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Postoperative delirium in patients after cardiac surgery
Vlk, Robert ; Suchopárová, Štěpánka (advisor) ; Vaněk, Tomáš (referee)
UNIVERZITA KARLOVA V PRAZE 3. LÉKAŘSKÁ FAKULTA Ústav ošetřovatelství Robert Vlk Pooperační delirium u pacientů po kardiochirurgickém výkonu Postoperative delirium in patients after cardiac surgery Bakalářská práce Praha, červen 2018 1 Abstract The aim of this research is to find the predisposing factors of postoperative delirium in cardiac surgery patients, especially due to the use of extracorporeal circulation during cardiac surgery. The delirium itself causes prolongation of the hospitalization of the patient, increases the cost of treatment, and may further endanger the patient's health or life. Delirium also puts higher demands on the medical and nursing care provided to the patient. The ground for the research are 652 patients who were treated in 2016 at the Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague. Depending on the occurrence of postoperative delirium, they are divided into two groups. By determining the level of statistical significance, it is determined how the individual factors are important for predicting the occurrence of postoperative delirium. Quite surprising is the finding that the use of extracorporeal circulation alone is not associated with an increased risk of post-operative delirium. However,...
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Legal forms of persecution of citizens in the Protectorate 1939-1945
Vaněk, Tomáš ; Kuklík, Jan (advisor) ; Soukup, Ladislav (referee)
standards, on the basis of which the confiscation of Jewish property occurred, are also discussed and described. In conclusion I summed up the personal knowledge and impressions, which I acquired during this project and the study of special materials. At the very end I focused on the question of reparations and compensation for damages and crimes under the Protectorate caused by the Nazis, especially on the compensation of the Jewish population of the Czech lands. Key words / Klíčová slova: persecution - perzekuce, Protectorate - Protektorát, legal forms - právní formy
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Influence of crystalloid and colloid solutions on blood coagulation using the rotational thromboelastometry (ROTEM) method
Binterová, Silvie ; Durila, Miroslav (advisor) ; Vaněk, Tomáš (referee) ; Bláha, Jan (referee)
Fluid resuscitation with crystalloid and colloid solutions is a common treatment in perioperative medicine. However, a variety of unbalanced or balanced solutions is used in clinical practice and there is still a vivid debate going on regarding the selection of optimal fluid with minimal negative effect on coagulation. The goal of the dissertation was to investigate the adverse effect of balanced crystalloids and colloids on whole blood coagulation measured by method of rotational thromboelastometry. In the first phase of the work we had assessed the adverse effect of balanced crystalloid, hydroxyethyl starch and gelatin after dilution of blood with the solution in vitro. Parametrs of EXTEM and FIBTEM tests were evaluated by using rotational thromboelastometry. In the second phase of the work we evaluated the negative effect of infusion solution after dilution in vivo. We had obtained blood samples from 30 patients during knee arthroscopy before and after administration of 500 ml of crystalloid or hydroxyethyl starch or gelatin. Parametrs of EXTEM and FIBTEM tests were evaluated by using rotational thromboelastometry.In compliance with the results of the dissertation, hydroxyethyl starch has the most obvious negative effect on clot formation followed by gelatin and finally by crystalloids. Based on...
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Antiproliferative, antioxidant and anti-inflammatory activity of quinones, terpenoids and their derivatives
Přibylová, Marie ; Vaněk, Tomáš (advisor) ; Smrček, Stanislav (referee) ; Hájek, Miroslav (referee)
Plant compounds play an important role in human medicine. They are a source of new drugs or serve as an inspiration for drugs' development. This thesis presents a study about syntheses of derivatives and biological activities of two groups of natural products, quinones and terpenoids. Terpenoids are plant secondary metabolites which are known for their antimicrobial, anti-inflammatory and anti-tumoral activities. We have focused on two representatives, paclitaxel and carvacrol. GnRH-paclitaxel anti-tumor conjugates potentially suitable for targeted delivery to cancer cells were prepared. Their antiproliferative activities in vitro were evaluated on MCF-7 cancer cell line and cytotoxicity in rat hepatocytes. Carvacrol and its derivative were tested for its possible anti- inflammatory effect, which was assessed in vitro as their potential to inhibit prostaglandin E2 biosynthesis via cyclooxygenase pathway. Quinones, other targets of the thesis, are well-known for biological activities similar to terpenoids. Thymoquinone, juglone and their derivatives were tested in vitro as inhibitors of cyclooxygenases and 5-lipoxygenase. Derivatives of juglone were prepared to help us to suggest structure-activity relationship of this compound. Thymoquinone and its derivatives were evaluated for their antioxidant capacity...
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Anesthesiological diffíeulties arising in the surgical treatment of chronic pulmonary hypertension
Kunstýř, Jan ; Lindner, Jaroslav (advisor) ; Vaněk, Tomáš (referee) ; Černá, Alena (referee)
Pulmonary hypertension is a serious syndrome with very unfavorable prognosis. It encompasses numerous diseases and the only one which is surgical ly treatable is chronic thromboembolic pulmonary hypertension. Pulmonary endarterectomy (PEA) is a curative method for select patients with surgically accessible thrombotic obstruction. It involves not only the operation itself, but also complicated diagnostics, preoperative preparation, and sophisticated postoperative intensive care. According to contemporary world reviews of professional literatuře, mortality rates following PEA, range from 5 to 24 percent. Better results with lower levels of mortality as well as morbidity are unambiguously proven in the centers with more experience where the highest numbers of such surgeries are undertaken. Good team work is an essential condition for a successíul PEA program and the anaesthetist is its indispensable member. Anaesthesia of patients with chronic right ventricle dysfunction undergoing cardiac surgery using extracorporeal circulation brings about several diffíeulties and we tried to deal with them in our work. This kind of operation was not available in the Czech Republic and the íirst goal of our work was to implement this surgical program in its complexity - including anaesthesia and intensive postoperative...
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The Impact of Analgosedation on Heart Function
Omran, Nedal ; Černý, Vladimír (advisor) ; Vaněk, Tomáš (referee) ; Kieslichová, Eva (referee)
Introduction Nowadays, sedation has become an essential part of clinical practice. Despite this fact, we still lack data describing the exact impact of sedation on cardiac function. Objective The aim of this work is to compare the changes in cardiac function induced after sedation with midazolam or dexmedetomidine by magnetic resonance imaging (MRI). A total of 30 volunteers were randomized into two groups: 15 patients in the midazolam (MID) group and 15 patients in the dexmedetomidine (DEX) group. Each participant underwent a one session MRI imaging of the heart during and after sedation administration. The following parameters were recorded: right ventricular (Pul-vol) and left ventricular (Ao-vol) stroke volume, maximal blood flow velocity through the aortic (Ao-flow) and through the pulmonary valve (Pul-flow) during systole, and maximal blood flow velocity through the mitral valve during early (E-diast) and late diastole (L-diast). The monitor recorded mean blood pressure (MAP), pulse (P), and blood oxygen saturation (SpO2) at 5minute intervals. Results As for the parameters of ventricular systolic function dexmedetomidine decreased significantly Ao-vol (p = 0.006), Pul-vol (p = 0.003), Ao-flow (p = 0.048) and Pul-flow (p = 0.007). Midazolam also significantly decreased Ao-vol (p = 0.001), Pul-vol (p =...
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Bleeding after cardiac surgery. Importance of fibrinolysis in off-pump versus on-pump coronary artery bypass surgery
Jareš, Martin ; Vaněk, Tomáš (advisor) ; Dominik, Jan (referee) ; Málek, Jiří (referee) ; Nečas, Emanuel (referee)
The aim of our two prospective randomized studies was to evaluate and compare haemostatic effects of fibrinolytic inhibitors in patients undergoing off-pump coronary artery bypass surgery (OPCAB). The first study evaluated efficacy of tranexamic acid vs. placebo, the second one compared effects of tranexamic acid vs. aprotinin vs. placebo. In addition, the risk of per operative myocardial ischemia and trombotic events was assessed. In the first study postoperative bleeding was significantly lower in the tranexamic acid group compared with the control group. We observed two postoperative myocardial infarctions (one in each group) and any cerebrovacular event or pulmonary embolism. In the second study we conclude that both tranexamic acid and aprotinin significantly reduce the postoperative blood loss in OPCAB patients, and the efficacy of tranexamic acid and aprotinin, respectively, seems to be quite similar. We did not observe any statistically significant difference in the need for allogenic transfusion, although the total number of re-transfused patients was the highest in placebo group. Treated groups did not demonstrate postoperative increase in mean levels of myocardial enzymes, compared with placebo group. Significantly higher mean values of D-dimer were found in placebo group 24 h...
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Fibrinolysis in cardiac surgery and possibillity of its control
Špegár, Ján ; Vaněk, Tomáš (advisor) ; Cvachovec, Karel (referee) ; Stříteský, Martin (referee)
Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study SUMMARY The study was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application during heart valve surgery in the post-aprotinin era. One-hundred patients were enrolled in the study and all the patients were given tranexamic acid intravenously. The participants were randomized into two groups (A, n = 49; B, n = 51), and before commencing the sternal suturing, the study solution (group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group B: 250 ml of normal saline) was poured into the pericardial cavity. The cumulative blood loss (geometric means [95% confidence intervals]) 4 h after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3, 194.4] in group B, test for equality of geometric means P = 0.107, test for equality of variances P = 0.059. Eight hours after the surgery, the blood loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in group B, P = 0.130 and P = 0.050, respectively. Twentyfour hours postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A, 569.7 [476.0, 681.7] ml in group B, P = 0.293 and P = 0.014, respectively. The proportion of patients...
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The fluid therapy during burn shock guided by hemodynamic parameters
Tokarik, Monika ; Vaněk, Tomáš (advisor) ; Cvachovec, Karel (referee) ; Kofránek, Jiří (referee)
ABSTRACT Keywords Burn shock; fluid therapy; arterial pulse contour analysis; dynamic preload parameters; hourly urine output. Introduction: Our hypothesis is based on the assumption that the volume therapy in the acute phase of burn shock corrected by a combination of dynamic preload parameters and hourly diuresis is reduced compared to fluid therapy which is corrected only by hourly diuresis. The dynamic preload parameters seem to be the most reliable predictors of response to fluid challenge. Materials and Methods: A group of 21 burned patients meeting preliminary criteria (age range 18 - 75 years with 2nd - 3rd - degree burns and TBSA ≥10 - 75 %) was randomized during 2009 - 2011 as follows. Hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group) while those without LiDCO monitoring were defined as a control group. The modified Brooke formula as a starting resuscitative formula, ...
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