There is increasing evidence that the microcirculation and its regulation are severely compromised during many pathological conditions, such as hemorrhage, sepsis, or trauma. The effects of anesthetic agents on macrohemodynamics were investigated intensively in the last several decades. Research regarding modern anesthetics and anesthesia techniques has increased knowledge regarding the nonanesthetic effects of anesthetic agents, including those on organ perfusion and the microcirculation. Alterations in microvascular reactivity, nitric oxide pathways, and cytokine release are presumably the main mechanisms of anesthetic-induced tissue perfusion changes. This review summarizes current methods of microcirculatory status assessment and current knowledge regarding the microcirculatory effects of intravenous and potent volatile anesthetics and anesthesia-related techniques under both normal and pathophysiological conditions.

• MeSH
• anestetika inhalační farmakologie   MeSH
• anestetika intravenózní farmakologie   MeSH
• anestezie metody   MeSH
• epidurální anestezie metody   MeSH
• kardiopulmonální bypass MeSH
• lidé MeSH
• mikrocirkulace účinky léků   MeSH
• peroperační monitorování metody   MeSH
• psi MeSH
• reperfuze MeSH
• tekutinová terapie MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• psi MeSH
• zvířata MeSH
• Publikační typ
• práce podpořená grantem MeSH

Background: This study was a proof of concept of a novel means to evaluate microcirculatory changes during spinal anesthesia for cesarean delivery. It sought to examine the distributive circulatory effects of spinal anesthesia and evaluate the impact of phenylephrine administration on the microcirculation of these women. Methods: After Research Ethics Board approval, healthy, non-laboring pregnant women with singleton, term pregnancies scheduled for elective cesarean delivery were recruited. Participants were randomly assigned to receive either phenylephrine infusion or phenylephrine bolus. Spinal anesthesia was standardized. A sidestream dark-field (SDF) MicroScan® video microscope was applied to the sublingual mucosa to obtain microcirculation videos in five different visual fields. Videos were made before and after spinal anesthesia. The resultant videos were analyzed randomly and blindly. The mean microvascular flow index (MFI) values were compared before and after spinal anesthesia. The difference in MFI following spinal anesthesia was compared between phenylephrine infusion and bolus groups. Results: Thirty-two patients were recruited for the study; 22 patients had complete video sets for analysis. Baseline characteristics were similar between the two groups, including preoperative hemodynamics. There were no significant differences between pre- and post-spinal MFI. The post-spinal MFI within the infusion group (mean ± standard deviation: 2.74 ± 0.21) was not significantly different from the bolus group (2.56 ± 0.42, P = 0.22). Conclusion: Despite theoretical physiological implications of spinal anesthesia and phenylephrine on the microcirculation, significant alteration of the MFI was not observed between pre- and post-spinal anesthesia (within group). Additionally, despite an eight-fold larger phenylephrine dose for continuous infusion prophylaxis used in this group of women, this did not result in a significant alteration of the microcirculation compared to those who received phenylephrine treatment for hypotension (between groups).

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Damage of the endothelial glycocalyx (EG) has been described during surgery, but the effect of different anesthesia techniques remains unknown. Perfused boundary region (PBR) evaluated by side-stream dark field (SDF) imaging of the sublingual microcirculation enables in vivo EG assessment. PBR values are inversely related to the EG thickness. OBJECTIVE: The aim of the observational study was to evaluate the changes of PBR in patients undergoing elective joint surgery under general (GA) vs. neuraxial anesthesia (NA). Our hypothesis was that PBR will be lower in patients in NA. METHODS: Sixty consecutive patients (ASA 1-3) undergoing elective total knee or hip replacement under GA or NA were included in this prospective observational cohort study. PBR in the sublingual microcirculation was recorded in each patient using SDF at two time points - before surgery and 2 hours after surgery. RESULTS: Before surgery, there was no significant difference in baseline PBR between groups (NA: 1.95 μm (±0.24); GA: 2.02 μm (±0.26); p = 0.098). Postoperatively (2 hours after surgery) PBR was significantly increased in both groups with respect to baseline values (NA: 2.09 μm (±0.19), GA: 2.20 μm (±0.25); p < 0.001). In the GA group, postoperative PBR values were significantly higher than in the NA group (p = 0.006). CONCLUSION: Joint surgery led to significant increases of PBR. Patients in the GA group had significantly higher PBR values 2 hours after surgery compared to NA group. This might implicate that NA is associated with less EG damage then GA in elective hip/knee surgery.

• MeSH
• celková anestezie metody   MeSH
• glykokalyx účinky léků   MeSH
• klouby chirurgie   MeSH
• kohortové studie MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• spinální anestezie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The microcirculation is responsible for distribution of blood within tissues, delivery of oxygen and other nutrients, and regulation of blood pressure. The objective of this study was to compare the sublingual microcirculation of pregnant participants to that of comparable non-pregnant volunteers. METHODS: Two groups of participants were recruited: a group of pregnant, non-laboring women with singleton pregnancies at term gestation and a control group of age-comparable non-pregnant volunteers. A sidestream dark field imaging device was applied to the sublingual mucosal surface obtaining a steady image for at least 20 s duration, in five visual fields. The resultant five video clips per participant were analyzed blindly and at random to prevent coupling between images. The mean microvascular flow index values for each group were compared using a paired t-test. RESULTS: Thirty-seven participants were recruited (19 pregnant, 18 non-pregnant); a single pregnant participant was withdrawn because of technical issues. Baseline characteristics were similar with the exception of weight and body mass index. The mean microvascular flow index was significantly higher in the pregnant group 2.7 ± 0.2 compared to the non-pregnant group 2.5 ± 0.3 (P = 0.021), while the perfused vessel density and proportion of perfused vessels were not significantly different (P = 0.707 and 0.403, respectively). CONCLUSION: The microvascular flow index of pregnant women is higher than a comparable non-pregnant group, which appears to correlate with the physiological changes of pregnancy.

• MeSH
• audiovizuální záznam metody   MeSH
• dospělí MeSH
• lidé MeSH
• mikrocirkulace fyziologie   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• ústní spodina krevní zásobení   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

• MeSH
• celková anestezie MeSH
• dítě MeSH
• ketamin MeSH
• kůže krevní zásobení   MeSH
• lidé MeSH
• mikrocirkulace MeSH
• popálení chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

BACKGROUND: Hyperosmolar solutions have been used in neurosurgery to modify brain bulk. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of hypertonic saline (HTS) and sodium lactate (HTL) on cerebral cortical microcirculation and brain tissue oxygenation in a rabbit craniotomy model. METHODS: Rabbits (weight, 1.5 to 2.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3.75 mL/kg intravenous infusion of either 3.2% HTS (group HTS, n=9), half-molar sodium lactate (group HTL, n=10), or normal saline (group C, n=9). Brain tissue partial pressure of oxygen (PbtO2) and microcirculation in the cerebral cortex using sidestream dark-field imaging were evaluated before, 20 and 40 minutes after 15 minutes of hyperosmolar solution infusion. Global hemodynamic data were recorded, and blood samples for laboratory analysis were obtained at the time of sidestream dark-field image recording. RESULTS: No differences in the microcirculatory parameters were observed between the groups before and after the use of osmotherapy. Brain tissue oxygen deteriorated over time in groups C and HTL, this deterioration was not significant in the group HTS. CONCLUSIONS: Our findings suggest that equivolemic, equiosmolar HTS and HTL solutions equally preserve perfusion of cortical brain microcirculation in a rabbit craniotomy model. The use of HTS was better in preventing the worsening of brain tissue oxygen tension.

• MeSH
• anestezie MeSH
• hemodynamika účinky léků   MeSH
• hypertonický solný roztok farmakologie   MeSH
• králíci MeSH
• kraniotomie MeSH
• mikrocirkulace účinky léků   MeSH
• modely u zvířat MeSH
• mozek - chemie účinky léků   MeSH
• mozková kůra krevní zásobení   účinky léků   MeSH
• mozkový krevní oběh účinky léků   MeSH
• natriumlaktát farmakologie   MeSH
• osmolární koncentrace MeSH
• spotřeba kyslíku účinky léků   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF REVIEW: This review presents important pathophysiological alterations associated with impaired liver function and discusses protective perioperative strategies and the various anaesthetic agents recommended. RECENT FINDINGS: Perioperative liver impairment is a serious complication of anaesthesia and surgery. Unfortunately, clinicians are provided with only crude macrohaemodynamic monitoring devices to optimize their therapy. Technical improvements have revealed some complex mysteries of perioperative microcirculatory alterations and have disclosed a large heterogeneity between different vascular beds. The present review will critically discuss current clinical concepts of optimizing global haemodynamic variables and the often contrasting effects of vasoactive agents on the microcirculatory nutritional blood flow. Finally, promising protective experimental interventions of pharmacological or ischaemic preconditioning are presented and their often disillusioning transition into recent clinical trials is highlighted. SUMMARY: Targeted perioperative liver protection still lacks adequate monitoring tools and is currently based on optimization of global haemodynamic variables. While there is currently no evidence suggesting a positive effect of ischaemic preconditioning, promising experimental results of pharmacological preconditioning and therapeutic hypothermia require further evaluation in larger randomized clinical trials.

• Klíčová slova
• hepatotoxicita, ochrana, perioperační, preconditioning,
• MeSH
• anestetika inhalační škodlivé účinky   MeSH
• anestezie MeSH
• celková anestezie metody   škodlivé účinky   MeSH
• ischemie komplikace   MeSH
• jaterní testy využití   MeSH
• játra krevní zásobení   účinky léků   MeSH
• lidé MeSH
• mikrocirkulace účinky léků   MeSH
• perioperační péče metody   ošetřování   MeSH
• peroperační komplikace etiologie   prevence a kontrola   MeSH
• terapeutická hypotermie využití   MeSH
• Check Tag
• lidé MeSH

The endothelial glycocalyx (GCX) coats all the vascular endothelium and plays the pivotal role in the microcirculation under physiological and pathological conditions. Alteration of GCX may play the key role in the critical illness associated microcirculatory dysfunction, promoting tissue hypoperfusion and contributing to organ failure. GCX integrity may be impaired by many factors, but focused human studies evaluating the effect of anesthesia, major surgery or common ICU interventions are scarce. GCX protection bears potential to limit organ damage. The aim of the project is to apply new technologies for bed-side assessment of GCX and to describe its relevance dynamics in critical illness and after major surgery. Major expected impact of the research is to bring vitally important data on factors affecting and/or modulating GCX integrity, to assess feasibility and reliability of measuring GCX in clinical practice in order to optimize treatment modalities with regard to protect the GCX.

Endoteliální glykokalyx (GCX) pokrývá povrch endoteliálních buněk v cévním systému, má významnou roli v regulaci mikrovaskulární homeostázy za fyziologických i patologických stavů. K alteraci GCX v kritických stavech dochází řadou mechanismů, výsledkem je ztráta bariérové funkce GCX. Porucha integrity GCX hraje významnou roli v rozvoji tkáňové hypoperfuze a orgánového selhání. Vliv většiny postupů orgánové podpory v rámci anestezie a intenzivní péče (nutriční podpora, metody mimotělní podpory/náhrady orgánových funkcí) na GCX není znám. Cílem projektu je zhodnocení klinické využitelnosti nových poznatků o změnách GCX během operačního traumatu, anestezie a intenzivní péče a získání prioritních poznatků o vlivu lipidomu a parenterální výživy na GCX pro vývoj a optimalizaci postupů nutriční podpory. Vytvoření zvířecího modelu na praseti by mělo dále otevřít možnosti testování nových postupů na ochranu GCX.

• MeSH
• cytoprotekce MeSH
• endoteliální buňky MeSH
• glykokalyx MeSH
• kritický stav MeSH
• lipidomika MeSH
• parenterální výživa MeSH
• peroperační doba MeSH
• peroperační komplikace MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• cytologie, klinická cytologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

Two mechanisms contribute in the development of pulmonary hypertension in pulmonary embolism (PE) - obstruction of pulmonary blood vessels and vasoconstriction. We hypothesize that hypoxia, increased shear stress and/or activation of gathered leukocytes in the PE may cause a release of reactive oxygen species (ROS). Therefore our aim was to determine the influence of the ROS scavenger Tempol on pulmonary hypertension and to describe NO synthase activity and production of NO oxidative products (NOx) after PE. In general anesthesia sephadex microspheres suspended in PSS were applied in right jugular vein as the pulmonary microembolism. Than we measured in isolated salt solution-perfused lungs the changes in perfusion pressure, activity of NO synthase and NOx plasma concentration in 7 groups of rats: C: control group (n=5), CN: C + sodium nitroprusside (SN) (n=5), EN: PE + SN (n=5), ETN: Tempol + PE + SN (n=5), CL: C + L-NAME (n=5), EL: PE + L-NAME (n=5), ETL: Tempol + PE + L-NAME (n=5). Tempol was applied intraperitoneally before PE. Animals that received Tempol (groups TN, TL) had significantly lower basal perfusion pressure than those which did not receive Tempol (EN, EL). Overall we measured a higher decrease of perfusion pressure than in the control group (C) after application of SN. Administration of L-NAME after PE (EL) increased the pressure more than in the control group (NL). NOx concentration was higher after PE. We found that preventive administration of Tempol decreases the increase in perfusion pressure after PE. PE increased NO release and concentration of NOx.

• MeSH
• aktivace enzymů účinky léků   fyziologie   MeSH
• cyklické N-oxidy farmakologie   terapeutické užití   MeSH
• krevní tlak účinky léků   fyziologie   MeSH
• krysa rodu rattus MeSH
• mikrocirkulace účinky léků   fyziologie   MeSH
• NG-nitroargininmethylester farmakologie   MeSH
• orgánové kultury - kultivační techniky MeSH
• plicní embolie farmakoterapie   metabolismus   MeSH
• plicní oběh účinky léků   fyziologie   MeSH
• potkani Wistar MeSH
• reaktivní formy kyslíku antagonisté a inhibitory   metabolismus   MeSH
• scavengery volných radikálů farmakologie   terapeutické užití   MeSH
• spinové značení MeSH
• synthasa oxidu dusnatého antagonisté a inhibitory   metabolismus   MeSH
• vazokonstrikce účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH