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Anaesthesiology nursing care of the patient with diagnosis colorectal cancer during surgical procedure
Svobodová, Dagmar ; Zvoníčková, Marie (advisor) ; Málek, Jiří (referee)
Cílem mé bakalářské práce je zpracování ošetřovatelského procesu během chirurgického výkonu na operačním sále z pohledu anesteziologické sestry. Ve své studii jsem se věnovala 55letému pacientovi s diagnózou karcinom rektosigmatu. Pacient podstoupil plánovaný operační výkon - nízkou přední resekci rekta. Byl hospitalizován na chirurgickém oddělení 11 dní. Nemocného s touto diagnózou a technikou anestezie jsem si vybrala, protože mne tato problematika zajímá. Předoperační polohování, technika kombinované anestezie a vlastní operační výkon dávají prostor pro řešení ošetřovatelských problémů u pacienta na operačním sále. Klinická část zahrnuje základy anatomie a fyziologie tlustého střeva a rekta, charakteristiku nádorového onemocnění rektosigmatu, jeho příčiny a klinické projevy. Dále práce obsahuje vyšetřovací metody, pomocí kterých je toto onemocnění diagnostikováno, možnosti terapie a prevence. Podrobněji se zabývám objektivním vyšetřením nemocného při příjmu a jeho předoperační přípravou, anesteziologickými postupy během operačního výkonu a pooperačním obdobím. Na závěr klinické části se věnuji ukazatelům prognózy u nemocných s karcinomem kolorekta a faktorům, které tuto prognózu ovlivňují. Ošetřovatelská část zahrnuje stručnou charakteristiku ošetřovatelského procesu a ošetřovatelských modelů. Věnuji se...
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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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Influence of anesthesia type on the incidence of postoperative cognitive dysfunction
Kletečka, Jakub ; Chytra, Ivan (advisor) ; Dostál, Pavel (referee) ; Málek, Jiří (referee)
Resume Cognitive decline is a common perioperative complication, affecting about one-quarter of patients at one week after surgery. It is a temporary disorder, which influences mainly executive functions, memory and spatial orientation. The decline is short-lived, with complete resolution in first months after surgery. Low education and higher age are the only known risk factors with hard evidence, although it can be diagnosed also in younger patients. Particularly in seniors, this disorder is associated with deterioration of the quality of life. No differences in incidence were found between general and regional anaesthesia, neither between certain anaesthetics. The only evidence-based prevention is a minimalization of the impact of surgery and anaesthesia on patients, e.g. with fast-track approach. Optimization of the depth of the anaesthesia using EEG and derived parameters is promising, but with little evidence yet. Research of the postoperative cognitive dysfunction (POCD) is significantly influenced with the heterogeneity of published studies, consensus on POCD definition and diagnostics is still missing. Another important limiting factor is a continuous change in methods and drugs in anaesthesia and perioperative care in last twenty years, and therefore comparing current results with older studies is...
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Hemodynamic optimalization in hepatic recection
Zatloukal, Jan ; Pradl, Richard (advisor) ; Cvachovec, Karel (referee) ; Málek, Jiří (referee)
Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia
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A sudden cardiac arrest and use of capnometry in cardiopulmonary resuscitation
Pokorná, Milana ; Nečas, Emanuel (advisor) ; Málek, Jiří (referee) ; Bělohlávek, Jan (referee)
The study is focused on advanced life support (ALS) performed by rescue team physicians in an out-of-hospital setting. The first part of the study analyzes diagnostic possibilities and correctness of assumed aetiology of the sudden cardiac arrest during cardiopulmonary resuscitation (CPR) in the field. It introduces an original method of "Crosscheck Tables" and applies this method to 211 cases of CPR provided by physicians of the Emergency Care Service. The study demonstrates that significantly misleading conclusions can result from a global analysis of a set of cases. It stresses importance of diagnostic analyses applied to individual cases. The second part of the study concentrates on changes in PETCO2 level as related to the return of spontaneous circulation (ROSC - Return of Spontaneous Circulation) as opposed to the circulation fully dependent on chest compressions. The study demonstrates that in constantly ventilated patients undergoing CPR in an out-of-hospital setting, PETCO2 is significantly higher (about 10 mmHg) after ROSC than before ROSC. It demonstrates that a sudden increase in PETCO2 exceeding 10 mmHg is likely to indicate the moment of ROSC. The study also support a view that steadily low levels of PETCO2 values (<10 mmHg) indicate a low chance for a successful resuscitation outcome. Key...
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Opioids in caesarean section
Nosková, Pavlína ; Bláha, Jan (advisor) ; Málek, Jiří (referee) ; Vymazal, Tomáš (referee)
The thesis is focused on perioperative use of opioids during caesarean section. The general part is concerned with pharmacology of opioids due to their practical use during general and regional anaesthesia and postoperative analgesia with particular focus on remifentanil. Emphasis is put on the placental transfer of opioids into breast milk which has the possible influence on postnatal adaptation of the newborns and breastfeeding/lactation. The first part of the research describes current anaesthetic practice and opioid use in obstetrics in the Czech Republic according to the OBAAMA-CZ study in 2011. The second study on a unique group of 151 parturients showed that bolus application of remifentanil at a dose of 1 μg/kg at the time of 30 seconds before induction of general anaesthesia for caesarean section significantly stabilizes maternal hemodynamic parameters (blood pressure, heart rate) and reduces the stress response to tracheal intubation and skin incision. On the contrary, no influence on depth of anaesthesia (monitored by BIS) was found. But we demonstrated a slight effect of remifentanil on the assessment of postnatal adaptation of newborns at first minute after delivery. However, this attenuation was very short and in the fifth minute the results were already fully comparable to the control...
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Experimental surgical airway in special conditions.
Henlín, Tomáš ; Michálek, Pavel (advisor) ; Málek, Jiří (referee) ; Trča, Stanislav (referee)
The thesis analyzes the issue of securing the airways in special conditions. The author is a military anesthesiologist, so the special conditions in this work are understood as the situation on the battlefield. The introductory part of the thesis discusses the historical development of the view of airway management, describes the various methods of airway management and their position in "combat airway management". The research part of the thesis first explores supraglottic airway management techniques, which in today's concept of algorithms and recommendations is intended primarily for non-medical professionals and/or health professionals who do not have much experience with complex methods of airway management. The first part has shown that the use of supraglottic devices by inexperienced rescuers is safe and that it is possible to define and choose from a large number of aids that are the most suitable on the market. The second part of the research part was focused on tracheal intubation and portable video laryngoscopes. It has shown that these can improve intubation conditions even if performed by an inexperienced rescuer. The main research effort has been focused on the most critical part of airway management procedures, surgical airway access. A live large laboratory animal proved to be the...
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Utilization of Financial Analysis as a Tool for Investment Decisions
Málek, Jiří ; Novák, Jaromír (referee) ; Ptáček, Roman (advisor)
This diploma thesis on the topic "Use of financial analysis as an instrument of investment decision-making" processes the financial evaluation of the economy and the effectiveness of selected investment decisions in the past years using methods of financial analysis. For this purpose, I chose the monitored period from 2012 to 2018. In the first part of the thesis, attention is paid to the evaluation of performance and financial sustainability in terms of implemented and planned investments of the theoretical base. The methods and analyzes used also include the methodology of their calculation. The second part deals with the individual indicators applied to Škoda Auto a.s., based in Mladá Boleslav a subsidiary of the Volkswagen Group. In addition, this section addresses the approach and decision making of the management of the company on investment projects that have already been planned or are planned in the near future, and recommendations are proposed for improving.
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