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Intraoperative evoked potentials monitoring is an essential neurophysiological modality used in surgeries with a risk of CNS functional integrity damage. Transcranial motor evoked potentials (MEPs) are one of the most important modalities. Trained surgeons can effectively monitor MEPs under the supervision of a neurophysiologist. Effective cooperation among all operating team members, anaesthesiologists, and neurophysiologist is essential for proper neuromonitoring. The aim of this article is to comprehensively summarize all possible factors that can affect the quality of intraoperative MEPs monitoring. The authors focus on the effect of anaesthetic drugs and anaesthetic management, including anaesthesia maintenance or non-pharmacological factors, which can affect the MEPs’ reproducibility. This review provides essential information to all members of a perioperative team that take care for patients during surgery with MEPs monitoring. This information can facilitate cooperation and streamline communication across all related disciplines. [ABSTRACT FROM AUTHOR]

Author relates to professional community hidden musical face of influential pioneer of Czech Anaesthesiology and Resuscitation through parts of his personal correspondence with Vladimír Lemon. [ABSTRACT FROM AUTHOR]

The fast track postoperative protocol, also referred to as the method of accelerated rehabilitation, or ERAS (enhanced recovery after surgery), includes complex, modern procedures aimed at diminishing the frequency of postoperative complications, reducing the length of hospital stay and enhancing a patient's comfort. It is characterized by a multidisciplinary approach which involves a urologist, anesthesiologist, nurse, physiotherapist and sometimes also nutrition specialist. Although, there is clear evidence that this method is beneficial, the majority of urology departments have not adopted this approach yet. [ABSTRACT FROM AUTHOR]

Objective: Progress in other medical specialities sometimes brings a challenge for the anaesthetist to adopt anaesthetic care while scarce information is available. One such example is irreversible electroporation (IRE). The aim is to describe the anaesthetic technique for IRE based on our own experience and available studies. Design: Observational study. Setting: University hospital. Patients and methods: Up to 1st May 2012, 14 patients were treated by IRE, one of the patients twice. We assessed the anaesthetic charts and laboratory examinations. Results: The study included 9 women and 5 men aged 65 ± 11 years, BMI 22.2 ± 4.4 kg/m2. The diagnoses included cancer or metastases in the liver (10), lung (3), pancreas (1) and kidney (1). The average duration of the procedure was 135 ± 38 (median 125) minutes. The main challenges included prolonged positioning on the CT table with abducted arms, extensive movements of the examination CT table and episodes of strong stimulation requiring maximal muscle relaxation. We used relaxant general anaesthesia; boluses of 1-2 mg of alfentanil were empirically chosen for analgesia during the electric discharges. Neuromuscular blockade monitoring was essential. Laboratory examinations demonstrated significant elevation of ALT and AST to maximum 10 µkat/l and bilirubin to approximately 40 µmol/l with excess of 350 µmol/l in a single patient. Renal function remained unchanged with some cases of clinically insignificant decrease in creatinine and urea levels. Conclusion: The optimal anaesthetic technique was based on short-acting agents and obligatory monitoring of the neuromuscular transmission. The post-operative course was usually without problems. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to ascertain the usage of perioperative transoesophageal echocardiography (TOE) by anaesthetists during cardiac surgery in the Czech Republic. Design: Nationwide questionnaire survey. Setting: All twelve adult cardiac centres in the Czech Republic, mostly parts of University hospitals. Materials and methods: An electronic questionnaire was sent to chief cardiac anaesthetists in all centres. All of them responded. Methods of descriptive statistics were used for statistical analysis. Results: Only a minority (13%) of all cardiac anaesthetists have passed or are currently in the process of TOE accreditation. Therefore TOE is performed by cardiologists only at most centres (67 %). There is no cardiothoracic centre in Czech Republic where TOE is performed for the full range of procedures. However, it is available 24 hours every day in every centre. TOE is mostly used during valve repair procedures (100 % centres) and septum defect procedures (83 % centres). TOE is used less frequently before weaning off the cardiopulmonary bypass (58 % centres), in valve replacements (8 % centres), and in patients with left ventricular dysfunction (8 % centres). Lack of trained doctors and adequate equipment are the major obstacles of routine usage of TOE by anaesthetists. An absolute majority of respondents (92 %) are interested in education in echocardiography. Conclusion: The survey showed that TOE is a technique available in all cardiac surgical centres in the Czech Republic, though still mostly used by cardiologists. There is a lack of cardiac anaesthetists with TOE accreditation. Establishment of a national system of education for anaesthetists guaranteed by scientific societies is strongly required. [ABSTRACT FROM AUTHOR]

Objective: To inform the young generation of anaesthesiologists about the early days of the specialty, the decisions and the steps taken by the representatives of surgery at Prague's Medical Faculties after WWII, leading to the organized development within the frame of the J. E. Purkynje Czechoslovak Medical Society and in the Health Service. Methods: Literature and personal experience. Impulses, decisions and measures coming from the Prague Medical Faculties which fundamentally influenced the development into a higher medical specialty--Anaesthesiology (1954), and to the basic specialty of Anaesthesiology and Resuscitation (1971). Results: As back as in 1947, academician A. Jirásek sent his assistant J. Pastorová to Oxford to learn about anaesthesia in Great Britain. Pastorová wrote a textbook on General Anaesthesia and became the first chairman of the Committee of Anaesthesiology within the frame of the Czechoslovak Surgical Society. Having fulfilled her mission she returned to surgery. Her colleague, J. Hoder, who spent his professional life at the Faculty of General Medicine (now the 1st Medical Faculty) in Prague, became an important representative of the specialty. From 1956 M. Drapka developed paediatric anaesthesiology at the Paediatric Faculty Hospital in Prague-Motol, at the Faculty of Paediatric Medicine (now the 2nd Medical Faculty). In 1973 the Ministry of Health set up the first Clinic of Anaesthesiology and Resuscitation at the Paediatric Faculty Hospital in the Czech Republic. It became the clinical basis for the Chair of Anaesthesiology and Resuscitation at the Institute for Postgraduate Medical Education and, therefore, it had nationwide impact on the postgraduate education of physicians. In 1958--1969 there was a prominent anaesthesiologist B. Dvořáček at the Faculty of Medicine and Hygiene (now the 3rd Medical Faculty), who--after his stay in Copenhagen in 1959, began his systematic effort to extend anae sthesiology to intensive therapy--and became successful. Departments of anaesthesiology became the location for wards where resuscitative care was provided according to the concept of anaesthesiology and resuscitation. Currently all university hospitals have clinics of anaesthesiology and resuscitation and the representatives of the specialty are academic teachers, professors and assistant professors. Conclusions: In the second half of the 20th century anaesthesiology and resuscitation underwent massive development in the Czech Republic, from a few dozen of interested physicians at the end of the 1940s and 1950s to the position of a fundamental medical specialty, with the current departments of anaesthesia being some of the biggest departments in most hospitals. The originally modest specialty of anaesthesiology has developed into subspecialties e. g. pain management, emergency medicine and intensive medicine. Last year the specialty was renamed to Anaesthesiology and Intensive Medicine. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to take a snapshot of the anaesthetic modes and techniques used in the Czech Republic. Design: A prospective, one-day, questionnaire study. Setting: All units delivering anaesthetic services registered prior to the commencement of the study. Materials and methods: The study enrolled all patients in the registered units whose care by the anaesthetist commenced between 07:00 and 24:00 on 1st June 2010. Each patient's data were entered on-line via an internet based form. The studied parameters included basic demographic data, ASA class, procedure, type of anaesthesia, airway management, anaesthetic agents, neuro-muscular blocking drugs (NMBDs) and neuro-muscular blockade antagonism, infusion therapy and post-anaesthesia care location. Results: Data for 2520 patients were collected, of whom 2514 were analyzed (1176 men, 1338 women). Total 2306 (91.7 %) procedures were performed as in-patient and 208 (8.3 %) as day-case procedures. General anae sthesia (GA) was performed in 82.6 % and 79.3 % of in-patients and day-patients respectively. A total of 92 % of all procedures performed under GA were carried out as in-patient and 8 % as day-case procedures. Airway management for GA: tracheal intubation (59.8 %), LMA (18.8 %), other devices (11.2 %) and device-free (10.1 %). The most common induction agent was propofol (71.3 %) and opioids (76.4 %), the most frequently used NMBDs were non-depolarizing NMBDs (36.4 %) and suxamethonimum (18.5 %). Maintenance agents: opioids (66 %), isoflurane (43.8 %), sevoflurane (38.5 %) and nitrous oxide (58.3 %). The most commonly used NMBDs were atracurium (43.1 %) and rocuronium (24.2 %). The most common intravenous fluids were crystalloids (85.4 %). Following GA 41 % patients went to the ward, 25.9 % to the post-anaesthesia care unit (recovery) and 23.3 % to HDU/ICU. Conclusion: Anaesthetic care is most frequently given to ASA I -- II patients in the Czech Republic. GA is the most common technique. The most frequently used agents include propofol, opioids, isoflurane, sevoflurane and atracurium / rocuronium. Post-anaesthesia care is usually provided on post-anaesthesia care units, HDU/ICUs or on standard wards. In comparison with other countries there is a low proportion of procedures performed without subsequent hospitalisation of the patient. [ABSTRACT FROM AUTHOR]

Objective: The double-lumen fibreoptic tube Vivasight ETView® is a new tool that allows lung isolation without the use of a fibrescope. The aim of the study was to evaluate the success and complication rates of its insertion in thoracic surgery procedures. Design: Prospective observational study (clinical audit). Settings: Department of Anaesthesiology and Intensive Care Medicine, University Hospital. Material and methods: We evaluated the success rate, speed of insertion, incidence of malposition and other complications associated with the insertion of a fibreoptic double-lumen tube in 65 patients scheduled for thoracic surgery requiring separation of the lungs. Results: The tube was successfully inserted in 64 of 65 patients (98.5%). One patient (1.5%) experienced tube dislocation requiring subsequent repositioning using a flexible bronchoscope. The average speed of insertion was 23.4 (± 4.67) seconds. We did not observe any significant differences in the insertion success rates between experienced anaesthesiologists and trainees. Conclusion: The double-lumen Vivasight ETView® fibreoptic cannula is a good tool for the separation of the lungs in thoracic anaesthesia. It is also suitable for educational purposes. [ABSTRACT FROM AUTHOR]

Xylazine is a veterinary anaesthetic used on all kinds of animals. Accidental human intoxication is rare, mostly among veterinarians. This case study describes an oral accidental intoxication of two siblings (brothers, a 5- and a 3-year-old). They drank the anaesthetic stored in soda bottles. They drank 60-80 ml together. The older brother developed altered consciousness (GCS -- Glasgow coma Scale -- 8), with hypoventilation. He had to be intubated and mechanical ventilation was needed. After 5 hours he started to breathe spontaneously again, in 20 hours he developed gastrointestinal symptoms -- repetitive vomiting. The younger brother developed bradycardia and mildly altered consciousness (GCS 11). The anaesthesiologist administered him 1.5 mg Atropine i. v. Both brothers tended to mild hyperglycaemia but were in very good condition 38 hours after intoxication. Conclusions: The dominant effect of xylazine on a child is the CNS (Central nervous system) inhibition and cardiac depression. Hyperglycaemia, miosis and vomiting can also occur. [ABSTRACT FROM AUTHOR]