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Clanek je pokracovanim cyklu o významu fascii pro regionalni anestezii. Tato kapitola se zaměřuje na kožni inervaci stehna. Blokady kožniho povrchu jsou nedilnou soucasti centralnich blokad i zavedených blokad hlavnich perifernich nervů směřujicich do oblasti stehna. Průběh kožnich nervů je vazan na dispozici povrchni i hluboke fascie. Fascialni struktury jsou dobře identifikovatelne pomoci ultrazvukoveho obrazu, což usnadňuje identifikaci kožnich nervů a umožňuje jejich selektivni blokadu. Blokada perifernich kožnich nervů stehna neovlivni svalovou silu a mobilitu. Selektivni blokady podkožnich nervů usnadňuji diagnostiku chronických bolesti v jimi zasobene oblasti.

Clanek popisuje embryologicke a anatomicke důsledky vývoje fascialniho systemu trupu ve vztahu k možnostem regionalni anestezie lumbalni oblasti. S použitim literarnich zdrojů, schemat, ultrazvukových vysetřeni, a pocitacove tomografie představuje koncept ctyř samostatných fascialnich kompartmentů v lumbalni oblasti. Tento koncept může usnadnit porozuměni blokadam v lumbalni oblasti a zpřesnit indikace a postupy.

Regional anesthesia is undergoing technological change from electro stimulation to ultrasound era By its creative nature it is resistant to be tighten up by evidence-based recommendations at least at this stage of development Existing guidelines tend to be local in nature and are tailored to individual hospitals rather than countries or regions The COVID-19 pandemic, however, set a precedent ASRA (American Society of Regional Anesthesia) and ESRA (European Society of Regional Anes thesia) have issued joint COVID-19 Guidance for Regional Anesthesia

Background and aims This pilot clinical case series describes a technique of ultrasound guided blockade of second and third branches of the trigeminal nerve for facial surgery in geriatric patients. Methods Five geriatric patients (4 females and 1 male), average age of 74.5 years, were indicated for facial tumor surgery at the Department of Surgery, Masaryk Hospital in Usti nad Labem. Written informed consent was obtained from all patients. Anesthesia was performed using ultrasound guided blockade of nerve temporalis and second branches of the trigeminal nerve in the fossa pterygopalatine (maxillary nerve), a novel technique developed at the Department of Anesthesiology, Perioperative and Intensive Care Medicine. the ultrasound guidance allowed for the visualization of the fossa pterygopalatine. Landmarks are the lateral lamina of the pterygoid process of the sphenoide bone. Visualization of the maxillary artery and other vascular structures before and during the spread of the local anesthetic reduced the likelihood of intravascular anesthetic administration. the blockade itself was induced by 5ml (nerve temporalis) and 7 ml 0.5% Marcaine to second branch of trigeminal nerve. Results The blockade was successful in all five patients, allowing for spontaneous breathing and patient’s cooperation under mild sedation. Cardiovascular stability was excellent despite the high anesthetic risk. Conclusions Blockade of maxillary nerve in the fossa pterygopalatine and temporalis nerve, branch of the third trigeminal nerve proved to be a technique suitable for facial surgery in high risk geriatric patients.

In our ICU we use modified bedside operative tracheostomy. The operation consists of consecutive blunt dilatation of all tissular structures above the trachea with the aim of denudating it. After that we execute a small incision of the trachea between the second and the third annulus, dilatation of trachea and insertion of a tracheostomy cannula with the possibility of an adjustment tracheal aperture. There is no need for ligation of the thyroideal isthmus or resection of the tracheal cartilage. The aim of this study was to compare our method with surgical tracheostomy (ST) and percutaneous dilation tracheostomy (PDT-Ciaglia) for early and long-term complications.

Myocardial contusion can result from blunt thoracic trauma and is commonly suspected in deceleration injuries. Unfortunately, traumatic heart disease is frequently overlook and the diagnosis of myocardial contusion is often unrecognized. Also the frequency and prognostic influence of cardiac injury in patient with blunt trauma is contraversial. Myocardial contusion is reported to be present in as few as 0% of patients and as many as 76% with blunt chest trauma depending on the criteria used for establishing the diagnosis. Diagnosing myocardial damage as a result of trauma may be a problem because there is a lack of a gold standard for establishing the diagnosis. More articles brought no clear results about specifity and signification of these methods. The conventional CKMB activity and CKMB/CK-total ratio are still used in our country even if low specifity of these markers has been demonstrated, especially in American literature. On the contrary echocardiography (and particularly transesophageal echocardiography) is still not fully used and in many hospitals is not accessible at all.