[Special features of anesthesia during surgery for acquired heart valve defects]. / Nekteré zvlástnosti vedení anestézie u nemocných operovaných pro získané chlopenní vady.

The authors describe some special features as regards anesthesia with large opioid doses in patients operated on account of acquired valvular disease. They emphasize in particular the importance of adequate knowledge of pathophysiological changes associated with the damage of different orifices and their interpretation in the anaesthesiological procedure which is the basis of its success. In the conclusion the authors describe basic haemodynamic changes in combined simultaneous affection of several valves.

[An unusual cause of recurrent septic states]. / Neobvyklá prícina opakovaných septických stavu.

The authors describe the septic sequelae of an unobserved embolization of a central venous catheter into right-sided cardiac compartments. The finding of an embolized fragment of a catheter which was in the patient's circulation for 89 days was quite incidental. The previous period was associated with diagnostic doubts in various departments. The most frequent diagnosis of repeated septicaemia was bacterial endocarditis, although repeated echocardiographic examinations did not confirm it. Similarly, repeated X-rays did not contribute to the diagnosis--this can be explained by dilatation of the heart of the patient. Extraction of the embolized fragment by means of a catheter resolved the problem. The fragment was colonized by the causal agent of the febrile conditions--Staphylococcus aureus.

[Hemodynamic effects of enoximone in patients with low left ventricular ejection fraction in surgery for ischemic heart disease]. / Hemodynamické úcinky enoximonu u nemocných s nízkou ejekcní frakcí levé komory srdecní operovaných pro ischemickou chorobu srdecní.

Acute heart failure following cardiac surgery in extracorporeal circulation (EC) still poses a formidable problem requiring intensive pharmacological therapy and, often, also mechanical support. Preoperatively reduced left ventricular (LV) function raises the risk for the development of this complication. In their pilot study, the authors evaluated the haemodynamic effects of enoximone, a selective phosphodiesterase III inhibitor, administered at a dose of 1 mg/kg b.w. to 15 patients with a preoperative LV ejection fraction < or = 35% 15 minutes before weaning from EC after an elective myocardial revascularization procedure. All patients were weaned from EC at first attempt without any problems and left the operating theatre in good condition. Enoximone administration led, in the monitored period (45 minutes after administration), to statistically significant increases in cardiac index (+68%; p < 0.01), oxygen supply (+75%; p < 0.01) and oxygen saturation in mixed venous blood (+10%; p < 0.1) and statistically significant decreases in pulmonary and systemic vascular resistance indexes (-52% and -48%, respectively; p < 0.001) and in oxygen extraction (-31%; p < 0.001). These changes were associated with decreases in central venous, mean pulmonary artery, and pulmonary capillary wedge pressure (n.s.). No serious side effects were seen, and the authors conclude enoximone can be the drug of first choice in high-risk patients following heart surgery in EC and requiring inotropic support.

[Anesthesia using high doses of fentanyl in cardiac surgery]. / Anestézie vysokými dávkami fentanylu v kardiochirurgii.

The authors describe their own experience with anaesthesia using large doses of fentanyl in patients operated on account of ischaemic heart disease and acquired valvular defects. Considerable stability of the circulation and careful monitoring of cardiorespiratory parameters along with aimed influencing of serious deviations is the basis of success of this procedure, which makes it possible to perform cardiosurgery in high risk patients. The authors try to improve the described method further by using some modern procedures.