anesthesia Dotaz Zobrazit nápovědu
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
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- anestetika inhalační MeSH
- anestetika intravenózní MeSH
- Klíčová slova
- ANESTHESIA, SPINAL *, UROGENITAL SYSTEM/surgery *,
- MeSH
- anestezie * MeSH
- epidurální anestezie * MeSH
- lidé MeSH
- spinální anestezie * MeSH
- urogenitální systém chirurgie MeSH
- urologie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- GYNECOLOGY/anesthesia and analgesia *,
- MeSH
- analgezie * MeSH
- anestezie a analgezie * MeSH
- anestezie * MeSH
- gynekologické chirurgické výkony * MeSH
- gynekologie * MeSH
- lidé MeSH
- porodnická anestezie * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- ANESTHESIA, INTRATRACHEAL *, LARYNX *,
- MeSH
- anestezie * MeSH
- intratracheální anestezie * MeSH
- larynx * 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.
- Klíčová slova
- Children, Emergence delirium, PAED score, Postoperative outcomes, Postoperative recovery,
- 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
- Názvy látek
- sevofluran MeSH
- Klíčová slova
- ANESTHESIA, OBSTETRICAL *, CESAREAN SECTION *,
- MeSH
- císařský řez * MeSH
- lidé MeSH
- porodnická anestezie * MeSH
- porodnictví * MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The administration of local anesthesia (LA) in dental practice requires an injection which is the leading cause of patients' fear and anxiety. Computer-controlled local anesthetic injector, designed to reduce the pain of performing local anesthesia by controlling the speed of injection. This single-blind randomised control trial aimed to compare the pain perception after computer-controlled local anesthesia (CCLA) and conventional LA. METHODS: Dental students were both test and operator group versus an experienced dentist as additional operator of the LA. Data were collected regarding gender, age, medical condition, smoking habits. Additionally, operator feedback about the handling, pain at insertion and during infiltration, excitement (Dental Anxiety Scale), and complications were assessed. RESULTS: Out of the 60 included participants, the majority were females (n = 41; 68.3%), medically healthy (n = 54; 90%), and did not receive medications (n = 54; 90%). While the participating students administered 62 (51.7%) injections, the experienced dentist administered 58 (48.3%) injections. The difference in pain perception on puncture between CCLA and conventional injections was not statistically significant (Sig. = 0.285); however, pain perception during injection was significantly different (Sig. = 0.029) between CCLA (1.65 ± 1.93) and conventional injections (2.49 ± 2.31). CONCLUSION: The professional experience influenced the pain perception while applying the LA. CCLA did not reduce pain on puncture significantly; however, pain perception during the injection was significantly reduced in the case of using CCLA devices compared to the conventional syringe.
- Klíčová slova
- Computed-controlled local anesthesia, Dental anesthesia, Dental education, Local anesthesia, Nerve block, Pain perception, RCT, Split-mouth,
- MeSH
- anestetika lokální * MeSH
- bolest MeSH
- jednoduchá slepá metoda MeSH
- lidé MeSH
- lokální anestezie MeSH
- percepce bolesti MeSH
- počítače MeSH
- zubní anestezie * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- anestetika lokální * 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
- analgézie porodnická trendy 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 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
- Klíčová slova
- ANESTHESIA *,
- MeSH
- anestezie * MeSH
- anesteziologie * MeSH
- lidé MeSH
- lokální anestezie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
