bradykardie u ALFNT (p < 0,05). Závěr: Dexmedetomidin v kombinaci s fentanylem a ketaminem potlačí nežádoucí oběhové účinky kapnoperitonea, snižuje peroperační spotřebu fentanylu, prodlužuje dobu pooperační analgezie a nemá významné vedlejší účinky. Obě kombinace dexmedetomidinu s opioidem ve srovnání s petidinem poskytují hemodynamickou stabilitu během kapnoperitonea a celé operace.

The aim of the study: Recently, alpha2 sympathoadrenergic drugs are used in premedication to improve the perioperative course. The aim of our study was to compare a premedication with a new alpha2 sympathoadrenergic drug and standard premedication. Methods: After ethic committee approval and written patient consent, in a randomised, double-blinded study, combination of dexmedetomidine 1.0 µg.kg-1 + ketamine 0.5 mg.kg-1 + fentanyl 1.0 µg.kg-1 + atropine 0.5 mg (group FNT), dexmedetomidine 1.0 µg.kg-1 + ketamine 0.5 mg.kg-1 + alfentanil 5.0 µg.kg-1 + atropine 0.5 mg (group ALFNT), or pethidine 1.0 mg.kg-1 + atropine 0.5 mg (group Dolsin) was administered to a deltoid muscle 15 min. before anaesthesia (GA) in patients elicited for laparoscopic cholecystectomy (LCHE). GA was performed in a standard way, ECG, NIBP, respiration rate, SpO2, onset of effect, Observers Assessment of Alertness Sedation Score (OAASS) before GA, circulatory reaction to intubation and capnoperitoneum, fentanyl consumption during GA, time to the first request for post-operative analgesia and postoperative nausea and vomiting were measured. The data were processed by Kruskal-Wallis and Fisher tests. P-value < 0.05 was considered significant. Results: There were 16 patients in FNT and Dolsin and 15 patients in ALFNT with no differences in demography except for younger age in ALFNT. The main differences were in hypertension during capnoperitoneum: 0/16 FNT and 1/15 ALFNT vs. 11/16 Dolsin, both p < 0.001, per-operative fentanyl consumption: FNT 31.5 µg vs. Dolsin 165.0 µg, p < 0.001 and ALFNT 50.0 µg, p < 0.05 (ALFNT vs. Dolsin, p < 0.01) and request to the first analgesic post surgery: FNT 1.3 h. vs. Dolsin 0.45 h., p < 0.05 vs. ALFNT 0.8 h., p < 0.01. There were no differences in side effects except for bradycardia in ALFNT (p < 0.05). Conclusions: Dexmedetomidine-ketamine-fentanyl-atropine combination is superior to pethidine-atropine combination in suppressing of adverse hemodynamic effects of capnoperitoneum, decreased need for analgesia during GA and prolonged postoperative analgesia.

• Klíčová slova
• operace,
• MeSH
• alfentanil MeSH
• anestetika disociativní aplikace a dávkování   MeSH
• atropin aplikace a dávkování   MeSH
• cholecystektomie laparoskopická MeSH
• dexmedetomidin aplikace a dávkování   MeSH
• dvojitá slepá metoda MeSH
• fentanyl aplikace a dávkování   MeSH
• hemodynamika účinky léků   MeSH
• hypnotika a sedativa aplikace a dávkování   MeSH
• ketamin aplikace a dávkování   MeSH
• kombinace anestetik aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• meperidin aplikace a dávkování   MeSH
• neopioidní analgetika MeSH
• opioidní analgetika aplikace a dávkování   MeSH
• pooperační bolest prevence a kontrola   MeSH
• premedikace MeSH
• probouzení z anestezie MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from percutaneous coronary intervention to inotropes and mechanical circulatory support (MCS). However, hemodynamic management in cardiogenic shock has not been well-studied. This State-of-the-Art review will provide a framework for hemodynamic management in cardiogenic shock, including a description of the 4 therapeutic phases from initial 'Rescue' to 'Optimization', 'Stabilization' and 'de-Escalation or Exit therapy' (R-O-S-E), phenotyping and phenotype-guided tailoring of pharmacological and MCS support, to achieve hemodynamic and therapeutic goals. Finally, the premises that form the basis for clinical management and the hypotheses for randomized controlled trials will be discussed, with a view to the future direction of cardiogenic shock.

• MeSH
• hemodynamika * fyziologie   MeSH
• jednotky intenzivní péče * MeSH
• kardiogenní šok * terapie   patofyziologie   MeSH
• lidé MeSH
• podpůrné srdeční systémy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: The natural course of dural arteriovenous fistulas (DAVFs) is unfavorable. Transarterial embolization with Onyx is currently the therapeutic method of choice, although the long-term stability of Onyx has been questioned. The literature reports a significant difference in the recurrence rate after complete DAVF occlusion and lacks larger series with long-term follow-up. The authors present the largest series to date with a long-term follow-up to determine the stability of Onyx, prospectively comparing magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) as follow-up diagnostic methods. METHODS: Demographics, clinical symptomatology, length of follow-up, diagnostic methods, and angiographic findings of DAVFs were recorded and retrospectively evaluated in 112 patients. A prospective group of 15 patients with more than 5 years of follow-up after complete DAVF occlusion was established. All 15 patients in the prospective group underwent a clinical examination and MRA; 10 of these patients also underwent DSA. The recurrences and the correlation between the two diagnostic methods were evaluated. RESULTS: Among the 112 patients, 71 were men and 41 were women, with an average age of 60 years. Intracranial hemorrhage (40%) was the most common clinical presentation of DAVF. At the last follow-up, 73% of the patients experienced clinical improvement, 21% remained unchanged, and 6% worsened. Overall, 87.5% of the DAVFs were occluded entirely with endovascular treatment, and 93% of the DAVFs were classified as cured at the last follow-up (i.e., completely embolized DAVFs and DAVFs that thrombosed spontaneously or after Gamma Knife surgery). Two recurrences of DAVFs were recorded in the entire series. Both were first diagnosed by MRA and confirmed with DSA. The mean follow-up was 27.7 months. In the prospective group, a small asymptomatic recurrence was diagnosed. The mean follow-up of the prospective group was 96 months. CONCLUSIONS: Onyx is a stable embolic material, although recurrence of seemingly completely occluded DAVFs may develop because of postembolization hemodynamic changes that accentuate primarily graphically absent residual fistula. These residuals can be diagnosed with MRA at follow-up. The authors' data suggest that MRA could be sufficient as the follow-up diagnostic method after complete DAVF occlusion with Onyx. However, larger prospective studies on this topic are needed.

• MeSH
• cévní malformace centrálního nervového systému diagnostické zobrazování   terapie   MeSH
• digitální subtrakční angiografie MeSH
• dimethylsulfoxid * MeSH
• dospělí MeSH
• endovaskulární výkony MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční angiografie MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozková angiografie metody   MeSH
• následné studie MeSH
• polyvinyly * MeSH
• prospektivní studie MeSH
• recidiva MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• terapeutická embolizace metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90-120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Intermittent blood pressure (BP) monitoring is the standard-of-care during low and intermediate risk anaesthesia, yet it could lead to delayed recognition of BP fluctuations. Perioperative hypotension is known to be associated with postoperative complications. Continuous, non-invasive methods for BP monitoring have been developed recently. We have tested a novel non-invasive, continuous monitor (using the volume clamp method) to assist with maintaining BP in safe ranges for patients undergoing surgery in a beach chair position. Forty adult patients undergoing thyroid gland surgery in an upright position were included in this prospective randomised controlled trial. Patients were equally allocated to the group with continuous monitoring of BP using the CNAP® Monitor and to the control group managed using an intermittent oscillometric BP cuff. The absolute and proportional time spent outside the range of ±20% of the target BP along with other hemodynamic and clinical parameters were evaluated. The continuous monitoring decreased the anaesthesia time spent below -20% pressure range [absolute: 12 min (4-20) vs. 27 min (16-34); p=0.001; relative to procedure length: 14% (7-20) vs. 33.5% (17.5-53); p=0.003]. No significant differences were observed in postoperative morbidity or in hospital length of stay. Continuous non-invasive BP monitoring via the CNAP® Monitor allows for better BP management in patients undergoing surgery in a beach chair position. In our randomised trial the time spent in hypotension was significantly shorter using continuous monitoring.

• MeSH
• anestezie metody   MeSH
• anesteziologie MeSH
• dospělí MeSH
• hypotenze patofyziologie   prevence a kontrola   MeSH
• katetrizace MeSH
• krevní tlak * MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku metody   MeSH
• monitorování fyziologických funkcí MeSH
• monitory krevního tlaku MeSH
• oscilometrie MeSH
• peroperační monitorování metody   MeSH
• polohování pacienta MeSH
• prospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

OBJECTIVES: A geometric annuloplasty ring could improve efficacy and stability of aortic valve repair. Toward this goal, a 1-piece 3-dimensional titanium annuloplasty ring with Dacron covering was developed and tested successfully in animals. The purpose of this study was to define hemodynamic outcomes with this device used as the annuloplasty component of human aortic valve repair. METHODS: In a 4-center pilot trial with informed consent, 16 patients underwent aortic valve repair for aortic insufficiency, with the annuloplasty device sutured into the annulus beneath the leaflets. Preoperative annular diameter averaged 26.5 ± 2.0 (mean ± standard deviation) mm, and average ring size was 22.3 ± 1.2 mm. After annuloplasty, leaflet defects were easy to identify, and 14 of 16 patients (88%) required leaflet plication and/or autologous pericardial reconstruction for leaflet defects. Three patients had ascending aortic replacement, and 2 had remodeling root replacement. One had ultrasonic leaflet decalcification and another tricuspid valve annuloplasty. Follow-up data were from site-specific studies at the 6-month postoperative time point. RESULTS: There were no in-hospital mortalities or major complications. Preoperative aortic insufficiency grade (0-4 scale) was 3.6 ± 1.0 and fell to 1.0 ± 0.8 at 6 months (P < .0001). New York Heart Association class fell from 2.5 ± 0.5 to 1.1 ± 0.3 (P < .0001). Postrepair valve area was 2.7 ± 0.2 cm(2), and 6-month mean systolic gradient was 11.3 ± 3.3 mm Hg. Left ventricular end-diastolic diameter and ejection fraction both normalized (both P < .0001). CONCLUSIONS: Geometric ring annuloplasty facilitated aortic valve repair, allowing more precise reconstruction of leaflet defects. Aortic insufficiency reduction and systolic gradients were excellent, and expansion of valve reconstruction into broader categories of aortic valve disease seems indicated.

• MeSH
• anuloplastika srdeční chlopně přístrojové vybavení   MeSH
• aortální chlopeň patofyziologie   chirurgie   ultrasonografie   MeSH
• aortální insuficience diagnóza   patofyziologie   chirurgie   MeSH
• barevná dopplerovská echokardiografie MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně přístrojové vybavení   MeSH
• echokardiografie transezofageální MeSH
• hemodynamika * MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• pilotní projekty MeSH
• polyethylentereftaláty MeSH
• protézy - design MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční chlopně umělé * MeSH
• stupeň závažnosti nemoci MeSH
• titan MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

Recombinant inbred (RI) strains (Prague HXB/BXH set) represent a unique model that allows for permanent summation of genetic and physiological information as well as the study of age-dependent changes in phenotypes and/or gene regulation. This study compared blood pressure (BP) measured in adult animals of RI strains by radiotelemetry with BP values obtained in conscious rats of comparable age subjected to short-term carotid catheterization or with those obtained by direct carotid puncture under ether anesthesia (almost 20 years ago). After radiotelemetry recording, the contribution of major vasoactive systems to BP maintenance was studied by consecutive inhibition of the renin-angiotensin system (RAS), sympathetic nervous system (SNS), and nitric oxide synthase. We found highly significant interrelationships among baseline BP values obtained by radiotelemetry, carotid catheterization, or carotid puncture. This indicates considerable stability of RI strains over the course of their long existence, and confirms the reliability of BP values used for genetic studies performed in the past. Subsequent analysis of vasoactive system participation revealed the importance of SNS for the maintenance of BP, as determined by either radiotelemetry or catheterization. The BP of catheterized rats also correlated closely with acute captopril-induced BP changes, but this was not the case for rats measured by radiotelemetry. NO-dependent vasodilatation matched the BP effects of SNS and RAS in both measuring conditions. Residual BP (recorded at sodium nitroprusside-induced dilatation of resistance vessels) was also responsible for a significant portion of the BP variation in RI strains. Our study confirms the validity of RI strains for the further genetic and physiological research of hypertension.

• MeSH
• antihypertenziva farmakologie   MeSH
• financování organizované MeSH
• hypertenze farmakoterapie   genetika   patofyziologie   MeSH
• inbrední kmeny potkanů genetika   MeSH
• katetrizace MeSH
• krevní tlak genetika   MeSH
• krysa rodu rattus MeSH
• modely nemocí na zvířatech MeSH
• monitorování fyziologických funkcí MeSH
• potkani inbrední SHR genetika   MeSH
• rekombinantní proteiny genetika   MeSH
• renin-angiotensin systém fyziologie   MeSH
• srdeční frekvence genetika   MeSH
• sympatický nervový systém fyziologie   MeSH
• synthasa oxidu dusnatého metabolismus   MeSH
• telemetrie MeSH
• velikost orgánu genetika   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• zvířata MeSH