BACKGROUND: Comparative data regarding the effect of percutaneous and thoracoscopic ablation of atrial fibrillation (AF) on cognitive function are very limited. The aim of the study was to determine and compare the effect of both types of ablations on patient cognitive functions in the mid-term. METHODS: Patients with AF indicated for ablation procedure were included. Forty-six patients underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system, followed by a catheter ablation three months afterward (Hybrid group). A comparative cohort of 53 AF patients underwent pulmonary vein isolation only (PVI group). Neuropsychological examinations were done before and nine months after the surgical or catheter ablation procedure. Neuropsychological testing comprised 13 subtests of seven domains, and the results were expressed as post-operative cognitive dysfunction (POCD) nine months after the procedure. RESULTS: Patients in both groups were similar with respect to the baseline clinical characteristics; only non-paroxysmal AF was more common in the hybrid group (98% vs. 34%). Major POCD was present in eight (17.4%) of hybrid patients versus three (5.7%) of PVI patients (p = 0.11), combined (major/minor) worsened cognitive decline was present in 10 (21.7%) hybrid patients versus three (5.6%) PVI patients (p = 0.034). On the other hand, combined (major/minor) improvement was present in 15 (32.6%) hybrid patients versus nine (16.9%) patients in the PVI group (p = 0.099). CONCLUSION: Hybrid ablation, a combination of thoracoscopic and percutaneous ablation, is associated with a higher risk of cognitive decline compared to sole percutaneous ablation.

• MeSH
• Atrial Fibrillation * surgery   MeSH
• Catheter Ablation * methods   MeSH
• Cognition MeSH
• Cognitive Dysfunction * etiology   MeSH
• Humans MeSH
• Recurrence MeSH
• Pulmonary Veins * surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Pooperační delirium je jednou z nejčastějších pooperačních komplikací u pacientů nad 65 let. Prevence vzniku deliria by měla začít už v anesteziologické ambulanci, identifikací rizikových pacientů a snahou optimalizovat stav před výkonem. Během operačního zákroku by měla být monitorována hloubka anestezie, minimalizovány dávky opioidů a využívány kombinované metody anestezie. Po výkonu je stěžejní automatická implementace nefarmakologických preventivních a léčebných postupů. Farmakologické postupy se používají jako metoda poslední volby u agitovaných a agresivních pacientů s hyperaktivní formou deliria. V současné době nejsou doporučené postupy v diagnostice, prevenci a léčbě deliria v klinické praxi rutinně využívány. Cílem článku je popsat aktuální možnosti prevence a léčby pooperačního deliria.

Postoperative delirium is one of the most common postoperative complications in patients over 65 years of age. The prevention of delirium should start already in the anesthesiology clinic, with the identification of patients at risk and efforts to optimize the condition before the procedure. During surgery, the depth of anesthesia should be monitored, opioid doses should be minimized, and combined methods of anesthesia should be used. After the surgery the automatic implementation of non-pharmacological preventive and treatment measures is crucial. Pharmacological approaches are used as a last option method in agitated and aggressive patients with hyperactive delirium. Currently, the recommended procedures in the diagnosis, prevention and treatment of delirium are not routinely used in clinical practice. The aim of the article is to describe the current possibilities of prevention and treatment of postoperative delirium.

• MeSH
• Anesthesia, General adverse effects   MeSH
• Risk Assessment MeSH
• Humans MeSH
• Emergence Delirium * drug therapy   prevention & control   therapy   MeSH
• Postoperative Cognitive Complications MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Increased incidence of postoperative cognitive dysfunction (POCD) is observed in elderly patients underwent intravenous anesthesia (TIVA) with endotracheal intubation. Modulation of anesthetics compatibility may reduce the severity of POCD. Elderly patients scheduled for TIVA with endotracheal intubation were randomly divided into the control group (1.00?2.00 mg/kg propofol) and the etomidate and propofol combination group (1.00?2.00 mg/kg propofol and 0.30 mg/kg etomidate). Serum cortisol, S100?, and neuron-specific enolase (NSE), interleukin (IL)-6, and IL-10 were monitored during or after the operation. Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were utilized to assess the severity of POCD. 63 elderly patients in the etomidate and propofol combination group and 60 patients in the control group were enrolled, and there was no significant difference in gender, American Society of Anesthesiologists (ASA) physical status, surgical specialty, intraoperative blood loss, and operation time between the two groups. Significantly increased serum cortisol, S100?, NSE, IL-6, and reduced MMSE and MoCA scores were detected in the control group at different time points after the operation (0-72 h post operation) when compared to those before the operation. Similar trends for these observed factors were found in the etomidate and propofol combination group. In addition, the etomidate and propofol combination group showed better effects in reducing the serum levels of cortisol, S100?, NSE, IL-6, and increasing the MMSE and MoCA scores when compared to the control group. The present study demonstrates that the combination of propofol with etomidate could alleviate POCD in elderly patients underwent TIVA with endotracheal intubation anesthesia.

• MeSH
• Anesthesia, General MeSH
• Etomidate * adverse effects   MeSH
• Hydrocortisone MeSH
• Interleukin-6 MeSH
• Anesthesia, Intravenous adverse effects   MeSH
• Humans MeSH
• Postoperative Cognitive Complications * MeSH
• Propofol * adverse effects   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

BACKGROUND: Primary graft dysfunction (PGD) after lung transplantation (LuTx) contributes substantially to early postoperative morbidity. Both intraoperative transfusion of a large amount of blood products during the surgery and ischemia-reperfusion injury after allograft implantation play an important role in subsequent PGD development. METHODS: We have previously reported a randomized clinical trial of 67 patients where point of care (POC) targeted coagulopathy management and intraoperative administration of 5% albumin led to significant reduction of blood loss and blood product consumption during the lung transplantation surgery. A secondary analysis of the randomized clinical trial evaluating the effect of targeted coagulopathy management and intraoperative administration of 5% albumin on early lung allograft function after LuTx and 1-year survival was performed. RESULTS: Compared to the patients in the control (non-POC) group, those in study (POC) group showed significantly superior graft function, represented by the Horowitz index (at 72 h after transplantation 402.87 vs 308.03 with p < 0.001, difference between means: 94.84, 95% CI: 60.18-129.51). Furthermore, the maximum doses of norepinephrine administered during first 24 h were significantly lower in the POC group (0.193 vs 0.379 with p < 0.001, difference between the means: 0.186, 95% CI: 0.105-0.267). After dichotomization of PGD (0-1 vs 2-3), significant difference between the non-POC and POC group occurred only at time point 72, when PGD grade 2-3 developed in 25% (n = 9) and 3.2% (n = 1), respectively (p = 0.003). The difference in 1-year survival was not statistically significant (10 patients died in non-POC group vs. 4 patients died in POC group; p = 0.17). CONCLUSIONS: Utilization of a POC targeted coagulopathy management combined with Albumin 5% as primary resuscitative fluid may improve early lung allograft function, provide better circulatory stability during the early post-operative period, and have potential to decrease the incidence of PGD without negative effect on 1-year survival. TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov (NCT03598907).

• MeSH
• Allografts MeSH
• Hemorrhage MeSH
• Humans MeSH
• Primary Graft Dysfunction * MeSH
• Reperfusion Injury * MeSH
• Lung Transplantation * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

• MeSH
• Corneal Diseases diagnosis   therapy   MeSH

• Conspectus
• Ortopedie. Chirurgie. Oftalmologie
• NML Fields
• oftalmologie
• NML Publication type
• kolektivní monografie

Rok 2022 se publikačně již plně vrátil do standardu. To především znamená, že pro anesteziology je celosvětová pandemie viru SARS‐CoV- 2 již zapomenuta, a dominantním tématem je opět bezpečnost anestezie. K tradičnímu hledání odpovědí na otázky, jestli bychom měli spíše preferovat regionální nebo celkovou anestezii a u jakých výkonů, a jaká je nejlepší prevence PONV, se ale nově přidává další s tím spojené téma – pooperační delirium a pooperační kognitivní dysfunkce. Přestože obě tyto entity mají na celkový perioperační průběh zcela zásadní význam, stále jim není věnována dostatečná pozornost. A to přestože především u starších pacientů je již prokázáno, že ovlivňují významně perioperační morbiditu i mortalitu. A k překvapení mnohých recentní data ukazují, že jejich výskyt není zdaleka tak závislý na typu anestezie, jako na kvalitě jejího provedení. Cílem tohoto textu je ve zkratce shrnout některé klíčové publikace v oblasti anesteziologie, a upozornit na práce, které by neměly uniknout pozornosti.

By 2022, publishing has already returned to the standard. This means that the global SARS-CoV-2 pandemic for anaesthesiologists is all but forgotten, and the safety of anesthesia is again the dominant issue. However, in addition to the traditional search for answers to whether we should prefer regional or general anesthesia and for which procedures and what is the best prevention of PONV, there is now another associated topic - postoperative delirium and postoperative cognitive dysfunction. Although both entities are crucial to the overall perioperative course, they still need more attention. This is even though, especially in elderly patients, they have already been shown to significantly affect perioperative morbidity and mortality. Moreover, to the surprise of many, recent data show that their incidence is not so much dependent on the type of anesthesia but on the quality of its administration. This text aims to briefly summarize some key publications in the field of anesthesiology and to highlight papers that should not escape attention.

• MeSH
• Anesthetics, General administration & dosage   therapeutic use   MeSH
• Anesthesia, General * MeSH
• Humans MeSH
• Anesthesia, Local MeSH
• Emergence Delirium MeSH
• Postoperative Nausea and Vomiting MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Termínem pooperační kognitivní dysfunkce bývá označováno zhoršení mentálního výkonu pacientů v pooperačním období. Diagnostika a hodnocení kognitivních poruch v perioperačním období se dostaly do popředí zájmu v souvislosti s narůstajícím počtem geriatrických pacientů podstupujících operaci a celkovou anestezii, se snahou o jejich rychlé zotavení a zachování kvality života. Dříve se deteriorace kognitivních funkcí po operaci označovala pojmem pooperační kognitivní dysfunkce. Její definice byly nejednotné. Ve snaze sjednotit nomenklaturu byla v roce 2018 vydána nová doporučení, v kterých byla pooperační kognitivní dysfunkce nahrazena termínem perioperační neurokognitivní porucha. Dle délky trvání se dělí na preexistující neurokognitivní poruchu, pooperační delirium, opožděné neurokognitivní zotavení a pooperační neurokognitivní poruchu. Cílem advanced narrative review byl popis terminologie, identifikace rizikových faktorů, prevence a léčba perioperační neurokognitivní poruchy.

Term postoperative cognitive disorder stands for deterioration of cognitive function after surgery in postoperative period. Evaluation and diagnostics of cognitive disorders in perioperative period were highlighted by the increasing number of geriatric patients undergoing a surgery with general anaesthesia, with the goal of fast recovery and preservation of the quality of life. Deterioration in cognitive function after surgery was originally called postoperative cognitive dysfunction. The definitions of postoperative cognitive dysfunction varied. In order to unite them, in 2018 there were published new recommendations during which the postoperative cognitive dysfunction was replaced by the term perioperative neurocognitive disorder. This was divided based on different time frames of onset to pre-existing neurocognitive disorder, postoperative delirium, delayed neurocognitive disorder and (postoperative) neurocognitive disorder. Main goals of this advanced narrative review were description of terminology, identification of risk factors, prevention, and therapy of perioperative neurocognitive disorder.

• Keywords
• perioperační neurokognitivní porucha,
• MeSH
• Anesthesia, General adverse effects   MeSH
• Humans MeSH
• Emergence Delirium MeSH
• Postoperative Cognitive Complications * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND AND OBJECTIVE: Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women. METHODS: We performed a non-systematic literature review of the available publications in the PubMed database. KEY CONTENT AND FINDINGS: Over the past years, gender differences in oncological and functional outcomes after RC have received increased attention. According to the currently available literature, organ-sparing approaches can be safely performed in well-selected women without negatively impacting oncological outcomes. The orthotopic neobladder is feasible and oncologically safe in well-selected and informed women. The choice of the UD should be based on comprehensive counseling and the patient's comorbidities and preferences. There still is a lack of data on sexual recovery after the different surgical approaches aimed to mitigate sexual dysfunction in women undergoing RC. CONCLUSIONS: Pre-and post-operative counseling and support of females undergoing RC regarding their expectations and experiences in terms of quality of life and functional and sexual outcomes are currently insufficient. Well-designed studies in this field are necessary to further improve outcomes of women treated with RC with an overarching aim to close the gender gap in managing women with bladder cancer.

• Publication type
• Journal Article MeSH
• Review MeSH

INTRODUCTION: Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. OBJECTIVE: To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. METHODS: The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. RESULTS: The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. CONCLUSIONS: In this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.

• MeSH
• Hysterectomy methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Uterine Cervical Neoplasms surgery   MeSH
• Quality Indicators, Health Care standards   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

PURPOSE: Alloplastic total temporomandibular joint replacement (TMJR) is now considered to be a standard procedure for temporomandibular joint (TMJ) reconstruction. TMJR can improve mandibular mobility, restore the dental occlusion and improve facial aesthetics. The purpose was to assess the presence of intraoperative and post-operative complications, including the presence of post-operative chronic pain. METHODS: This retrospective study evaluated the use of 62 stock TMJR devices implanted in 45 patients who underwent surgery between the years 2006 and 2015 by the same surgeon at the Department of Oral and Maxillofacial Surgery, Stomatology Clinic, General Teaching Hospital (VFN) Charles University, Prague, Czech Republic. RESULTS: Intraoperative and post-operative complications recorded were facial nerve dysfunction (14-22%), open bite/malocclusion (2-3.2%), condylar component dislocation (1-1.6%), infection requiring revision surgery (1-1.6%) and (27-43%) reported chronic pain 24 months after surgery. CONCLUSIONS: As with any surgical procedure, TMJR can have complications. The results of this study demonstrate that the most common post-operative complication was continued pain. Chronic pain after TMJR was more common in patients with a preoperative diagnosis of degenerative joint disease. Also, the incidence of post-operative TMJR pain increased with the duration of symptoms prior to TMJR, leading to a question of the best timing for TMJR.

• MeSH
• Arthroplasty, Replacement * MeSH
• Esthetics, Dental MeSH
• Humans MeSH
• Temporomandibular Joint Disorders surgery   MeSH
• Retrospective Studies MeSH
• Temporomandibular Joint surgery   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH