Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study.

BACKGROUND: Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes. METHODS: In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension. RESULTS: Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective. CONCLUSION: GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.

Can difficult intubation be easily and rapidly predicted?

AIM: Failed endotracheal intubation and inadequate ventilation with subsequent insufficient oxygenation can result in serious complications potentially leading to permanent health damage. Difficult intubation may occur not only in patients with apparent pathologies in the orofacial region but also, unexpectedly, in those without abnormalities. This study aimed at finding anthropometric parameters that are easy to examine and that would aid in predicting difficult intubation. METHOD: A case-control study was undertaken. Based on defined criteria, 15 parameters were examined in patients with unanticipated difficult intubation. The parameters included a previous history of difficult intubation, pathologies associated with difficult intubation, clinical symptoms of airway pathology, the Mallampati score, upper lip bite test, receding mandible, and cervical spine and temporomandibular joint movement. Thyromental, hyomental and sternomental distances and inter-incisor gap were measured. The methods were precisely defined and the measurements were carried out by a trained anesthesiologist. Statistical analysis was performed on data from 74 patients with difficult intubation and 74 control patients with easy intubation. RESULTS: Significant predictors of difficult intubation were inter-incisor gap (IIG), thyromental distance (TMD) and class 3 limited movement of the temporomandibular joint. The IIG and TMD cut-offs were set at 42 mm and 93 mm, respectively. CONCLUSION: The results will be used to confirm these predictors in an anesthesiology clinic along with the aid of the laryngoscopic findings to improve the prediction of unanticipated difficult intubation.

Endovascular treatment of abdominal aortic paraanastomotic pseudoaneurysms after surgical reconstruction.

PURPOSE: To evaluate the efficacy of endovascular treatment of paraaortic postoperative abdominal aortic pseudoaneurysms. MATERIALS AND METHODS: From April 1996 to November 2007 five men with paraaortic postoperative abdominal aortic pseudoaneurysm underwent endovascular treatment. Average age was 64.2 years (range 54-73). The average time interval between the primary surgery and endovascular treatment was 12.4 years (4 months-23 years). Three patients were treated by aortouniiliacal stentgrafts and two patients by tube stentgrafts. RESULTS: Technical success rate was 100%. Pseudoaneurysms were primarily excluded from circulation without perioperative complications in all patients. At follow-up (mean 38.5 months) there were no deaths and no endoleaks. In one patient thrombosis of stentgraft was found and it was successfully treated by thrombectomy. All pseudoaneurysms still continued to be excluded from circulation in the last follow-up. CONCLUSION: Endovascular treatment is minimally invasive, effective and safe option of surgery for paraaortic postoperative pseudoaneurysms.

Association between obesity and cancer incidence in the population of the District Sumperk, Czech Republic.

BACKGROUND: Excess body weight was shown to be associated with risk of several types of cancer. In the Czech Republic, malignant tumors are the second leading cause of death. The aim of this study was to assess the association between the most frequent types of cancer and obesity. METHODS: A case-control study was accomplished, using data from the National Cancer Registry and from a preventive oncologic checkup database. Cases were defined as persons from the studied population who developed skin, breast, colorectal, prostate, lung, cervical, endometrial, kidney, ovarian, urinary bladder, stomach, pancreatic, or gallbladder cancers from 1987 to 2002. Controls were cancer-free men and women from the population. Among the cancer patients and healthy controls, proportions of obese, overweight, and nonobese individuals were compared, and odds ratios (OR) were computed. RESULTS: After adjustment for confounders, obese men had a significantly increased risk of colorectal cancer (OR: 2.07, 95% CI: 1.56-2.76) and kidney cancer (OR: 1.92, 95% CI: 1.14-3.24). Obese women were at higher risk of endometrial cancer (OR: 3.25, 95% CI: 1.65-6.37). An inverse association was observed between obesity and lung cancer (in men: OR: 0.49, 95% CI: 0.37-0.66; in women: OR: 0.41, 95% CI: 0.21-0.80). CONCLUSION: Obesity is associated with several frequent types of tumors and represents an important preventable cause of cancer in the population of the District Sumperk, Czech Republic.

The impact of obesity on cardiovascular disease mortality in the District Sumperk, Czech Republic.

OBJECTIVE: The impact of obesity on cardiovascular mortality in the District Sumperk (C2) is assessed. METHODS: A case-control design was selected to study the impact of obesity on cardiovascular mortality among the population of the District Sumperk, Czech Republic. Exposure to obesity was defined as body-mass index (BMI) higher or equal 30. Men and women with BMI lower than 30 were considered nonexposed. Odds ratios were calculated, comparing the probability of exposure among cases and controls. Cases were defined as persons from the studied population who died between 1987-2004, the cause of death being circulatory system diseases. Controls were persons from the studied population who had not died as to December 31, 2004. RESULTS: Cases were more likely to be obese than controls (OR = 1.68; 95% CI 1.56-1.80). In men OR was 1.56 (95% CI 1.40-1.74), in women OR was 1.89 (95% CI 1.72-2.06). The impact of obesity was decreasing with increasing age. CONCLUSIONS: An increased risk of cardiovascular mortality following exposure to obesity was observed. Younger age groups seem to be the important target population for preventive programmes focusing on treatment of obesity.

Influence of gender on the onset and duration of rocuronium-induced neuromuscular block.

AIMS: To assess the influence of gender on the course of rocuronium-induced neuromuscular block following a single bolus dose of 2 x ED(95) (0.6 mg kg(-1)). METHODS: Following the ethics committee approval and informed consent, 245 patients (121 men, 124 women) scheduled for elective general surgery under TIVA with muscle relaxation were studied. After rocuronium 0.6 mg kg(-1), the onset time for maximal depression of T(1), clinical duration until 25 % recovery and recovery index (T(1) from 25 to 75 %) were determined with TOF-Watch SX accelerometric monitor. The data for male and female groups were compared with appropriate statistical tests (Student's unpaired t-test, Mann-Whitney Rank Sum Test and Fisher's exact test). RESULTS: Men were significantly larger (p < 0.001) and heavier (p < 0.05) than women, but the body mass index was comparable (ns). The onset time was shorter in females [92.5 (SD 14.2) vs. 104.7 (12.2) s, p < 0.0001]. Clinical duration was increased in females [43.1 (7.9) vs. 31.3 (5.5) min; p < 0.0001], while the recovery index was identical in both groups [14.7 (5.0) min in females and 14.8 (4.0) min in males; ns]. CONCLUSIONS: Women are more sensitive than men to the dose 0.6 mg kg(-1) of rocuronium. Under the study conditions described, the onset time was shortened and the clinical duration increased in female patients. This suggests that the routine dose of rocuronium should be reduced in women.

Surgical corrections of endovascular aneurysms: repair complications.

The authors describe their experience with the use of 21 open surgical corrections after endovascular abdominal aneurysm repair, reporting the frequency, type and outcome of these procedures in their group of 165 patients treated during a 10-year period.

Access sites to vascular system for endovascular abdominal aortic aneurysms repair.

The authors describe their experience with access sites for endovascular abdominal aortic aneurysm repair in a group of 165 patients treated over a 10-year period.

Conversion to open surgery after endovascular abdominal aortic aneurysms repair.

The authors describe experience with conversions to open surgery after endovascular abdominal aneurysm repair and evaluate the frequency, causes and results of a total of 7 cases in their series of 165 patients treated over a 10-year period.

Cisatracurium vs. Rocuronium: A prospective, comparative, randomized study in adult patients under total intravenous anaesthesia.

AIMS: To compare the pharmacodynamics of cisatracurium and rocuronium-induced neuromuscular block following single dose, allowing either spontaneous or neostigmine-accelerated complete recovery. METHODS: Following the ethics committee approval and informed consent, 120 patients scheduled for elective surgery under TIVA with tracheal intubation were randomized into 4 groups with different cisatracurium (CIS, 0.10 or 0.15 mg.kg(-1)) or rocuronium (ROC, 0.60 or 0.90 mg.kg(-1)) doses administered. For each patient, the onset time for 95 % depression of T1, clinical duration until 25 % recovery, recovery index (T1 from 25 to 75 %) and time from T1 25 % to TOF-ratio 0.9 were determined allowing either spontaneous or induced recovery. RESULTS: The onset times were 277 (SD 58), 220 (46), 91 (16) and 77 (16) s for the CIS 0.10, CIS 0.15, ROC 0.60 and ROC 0.90 groups (p < 0.05), respectively, with lower variability in both ROC groups (p < 0.05). The clinical durations were 42 (7), 52 (7), 35 (11) and 52 (12) min, respectively (p < 0.05 for lower doses). Recovery index was identical in all groups allowing either spontaneous recovery - 15.9 (1.8), 15.5 (1.7), 16.1 (3.7) and 16.1 (4.0) min, or following neostigmine administration - 4.4 (0.9), 4.5 (0.8), 4.3 (0.8) and 4.7 (0.7) min for respective groups. During spontaneous recovery, the variability of DUR25-TOF90 was twice as great for ROC than CIS groups (p < 0.05), while after neostigmine administration it was uniform in all groups. CONCLUSIONS: For equipotent doses, the onset times for CIS were approximately three times longer than for ROC. The average clinical duration for both relaxants ranged from 35 to 52 min with acceptable variability. Neostigmine administration accelerated the recovery and reduced its variability. When allowing for spontaneous recovery, less scatter was demonstrated for both CIS groups than for ROC ones.

Combined strategy in AAA elective treatment.

The authors describe surgical treatment for high risk patients with abdominal aortic aneurysms of complicated morphology for standard endovascular repair. This was achieved by combining endovascular stent-grafting for aneurysmal sac exclusion with conventional vascular surgical procedures.

Treatment possibility for AAA of the visceral branches region.

The authors describe a promising abdominal aortic aneurysm treatment--a combined endovascular/surgical approach--used in two cases of aneurysm taking the aortic visceral branches region.

Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system.

PURPOSE: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. METHODS: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. RESULTS: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. CONCLUSION: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

AAA elective treatment indication tactics in EVAR era.

The authors describe their indication tactics for AAA elective treatment. Based on one-month morbidity and mortality they evaluate the results obtained in the past six years and compare the methods of open surgery, endovascular repair and combined strategy in AAAs elective repair.

Preventive oncologic check-ups in the District Sumperk, 1975-1986: the description of a database.

From 1975 through 1986, repeated preventive oncologic check-ups were carried out in the District Sumperk. In the course of the check-ups, 49,426 persons were examined. The examinations were aimed at surveillance of initial stadium of cancers as well as at detection of other serious chronic diseases. The results of the check-ups form a large database suitable for a number of epidemiological analyses. In this article, methods of the data collection are described, individual data items are characterized and their summary is presented in tables. Utilization of the database is proposed in specified types of epidemiological studies.