OBJECTIVE:This study's primary objective was to determine the predictive value and clinical significance of chest X-ray in diagnosing foreign body aspiration (FBA) in children. In addition, demographic, clinical, radiological, and bronchoscopic findings were evaluated. METHODS:This retrospective study included 203 children (0-18 years of age) admitted to the hospital with suspected FBA during 2013 to 2023. Patients' data were evaluated in terms of age, gender, symptoms, radiological findings, bronchoscopic findings, length of hospital stay, period of presence of foreign bodies (FBs), and post-procedural complications. RESULTS:FBA was confirmed in 52.2% (n = 106) of the children, the majority (76.4%) of cases occurring in children aged 0 to 3 years. Symptoms most frequently reported presenting were cough (63.0%), wheezing (25.1%), vomiting (24.6%), choking (23.2%), fever (11.0%), stridor (9.4%), and cyanosis (6.4%). Chest radiographs revealed pathological findings in 62.1%, most commonly being prominent bronchovascular markings (50.4%), hyperinflation (15.2%), reduced transparency (15.2%), and visible radiopaque FBs (3.2%). Auscultation was abnormal in 65.0% of cases, with wheezing, diminished breath sounds, and crackles found most frequently. Although both auscultation and X-ray findings are independently associated with FB detection, auscultation demonstrates stronger predictive value. Bronchoscopy identified the right bronchial tree as the most frequent location of FBs (47.2%), with nuts being the item most commonly retrieved (51.9%). CONCLUSIONS:This study highlights the value of chest X-ray in combination with clinical signs. While auscultation alone is more predictive, using both improves diagnostic accuracy. A structured approach with clinical exam, imaging, and timely bronchoscopy is essential for optimal outcomes.

Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25–80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff ≥10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED ≥10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED.

BACKGROUND:The indirect visualisation of the glottic area with a videolaryngoscope could improve intubation conditions which may possibly lead to a higher success rate of the first intubation attempt.OBJECTIVE:Comparison of videolaryngoscopy and direct laryngoscopy for elective airway management in paediatric patients.DESIGN:Prospective randomised controlled trial.SETTINGS:Operating room.PARTICIPANTS:535 paediatric patients undergoing elective anaesthesia with tracheal intubation. 501 patients were included in the final analysis.INTERVENTIONS:Patients were randomly allocated to the videolaryngoscopy group (n  = 265) and to the direct laryngoscopy group (n  = 269) for the primary airway management.MAIN OUTCOME MEASURES:The first attempt intubation success rate was assessed as the primary outcome. The secondary outcomes were defined as: the time to successful intubation (time to the first EtCO2 wave), the overall intubation success rate, the number of intubation attempts, the incidence of complications, and the impact of the length of the operator's clinical practice.RESULTS:The study was terminated after the planned interim analysis for futility. There were no significant demographic differences between the two groups. The first attempt intubation success rate was lower in the videolaryngoscopy group; 86.8% (n  = 211) vs. 92.6% (n  = 239), P = 0.046. The mean time to the first EtCO2 wave was longer in the videolaryngoscopy group at 39.0 s ± 36.7 compared to the direct laryngoscopy group, 23.6 s ± 24.7 (P < 0.001). There was no difference in the overall intubation success rate, in the incidence of complications nor significant difference based on the length of the clinical practice of the operator.CONCLUSIONS:The first attempt intubation success rate was lower in the videolaryngoscopy group in comparison to the direct laryngoscopy group. The time needed for successful intubation with videolaryngoscopy was longer compared with direct laryngoscopy.TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT03747250.

• Deep neuromuscular blockade is not linked with better surgical conditions. • Intubation and extubation times with rocuronium are superior to cisatracurium. • Deep blockade was not associated with increased rate of complications.

BACKGROUND Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN Online survey. SETTINGS A total of 56 countries. PARTICIPANTS Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O-2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4%(n=656) of respondents. First-linemedications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure<12cmH(2)O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12cmH(2)O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines.

BACKGROUND Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN Online survey. SETTINGS A total of 56 countries. PARTICIPANTS Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure <12 cmH2O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH2O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03694860

Cilem teto knihy je instruovat lekaře, jake naroky ma splňovat soucasna předoperacni připrava, nastinit organizaci provozu centralnich operacnich salů velkých nemocnic, ukazat soucasnou operativu s důrazem na nove operacni techniky u nejcastějsich výkonů a osvětlit anesteziologicke praktiky v sirsich souvislostech vztažených ke zdravotnimu stavu pacienta před operaci. Kniha uvadi do souvislosti i nutnost intenzivni pooperacni pece u některých nemocných a osvětluje požadavky, se kterými pacient přichazi zpět do ambulance po propustěni z nemocnice.

Laryngeal mask UNIQUE® (LMAU) is supraglottic airway device with good clinical performance and low failure rate. Little is known about the ideal position of the LMAU on the magnetic resonance imaging (MRI) and whether radiological malposition can be associated with clinical performance (audible leak) in children. The primary aim of the study was to evaluate incidence of the radiologic malposition of the LMAU according to size. The secondary outcome was the clinical performance and associated complications (1st attempt success rate, audible leak) in LMAUs in correct position vs. radiologically misplaced LMAUs.

Background. Neuromuscular blockade is associated with improved airway condi-tions for intubation and superior condi-tions for surgical interventions (predomi-nantly important in laparoscopic surgery). Residual neuromuscular blockade in the postoperative period is, according to re-cently published data, associated with a negative impact on perioperative morbid-ity and mortality. Aim. The aim of the study was to describe daily practice in clinical paediatric anaes-thesia in a tertiary children's hospital. Methods. Data from anaesthesiology records during the period 1.1.2016 to 31.12.2016 were retrospectively screened. Primary outcomes included the rate of surgery cases with neuromuscular block-ade, the incidence of cases with periop-erative neuromuscular blockade monitor-ing and the incidence of neuromuscular pharmacologic block reversal. Secondary outcomes were myorelaxant usage accord-ing to the age of patients and duration of surgery. Results. Overall 8046 paediatric patients underwent general anaesthesia in the study period. Muscle relaxants were adminis-tered in 1650 cases (20.5%). The most fre-quently administered muscle relaxant was mivacurium (48.2 %, n=795), followed by cis-atracurium (36.4 %, n=601), suxame-thonium (10.3 %, n=170) and rocuronium (7.0 %, n=115). Neuromuscular blockade monitoring was used only in 2.5% (n=41) of cases. Active neuromuscular blockade reversal was administered in 5.8% (n=95) of cases.Conclusion. Neuromuscular blockade in paediatric anaesthesia was less frequent compared to adults. The low rate of neuro-muscular blockade monitoring in combi-nation with the low rate of active block re-versal can be considered dangerous due to the relatively high risk of potential residual postoperative blockade, that can negatively influence clinical outcome.

Myringotomy is a surgical incision of tympanic membrane used mainly as therapy for acute otitis media. It is a safe and simple procedure; however possible complications must be considered. In this article is described a case study of a 2-and-a-half-year-old girl with a massive oto-liquorrhea following myringotomy.

Cil: Rapid sequence induction (RSI) jako soubor klinických postupů a opatřeni s cilem minimalizovat riziko aspirace a desaturace během uvodu do anestezie je soucasti každodenni anesteziologicke praxe. Vzhledem k aktualně chybějicimu narodnimu (ceskemu) a mezinarodnimu doporuceni je praxe RSI variabilni. Cilem dotaznikoveho setřeni bylo zhodnotit variabilitu RSI u ctyř modelových situaci (dospělý pacient s nahlou přihodou břisni /NPB/, dětský pacient s NPB, těhotna pacientka indikovana k elektivnimu cisařskemu řezu v celkove anestezii a geriatrický obezni pacient s hiatovou hernii). Typ studie: Dotaznikove setřeni (survey). Material a metoda: Dotaznik byl rozeslan clenům Ceske spolecnosti anesteziologie, resuscitace a intenzivni mediciny a soucasně ucastnikům lekařske sekce VIII. konference AKUTNĚ.CZ 2016. Výsledky byly hodnoceny metodami deskriptivni statistiky (MS Excel). Výsledky: Do akce se zapojilo celkem 164 lekařů (procento ziskaných odpovědi – 12,5 %). V indikacich RSI a taky v jednotlivých krocich postupu byla identifikovana vysoka variabilita jak u lekařů v předatestacni připravě, tak u lekařů s ukoncenou specializaci. Zavěr: Výsledky poukazuji na variabilitu v provedeni RSI u jednotlivých klinických scenařů (dospělý, ditě, těhotna). Zavedeni doporuceni založených na evidence-based medicine (EBM) a standardizace RSI postupu může vest ke zvýseni bezpecnosti pacientů během anesteziologicke pece. KLICOVA SLOVA rapid sequence.

Zajistěni dýchacich cest u dětskeho pacienta je rizikovým momentem pediatricke anestezie. Vzhledem k relativně mensimu poctu pacientů a operacnich výkonů ve srovnani s dospělou populaci a soucasnou centralizaci pediatricke anestezie ma větsina anesteziologů pouze male zkusenosti s airway managementem u děti. Spolecně s absenci Evidence-based medicine (EBM) dat a doporuceni to casto vede k tomu, že anestezie u děti je vedena podle „eminence- based“ principu (na zakladě zkusenosti lokalni autority – starsiho lekaře), což může mit negativni vliv na výsledný outcome. Cilem autorů bylo přibližit odborne veřejnosti aktualni dostupna EBM data a doporuceni týkajici se kontroverznich temat airway managementu pediatrických pacientů, bleskoveho uvodu do celkove anestezie a volby trachealni kanyly s obturacni manžetou nebo bez manžety během anestezie a perioperacniho obdobi.

Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.

Primarnim cilem studie bylo zjistit nemocnicni smrtnost upacientů, u kterých byla izolovana fraktura proximalniho koncefemuru řesena operacně. Sekundarnim cilem bylo zjistit, zda utěchto pacientů existuje nezavislý prediktor nemocnicnismrtnosti. Retrospektivni observacni monocentricka studiepacientů operovaných se zlomeninou proximalniho konce femuru vletech 2011 a 2012 ve Fakultni nemocnici (FN) Brno PROXIMORT.Kromě primarniho a sekundarniho cile studie byla hodnocena take30denni a celkova jednorocni smrtnost souboru a vlivsledovaných parametrů na smrtnost. Sledovanými parametry bylyvěk a pohlavi pacienta, ASA skore, cas od urazu k operacnimuřeseni (hod.), operacni řeseni v denni (7-20 hod.) ci nocni(20-7 hod.) dobu, typ podane anestezie (celkova vs.neuroaxialni), vstupni hladina hemoglobinu a hematokritu,aplikace transfuznich připravků a vazopresorů peroperacně,erudice anesteziologa a operatera. K hodnoceni vztahunemocnicni smrtnosti a sledovaných charakteristik bylo použitomodelovani pomoci jednorozměrne logisticke regrese a poměrusanci s použitim softwaru SPSS 22 (IBM, USA). Celkem bylaziskana data od 414 pacientů, zařazeno bylo 369 pacientů (muž,n=91, žena, n=278). Pro nesplněni vstupnich kriterii bylovyřazeno 45 pacientů (nejednalo se o izolovane poraněni).Nemocnicni smrtnost byla 6,5 % (n=24), 30denni byla 8,4 %(n=31) a celkova smrtnost souboru byla 35,8 % (n=132).Statisticky významný vliv na nemocnicni smrtnost ma vyssi věkpacienta v den operace (p=0,013), rizikovost podle ASA 3 a vice(p=0,002) a podani celkove anestezie (p=0,043). Na 30dennismrtnost pak vyssi věk v den operace (p=0,012), rizikovost dleASA 3 a vice (pu003c0,001), celkova anestezie (pu003c0,001), vyssihmotnost pacienta (p=0,028), vyssi BMI (p=0,006) a podanivazopresorů peroperacně (p=0,023). Nezavislým prediktoremnemocnicni smrtnosti byl shledan vyssi věk pacienta,klasifikace perioperacniho rizika ASA 3 a vice a podani celkoveanestezie oproti neuroaxialni.

Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.

Background: Takotsubo cardiomyopathy also known as transient balooning syndrome is an increasingly reported phenomenon characterized by acute reversible apical or midventricular dysfunction. This stress- induced cardiomyopathy mimics myocardial infarction, but without significant coronary artery disease, and rarely presents in perioperative period. Methods and Results: We report a case of postmenopausal woman scheduled to undergo elective cholecystectomy, with no history of coronary artery disease. She presented perioperatively with Takotsubo cardiomyopathy by unique manifestation- asystoly. This uncommon cause of cardiac arrest during anaesthesia was possibly induced by preoperative emotional stress. There was full recovery thanks to intensive management. In Takotsubo cardiomyopathy related cardiogenic shock we used the calcium sensitiser levosimendan successfully. Conclusion: Takotsubo cardiomyopathy has an excellent long-term prognosis and nearly all patients have full recovery of left ventricular function. We emphasize the importance of heavy premedication by stress compromised patients and the need of sufficiently deep anaesthesia and analgesia during surgeries.

Cilem studie bylo sledovani mortality v průběhu hospitalizace (in-hospital) pacientů s izolovanou zlomeninou proximalniho konce femuru řeseneho operacně v letech 2011 a 2012.Rizikovými faktory pro in-hospital mortalitu po izolovaných frakturach proximalniho konce femuru řesenými operacně byly shledany v tomto souboru pacientů mužske pohlavi, ASA 3 a vice, vyssi věk a podani celkove anestezie.