The issue of domestic violence is neglected in current medical practice and the dia-gnosis associated with it thus escapes the attention of medical professionals. In this case report, we demonstrate rare and typical diseases of abused women, which should become warning signs for physicians (red flags) and lead them to screen domestic violence and intervene early. Failure to recognize domestic abuse as the cause of chronic health problems leads to lasting consequences and economically and personally burdens the health care system. Healthcare professionals of all specialties encounter abused women during their clinical practice and can thus actively participate in the prevention of domestic violence. However, it is women of reproductive age who are most at risk, so educating gynecologists and obstetricians on this issue is crucial. The aim of this article with a case study is to demonstrate the syndrome of a battered woman, its recognition and the possibility of immediate and brief intervention.

• Klíčová slova
• Domestic violence, chronic subdural haematoma, chronic subdural hematoma, domestic violence, postdural puncture headache,
• MeSH
• bité ženy * MeSH
• domácí násilí * prevence a kontrola   MeSH
• gynekologie * MeSH
• lékaři * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• anesteziologie MeSH
• císařský řez statistika a číselné údaje   trendy   MeSH
• dospělí MeSH
• lidé MeSH
• porodnická anestezie statistika a číselné údaje   trendy   MeSH
• průzkumy a dotazníky MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH

AIMS: The purpose of this international survey was to describe the impact of current practices and techniques of caesarean section on the neonatal Apgar score in the Czech Republic (CZE) and Slovakia (SVK). METHODS: All Czech and Slovak departments that provide obstetric anaesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in details all peripartum anaesthetic practices, delivered by anaesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). RESULTS AND DISCUSSIONS: We collected data of 10119 women who delivered 10226 newborns. A caesarean section was recorded in 25.1% of deliveries (CZE 23.2%; SVK 30%). General anaesthesia was used for caesarean section in 37.5% of the cases (CZE 40%, SVK 33%). There was no statistically significant difference in the Apgar score lower than 7 in the 1, 5 or 10 min in groups of general and regional anaesthesia for caesarean section, when only elective sections of in-term babies with birth weight over 2500 g were analyzed. We found no statistically significant differences in the Apgar score in newborns of women intubated for caesarean section in rocuronium (n=21; 2.2%) and suxamethonium (n=889; 93%). CONCLUSION: We found no difference in neonatal outcomes in groups of general and regional anaesthesia for caesarean section when only out-of-risk newborns were analyzed. The risk factors were identified as follows: an acute caesarean section, preterm babies, birth weight less than 2 500 g, born in perinatological center and multiple pregnancy - second baby. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT02380586) https://clinicaltrials.gov/ct2/show/NCT02380586.

• Klíčová slova
• Apgar score, caesarean section, general anaesthesia, international survey, neonatal outcome, rapid sequence induction, rocuronium, suxamethonium,
• MeSH
• Apgar skóre * MeSH
• celková anestezie statistika a číselné údaje   MeSH
• císařský řez metody   MeSH
• depolarizující myorelaxancia terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• nedepolarizující myorelaxancia terapeutické užití   MeSH
• novorozenec MeSH
• porodnická anestezie MeSH
• retrospektivní studie MeSH
• rokuronium terapeutické užití   MeSH
• sukcinylcholin terapeutické užití   MeSH
• svodná anestezie statistika a číselné údaje   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH
• Názvy látek
• depolarizující myorelaxancia MeSH
• nedepolarizující myorelaxancia MeSH
• rokuronium MeSH
• sukcinylcholin MeSH

BACKGROUND: The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic. METHODS: In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT). RESULTS: The response rate was 51% (49 of 97 departments); participating centers represented 60% of all births in the country during the study period. There were 1943 cases of peripartum anesthesia care, of which 1166 cases (60%) were anesthesia for cesarean delivery. Estimates were weighted based on population distribution of cesarean delivery among types of participating centers. Neuraxial anesthesia was used in 55.6% (95% confidence interval [CI], 52.8%-58.5%); the distribution of anesthesia techniques differed among type of participating center. The rate of neuraxial anesthesia in university hospitals was 55.6% (95% CI, 51.5%-59.6%), 32.4% (95% CI, 26.4%-39.0%) in regional hospitals, and 60.7% (95% CI, 55.2%-66.0%) in local hospitals. The reasons for cesarean delivery under general anesthesia were emergency procedure (67%), refusal of neuraxial blockade by parturient (30%), failure of neuraxial anesthesia (6%), and preoperative administration of low-molecular-weight heparin (3%). Postcesarean analgesia was primarily provided by systemic opioid (66%) and nonopioid analgesics (61%), solely or in combination. Epidural postoperative analgesia was used in 14% of cases. Compared with national neuraxial anesthesia rate data published in the 1990s (6.7% in 1993), there has been an upward trend in the use of neuraxial anesthesia for cesarean delivery during the 21st century (40.5% in 2000) in the Czech Republic. CONCLUSIONS: The rate of neuraxial anesthesia use for cesarean delivery has increased in the Czech Republic in the last 2 decades. However, the current rate of general anesthesia is high compared with other Western countries.

• MeSH
• časové faktory MeSH
• celková anestezie trendy   MeSH
• centra s nižším počtem specializovaných operací trendy   MeSH
• císařský řez škodlivé účinky   trendy   MeSH
• elektivní chirurgické výkony MeSH
• epidurální analgezie trendy   MeSH
• lékařská praxe - způsoby provádění trendy   MeSH
• lidé MeSH
• náhlé příhody MeSH
• nemocnice univerzitní trendy   MeSH
• pooperační bolest prevence a kontrola   MeSH
• porodnická analgezie trendy   MeSH
• porodnická anestezie škodlivé účinky   trendy   MeSH
• průzkumy zdravotní péče MeSH
• specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby trendy   MeSH
• spinální anestezie trendy   MeSH
• svodná anestezie škodlivé účinky   trendy   MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Remifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn. METHODS: Using a double-blinded randomized design, a total of 151 parturients undergoing caesarean delivery under general anaesthesia were randomized into two groups--76 patients received a bolus of remifentanil prior to induction, while 75 patients were assigned to the control group. Remifentanil 1 μg/kg was administered 30 seconds before the standard induction of general anaesthesia. The primary outcome measure was an assessment of neonatal adaptation using the Apgar score, while secondary outcomes included the need for respiratory support after delivery and differences in umbilical blood gas analysis (Astrup). RESULTS: The incidence of lower Apgar scores between 0 and 7 was significantly higher in the remifentanil group at one minute (25% vs. 9.3% of newborns, p = 0.017); whilst at five minutes and later no Apgar score differences were observed. There was no difference in the need for moderate (nasal CPAP) or intensive (intubation) respiratory support, but significantly more neonates in the remifentanil group required tactile stimulation for breathing support (21% vs. 7% of newborns, p = 0.017). There was no difference in the parameters from umbilical cord blood gas analysis between the groups. CONCLUSION: At a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01550640.

• Klíčová slova
• Caesarean delivery, General anaesthesia, Neonatal effect, Remifentanil,
• MeSH
• anestetika celková škodlivé účinky   MeSH
• Apgar skóre MeSH
• celková anestezie škodlivé účinky   MeSH
• císařský řez * MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• fyziologická adaptace účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• opioidní analgetika škodlivé účinky   MeSH
• piperidiny škodlivé účinky   MeSH
• poruchy dýchání chemicky indukované   MeSH
• prospektivní studie MeSH
• remifentanil MeSH
• těhotenství MeSH
• umělé dýchání MeSH
• výsledek těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• anestetika celková MeSH
• opioidní analgetika MeSH
• piperidiny MeSH
• remifentanil MeSH