Emergentní delirium (ED) je častá pooperační komplikace u dětí, která se projevuje dezorientací, poruchou percepce a psychomotorickým neklidem. Incidence emergentního deliria je uváděna 10–50 %. Ačkoliv je ED self-limiting stavem, může způsobit řadu pooperačních komplikací včetně sebepoškození, dehiscence operační rány, krvácení a dalších obtíží pro ošetřující personál. I přes rozsáhlý výzkum zůstává přesná patofyziologie vzniku ED neznámá. PAED skóre je jediným validovaným nástrojem pro diagnostiku ED. Tento přehledový článek shrnuje rizikové faktory vzniku ED a současné možnosti jeho farmakologické a nefarmakologické prevence a léčby. Korespondující autor: doc. MUDr. Jan Pavlíček, Ph.D., MHA Klinika dětského lékařství Fakultní nemocnice Ostrava Tř. 17. listopadu 1789 708 52 Ostrava-Poruba jan.pavlicek@fno.cz
Emergence delirium (ED) is a common postoperative complication in children, characterized by desorientation, perception and psychomotor disorder. The described incidence of emergence delirium varies between 10-50 %. Although ED is self-limiting, it can induce postoperative complications, including self-injury, dehiscence of surgical wound, bleeding and other difficulties for medical staff. Despite extensive research of ED, precise pathophysiology remains uknown. PAED score is only validated tool for ED diagnosis. This review summarizes the risk factors of ED development and provide current options of pharmacologic and non-pharmacologic prevention and treatment.
- MeSH
- anestetika intravenózní aplikace a dávkování MeSH
- celková anestezie * škodlivé účinky MeSH
- dítě MeSH
- hypnotika a sedativa aplikace a dávkování MeSH
- lidé MeSH
- pooperační delirium * diagnóza farmakoterapie patofyziologie prevence a kontrola MeSH
- rizikové faktory MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Monitoring nociception during general anaesthesia remains a substantial challenge. The Conox monitor uses two EEG indices, the qCon and the qNox. The qNox refers to the probability that a nociceptive stimulation triggers a movement of the patient and the response probability of reaction to nociceptive stimulation. We decided to test the feasibility of monitoring the qNOX index during adult cardiac surgery and to investigate whether this index correlates with hemodynamic and hormonal signs of nociceptive stimulation. METHOD: We enrolled 19 patients undergoing elective cardiac surgery. These were randomised to 2 groups receiving different doses of sufentanil via target controlled infusion: group A (n=9) 0.25 ng/mL and group B (n=10) 0.75 ng/mL. All patients were maintained at the same depth of anaesthesia. We recorded the Conox monitor indices (qNOX, qCON, electromyographic), hemodynamic variables and plasmatic levels of cortisol and noradrenaline. RESULTS: There was significantly higher blood pressure (P=0.013) and plasmatic cortisol (P=0.003) in group A and a significant increase in plasmatic noradrenaline with increasing intensity of surgical stimulation in both groups: A (P=0.001), B (P=0.008). We found no significant corresponding changes in the qNOX index. There was a positive correlation between qNOX and hemodynamic signs of stimulation (P=0.012) and between the qNOX and EMG indices (P=0.013) after endotracheal intubation, but not later after EMG index dropped. CONCLUSION: Our results do not support the assumption that signs of nociceptive stimulation during adult cardiac surgery will be reflected by the qNOX index. This may be related to compounding of qNOX processing and use of muscle relaxants. Further investigation on this field is needed.
- MeSH
- celková anestezie MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- hydrokortison * MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- nocicepce MeSH
- noradrenalin MeSH
- studie proveditelnosti MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DESIGN: Randomized, prospective, and double-blind. SETTING: Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PATIENTS: A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months. INTERVENTIONS: Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MEASUREMENTS: The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. MAIN RESULTS: 86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). CONCLUSION: Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. CLINICAL TRIAL REGISTRATION: NCT04466579.
- MeSH
- celková anestezie * škodlivé účinky MeSH
- dítě MeSH
- inhalační anestezie * škodlivé účinky MeSH
- lidé MeSH
- pooperační delirium * epidemiologie prevence a kontrola etiologie MeSH
- předškolní dítě MeSH
- probouzení z anestezie MeSH
- prospektivní studie MeSH
- sevofluran MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
STUDY OBJECTIVE: Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of 'Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study' (LAS VEGAS) to evaluate differences between females and males with respect to PPCs. DESIGN, SETTING AND PATIENTS: Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs. MAIN RESULTS: The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81-1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89-1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts. CONCLUSIONS: In this conveniently-sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes. REGISTRATION: LAS VEGAS was registered at clinicaltrial.gov (study identifier NCT01601223).
- MeSH
- celková anestezie * škodlivé účinky MeSH
- délka pobytu * statistika a číselné údaje MeSH
- dospělí MeSH
- incidence MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní nemoci * epidemiologie etiologie MeSH
- pooperační komplikace * epidemiologie etiologie MeSH
- rizikové faktory MeSH
- senioři MeSH
- sexuální faktory MeSH
- tendenční skóre MeSH
- umělé dýchání statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
BACKGROUND: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice. METHODS: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported. RESULTS: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients. CONCLUSIONS: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.
- MeSH
- celková anestezie MeSH
- design vybavení MeSH
- dospělí MeSH
- elektivní chirurgické výkony * MeSH
- intratracheální intubace * přístrojové vybavení metody MeSH
- kohortové studie MeSH
- laryngální masky * MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace epidemiologie MeSH
- prospektivní studie MeSH
- senioři MeSH
- zajištění dýchacích cest přístrojové vybavení metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Postoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients. STUDY OBJECTIVE: Evaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV. DESIGN: Prospective, randomized, double-blind study. SETTING: A single center study in university hospital in Czech republic, from June 2021 to November 2022. PATIENTS: A total of 163 children, aged 3-8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included. INTERVENTIONS: In the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS. MAIN OUTCOME MEASURE: The primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery. RESULTS: The use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27-0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20-0.54); p = 0.01, respectively]. CONCLUSIONS: BIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04466579.
- MeSH
- adenektomie * škodlivé účinky metody MeSH
- celková anestezie * metody škodlivé účinky MeSH
- dítě MeSH
- dvojitá slepá metoda MeSH
- incidence MeSH
- lidé MeSH
- pooperační nevolnost a zvracení * epidemiologie prevence a kontrola MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: To compare changes in oesophageal (T-Oeso) and rectal (T-Rec) temperature in dogs during general anaesthesia and premedicated with fentanyl, medetomidine-fentanyl or acepromazine-fentanyl. STUDY DESIGN: Prospective, randomized, blind clinical study. ANIMALS: A total of 120 healthy dogs, aged 2-10 years and weighing 5-20 kg. METHODS: Dogs were randomly allocated to one of three groups. Animals of F group were premedicated with fentanyl (0.01 mg kg-1), MF group with medetomidine (0.005 mg kg-1) and fentanyl (0.01 mg kg-1) and AF group with acepromazine (0.01 mg kg-1) and fentanyl (0.01 mg kg-1). Anaesthesia was induced with propofol and maintained with isoflurane in oxygen-air mixture. Fentanyl was administered continuously (0.01 mg kg-1 hour-1). The T-Oeso, T-Rec and ambient temperatures were recorded after induction (T0) and subsequently at 10 minute intervals for 60 minutes (T10-T60). Data were analysed using anova or their non-parametric equivalents (p < 0.05). RESULTS: Median T-Oeso was significantly higher in MF group between T0-T20 compared with other groups. Median T-Oeso significantly decreased in F group from 38.0 °C (T0) to 37.4 °C (T30), 37.1 °C (T40), 36.9 °C (T50) and 36.6 °C (T60), in MF group from 38.3 °C (T0) to 37.7 °C (T30), 37.5 °C (T40), 37.2 °C (T50) and 37.1 °C (T60) and in AF group from 37.7 °C (T0) to 37.3 °C (T40), 37.2 °C (T50) and 37.1 °C (T60). The T-Rec significantly decreased in F group from 38.0 °C (T0) to 37.4 °C (T40), 37.2 °C (T50) and 36.9 °C (T60), in MF group from 38.3 °C (T0) to 37.5 °C (T50) and 37.4 °C (T60) and in AF group from 38.2 °C (T0) to 37.6 °C (T40), 37.5 °C (T50) and 37.4 °C (T60). CONCLUSIONS AND CLINICAL RELEVANCE: Premedication with fentanyl, medetomidine-fentanyl or acepromazine-fentanyl in the doses used decreased the T-Oeso and T-Rec. The T-Oeso at the beginning of anaesthesia was higher after premedication with medetomidine-fentanyl. However, this difference was not clinically significant.
- MeSH
- acepromazin * farmakologie aplikace a dávkování MeSH
- anestetika intravenózní farmakologie aplikace a dávkování MeSH
- celková anestezie veterinární MeSH
- ezofágus účinky léků MeSH
- fentanyl * farmakologie aplikace a dávkování MeSH
- kombinace anestetik aplikace a dávkování farmakologie MeSH
- medetomidin * farmakologie aplikace a dávkování MeSH
- premedikace anestezie veterinární MeSH
- prospektivní studie MeSH
- psi MeSH
- rektum MeSH
- tělesná teplota * účinky léků MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- psi MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie veterinární MeSH
This editorial discusses the recent study conducted by Macias et al., revealing that anesthesiologists' case volume history has only a marginal impact on improving operating room efficiency, resulting in minimal clinical significance. The idea that a specific anesthesia team or type of anesthesia could enhance productivity has been previously investigated, yielding similar conclusions. Although the study primarily focuses on the time from patient arrival to the completion of anesthesia induction, excluding the latter part of anesthesia-controlled time, Macias et al. have made a valuable contribution by challenging the prevalent notion that less experienced anesthesiologists adversely affect operating room efficiency.
- MeSH
- anesteziologie * MeSH
- anesteziologové * MeSH
- celková anestezie MeSH
- lidé MeSH
- operační sály MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
Anesteziologická a pooperační péče u výkonů na srdci a aortě je v určitých aspektech rozdílná od perioperační péče jiných chirurgických oborů. Tento přehled publikovaných metaanalýz a původních prací v kardiochirurgické perioperační péči představuje a komentuje nové doporučené postupy, implementaci moderních trendů v kardiochirurgii a jejich význam pro anesteziology, ale i nové poznatky vedoucí ke snížení perioperačních a pooperačních komplikací. Dále jsou představeny nejdůležitější lékové studie v oboru včetně vývoje nových farmak. Samostatná část je věnována srdečnímu selhání, mechanickým srdečním podporám a problematice transplantace srdce. Poslední část přehledu se týká monitorovacích technik a nových přístrojů používaných během kardiochirurgické péče.
Anesthesiological and postoperative care for procedures on the heart and aorta differs in certain aspects from the perioperative care of other surgical disciplines. This review of published meta-analyses and original studies in cardiac surgical perioperative care presents and comments on new guidelines, the implementation of modern trends in cardiac surgery and their importance for anesthesiologists, as well as new findings leading to the reduction of perioperative and postoperative complications. Furthermore, the most important drug studies in the field are presented, including the development of new substances. A separate section is designated for heart failure, mechanical circulatory support devices, and the issue of heart transplantation. The last part of the review concerns monitoring techniques and new devices used during perioperative care.
Ze všech prací publikovaných za posledních 12 měsíců z oblasti anesteziologie přináší tento článek publikační přehled ze tří tematických oblastí, které autoři tohoto textu považují za významné – srovnání vlivu celkové a regionální anestezie, srovnání vhodnosti inhalační a totální intravenózní anestezie a srovnání účinků remimazolamu versus propofolu.
Out of all the papers published in the last 12 months in anaesthesiology, this article presents a publication overview of three topic areas that the authors of this text consider significant - a comparison of the effects of general and regional anesthesia, a comparison of the suitability of inhalational and total intravenous anesthesia, and comparison of the effects of remimazolam versus propofol.
- MeSH
- celková anestezie * MeSH
- inhalační anestezie MeSH
- intravenózní anestezie MeSH
- lidé MeSH
- midazolam analogy a deriváty farmakologie terapeutické užití MeSH
- propofol farmakologie terapeutické užití MeSH
- svodná anestezie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
