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Non-traditional methods of drug administration in anesthesiology and emergency medicine
Kurzová, Alice ; Málek, Jiří (advisor) ; Bláha, Jan (referee) ; Gabrhelík, Tomáš (referee)
1 SUMMARY Introduction The thesis is focused on the research of efficacy and side effects of non-traditional, i.e. nasal administration of oxytocin and nasal and intramuscular administration of remifentanil. Nasal administration has the advantage of being non-invasive and useful in situations with difficult vein access (young children, extensive burns, terrorist attacks and battlefields). The dissertation has two parts that are closely related: nasal, intramuscular and conjunctival administration of remifentanil, nasal and intramuscular administration of oxytocin. Remifentanil is an ultra-short- acting opioid that is registered for intravenous administration only. Its main advantage over other opioids is its rapid metabolism after intravenous administration and absent accumulation even after prolonged infusion. Remifentanil is the only opioid for which, with the exception of two papers, intranasal administration has not been described yet; data on intramuscular and conjunctival administration are completely lacking. Oxytocin is a hormone that is used therapeutically primarily for its peripheral effects in the uterus and breast during pregnancy. However, other central effects have also been observed, i.e. anxiolytic effect, reduction of social stress levels and increase in empathy. It can be useful in...
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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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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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