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The article is a continuation of the series on the importance of fascia for regional anesthesia. This chapter attempts to align the anatomical structure of the lower limb with the requirements for regional anesthesia. The basic structure studied are deep fascia in the thigh area - fascia lata and deep myofascial structures. Fascia lata divides the muscles of the thigh into three compartments. The thickness of the fascia late makes it impossible for the local anesthetic to penetrate into a different compartment than the one into which it was administered. The local anesthetic is spread only in the myofascial spaces of individual compartments. The anterior compartment of the thigh is supplied by the branches of n. femoralis. The medial compartment is supplied by the branches of the obturatorius nerve, and the posterior compartment is supplied by the sciatic nerve. The second part of the text is focused on a more detailed analysis of thigh areas suitable for an application of regional anesthesia. [ABSTRACT FROM AUTHOR]

This review article offers a selection of publications in the field of regional anesthesia for 2023. The aim of this publication is not to list all important articles but to offer readers an overview of information that can be used in common practice. [ABSTRACT FROM AUTHOR]

The article describes an innovative method of placing the catheter for continual blockade of the brachial plexus. The combination of visualisation of the brachial plexus from the supraclavicular approach with catheter insertion via the infraclavicular approach allows visual control of the insertion and optimum fixation of the catheter while observing the rules of aseptic technique. The continual analgesic technique was used for intermittent application of local anaesthetic in a patient in whom passive physiotherapy of the elbow using a motorised splint was held back by pain. [ABSTRACT FROM AUTHOR]

This small clinical case series describes a technique of ultrasound-guided blockade of the second and third branches of the trigeminal nerve for facial surgery in geriatric patients. Four geriatric patients (3 females and 1 male), average age of 74.5 years, were indicated for cancer surgery on the face at the Department of Surgery, Masaryk Hospital, in Ústi nad Labem. Anaesthesia of the second and third branches of the trigeminal nerve was performed by application of 8 ml 0.5% bupivacaine in the fossa pterygopalatina. The use of ultrasound allowed visualization of the trigeminal nerve branches, the maxillary artery and other vascular structures during the spread of the local anaesthetic. This reduced the likelihood of intravascular anaesthetic administration. The blockade was successful in all four patients without the need for conversion to general anaesthetic, patient complaints or discomfort. The patients were co-operating and breathing spontaneously under mild sedation. The cardiovascular stability was excellent despite the patients being considered high anaesthetic risk. The blockade of the second and third branches of the trigeminal nerve in the fossa pterygopalatina proved to be a simple technique suitable for facial surgery in geriatric patients. [ABSTRACT FROM AUTHOR]

Context: Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formate-induced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined., Objective: We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning., Methods: The study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO 3 - , 0.01 unit arterial blood pH, and the total time for correction of HCO 3 - were determined in IHD- and CRRT-treated patients., Results: Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p = 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO 3 - correction correlated with arterial blood pH (r= -0.511; p = 0.003) and creatinine (r = 0.415; p = 0.020). There was association between the time to HCO 3 - correction and dialysate/effluent and blood flow rates (r= -0.738; p < 0.001 and r= -0.602; p < 0.001, correspondingly). The mean time for HCO 3 - to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p = 0.024). The mean increase in HCO 3 - was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001)., Conclusions: Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction.

Introduction: Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic., Methods: This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS)., Results: 394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%., Conclusion: Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

Purpose: This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings)., Methods: In 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews., Results: A total of 304 physicians, 386 nurses, 248 patients and 330 family members were included in the study. Professionals wanted less treatment (ICU admission, CPR, ventilator treatment) than patients and family members. Religious respondents wanted more treatment and were more in favor of life prolongation, and they were less likely to want active euthanasia than those affiliated. Southern nurses and doctors favored euthanasia more than their Northern colleagues. Three quarters of doctors and nurses would respect a competent patient's refusal of a potentially life-saving treatment. No differences were found between religious and affiliated professionals regarding patient's autonomy. Inter-religious differences were detected, with Protestants most likely to follow competent patients' wishes and the Jewish respondents least likely to do so, and Jewish professionals more frequently accepting patients' wishes for futile treatment. However, these findings on autonomy were due to regional differences, not religious ones., Conclusions: Health-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.

Objective: To evaluate attitudes of Europeans regarding end-of-life decisions., Design and Setting: Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment., Measurements and Results: Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%). Physicians (88%) and nurses (87%) found quality of life more important and value of life less important in their decisions for themselves than patients (51%) and families (63%). If diagnosed with a terminal illness, health professionals wanted fewer ICU admissions, uses of CPR, and ventilators (21%, 8%, 10%, respectively) than patients and families (58%, 49%, 44%, respectively). More physicians (79%) and nurses (61%) than patients (58%) and families (48%) preferred being home or in a hospice if they had a terminal illness with only a short time to live., Conclusions: Quality of life was more important for physicians and nurses than patients and families. More medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness than patients and families.

Therapeutic plasmapheresis is nowadays the method of choice in severe cases of myasthenia gravis. The authors confirm the therapeutic effect of this method and emphasize its importance in the differential diagnosis of severe cases where myasthenia gravis is suspected only from clinical symptoms, and electromyographic, roentgenological and laboratory evidence (antibodies against acetylcholine receptors) is lacking. The mentioned procedure led to thymectomy with the finding of a tumour of the thymus within three and a half months after the development of the first symptoms of the disease.