{"id":32,"date":"2021-09-26T18:34:05","date_gmt":"2021-09-26T18:34:05","guid":{"rendered":"https:\/\/anesteziologie-tabor.cz\/?page_id=32"},"modified":"2021-09-26T18:36:25","modified_gmt":"2021-09-26T18:36:25","slug":"odborna-problematika","status":"publish","type":"page","link":"https:\/\/anesteziologie-tabor.cz\/?page_id=32","title":{"rendered":"Odborn\u00e1 problematika"},"content":{"rendered":"\n

Anestezie<\/strong><\/em><\/p>\n\n\n\n

S pou\u017eit\u00edm nejmodern\u011bj\u0161\u00edch anesteziologick\u00fdch metod je prov\u00e1d\u011bna tzv. celkov\u00e1 anestezie ,tj. uveden\u00ed klienta do stavu um\u011ble vyvolan\u00e9ho monitorovan\u00e9ho bezv\u011bdom\u00ed pomoc\u00ed anesteziologick\u00fdch plyn\u016f \u010di nitro\u017eiln\u00edch anestetik.Tento stav je pr\u016fb\u011b\u017en\u011b udr\u017eov\u00e1n b\u011bhem cel\u00e9ho opera\u010dn\u00edho v\u00fdkonu za st\u00e1l\u00e9 monitorace (sledov\u00e1n\u00ed) z\u00e1kladn\u00edch \u017eivotn\u00edch funkc\u00ed,p\u0159edev\u0161\u00edm \u010dinnosti srde\u010dn\u00ed,dechov\u00e9 a ob\u011bhov\u00e9.Celkov\u00e1 anestezie obvykle kon\u010d\u00ed probuzen\u00edm klienta po ukon\u010den\u00ed opera\u010dn\u00edho v\u00fdkonu a jeho dal\u0161\u00ed sledov\u00e1n\u00ed s d\u016frazem na poopera\u010dn\u00ed bolest.<\/p>\n\n\n\n

Anestezie se skl\u00e1d\u00e1 z bezprost\u0159edn\u00ed p\u0159edopera\u010dn\u00ed p\u0159\u00edpravy ( nap\u0159. nutnost vypr\u00e1zdn\u011bn\u00ed tr\u00e1vic\u00edho traktu,pod\u00e1n\u00ed tzv.premedikace ,p\u0159\u00edprava polohy na opera\u010dn\u00edm stole,zaji\u0161t\u011bn\u00ed \u017eiln\u00edho vstupu),vlastn\u00ed anestezie (\u00favod a veden\u00ed anestezie a ukon\u010den\u00ed – vyveden\u00ed z anestezie), poopera\u010dn\u00ed anesteziologick\u00fd dohled a analgezie.Metody v jednotliv\u00fdch f\u00e1z\u00edch vol\u00ed anesteziolog podle p\u0159edopera\u010dn\u00edho vy\u0161et\u0159en\u00ed ,zdravotn\u00edho stavu a povahy opera\u010dn\u00edho v\u00fdkonu.Prakticky to znamen\u00e1 dohodu mezi klientem a anesteziologem,kter\u00fd se dostav\u00ed v den a hodinu na m\u00edsto opera\u010dn\u00edho v\u00fdkonu a provede celkovou anestezii. Podrobnosti viz p\u0159edopera\u010dn\u00ed anesteziologick\u00e9 vy\u0161et\u0159en\u00ed a p\u0159\u00edprava.<\/em><\/p>\n\n\n\n

Sedace p\u0159i v\u011bdom\u00ed<\/strong><\/em><\/p>\n\n\n\n

Definice: Sedace p\u0159i v\u011bdom\u00ed (d\u00e1le jen SPV) je anesteziologick\u00e1 technika spo\u010d\u00edvaj\u00edc\u00ed v aplikaci farmak za \u00fa\u010delem navozen\u00ed takov\u00e9ho stavu v\u011bdom\u00ed,p\u0159i kter\u00e9m je zcela zachov\u00e1na kooperace pacienta s l\u00e9ka\u0159em,vit\u00e1ln\u00ed funkce nejsou ovlivn\u011bny a ochrann\u00e9 reflexy horn\u00edch cest d\u00fdchac\u00edch jsou zachov\u00e1ny.<\/strong>SPV nen\u00ed ur\u010dena pro v\u00fdkony,kter\u00e9 z opera\u010dn\u011b \u2013 technick\u00fdch d\u016fvod\u016f vy\u017eaduj\u00ed celkovou anestezii s trache\u00e1ln\u00ed intubac\u00ed.<\/p>\n\n\n\n

K nej\u010dast\u011bji pou\u017e\u00edvan\u00fdm a ov\u011b\u0159en\u00fdm benzodiazepin\u016fm k proveden\u00ed SPV ordinac\u00edch ter\u00e9n\u00edch specialist\u016f pat\u0159\u00ed midazolam <\/strong>(Dormicum).<\/p>\n\n\n\n

V\u00fdhody midazolamu:<\/p>\n\n\n\n

1 .je ve vod\u011b rozpustn\u00fd,tak\u017ee m\u016f\u017ee b\u00fdt pod\u00e1n i netradi\u010dn\u00edmi zp\u016fsoby aplikace (v \u00favahu p\u0159ich\u00e1z\u00ed nas\u00e1ln\u00ed pod\u00e1n\u00ed u mal\u00fdch d\u011bt\u00ed),nezp\u016fsobuje tromboflebitidy,aplikace i.v. je bezbolestn\u00e1<\/p>\n\n\n\n

2..velmi kr\u00e1tk\u00fd biologick\u00fd polo\u010das zaru\u010duje dobrou \u0159iditelnost \u00fa\u010dinku,nedoch\u00e1z\u00ed ke kumulaci<\/p>\n\n\n\n

3 .neobsahuje propylenglykol ani jin\u00e9 stabiliz\u00e1tory,proto m\u016f\u017ee b\u00fdt bez obav pou\u017eit i u mal\u00fdch d\u011bt\u00ed<\/p>\n\n\n\n

4 .lze jej spolehliv\u011b antagonizovat flumazenilem (Anexate) .<\/p>\n\n\n\n

Z ji\u017e zaveden\u00fdch odborn\u00fdch prax\u00ed (nej\u010dast\u011bji stomatologick\u00fdch) jsou nejv\u00edc vyzdvihov\u00e1ny p\u0159edev\u0161\u00edm \u00fa\u010dinky sedativn\u00ed,anxiolytick\u00e9 a amnestick\u00e9.<\/strong>Zjednodu\u0161en\u011b \u0159e\u010deno : obvykle u\u017e po pod\u00e1n\u00ed \u00favodn\u00ed d\u00e1vky doch\u00e1z\u00ed k vymizen\u00ed obav a nap\u011bt\u00ed z nadch\u00e1zej\u00edc\u00edho v\u00fdkonu,amnestick\u00e9 \u00fa\u010dinky jsou \u010dasto vzta\u017eeny i retrogr\u00e1dn\u011b ,co\u017e se cen\u00ed zvl\u00e1\u0161t\u011b u d\u011bt\u00ed (nepamatuj\u00ed si nejen v\u00fdkon samotn\u00fd,ale ani p\u0159\u00edpravu na n\u011bj).SPV je nej\u010dast\u011bji pou\u017e\u00edv\u00e1na k \u010dasov\u011b n\u00e1ro\u010dn\u011bj\u0161\u00edm nebo bolestiv\u00fdm v\u00fdkon\u016fm ,nen\u00ed v\u0161ak d\u016fvod odep\u0159\u00edt ji komukoliv,kdo se jen prost\u011b \u201eboj\u00ed bolesti\u201c..<\/p>\n\n\n\n

Obvykl\u00fd zp\u016fsob proveden\u00ed<\/strong> (dosp\u011bl\u00fd pacient): intravenozn\u00ed kanyla (+ spojovac\u00ed hadi\u010dka),titra\u010dn\u00ed pod\u00e1n\u00ed midazolamu do navozen\u00ed \u017e\u00e1douc\u00edho \u00fa\u010dinku, udr\u017eov\u00e1n\u00ed \u00farovn\u011b sedace, b\u011bhem v\u00fdkonu monitorace TK a tzv.pulsn\u00ed oxygenace (mal\u00fd \u201ekol\u00ed\u010dek\u201c na prst\u011b ).Po skon\u010den\u00ed dle stavu klienta bu\u010f pod\u00e1n\u00ed protil\u00e1tky (flumazenil) nebo bez pod\u00e1n\u00ed propu\u0161t\u011bn dom\u016f (v\u017edy v\u00a0doprovodu jin\u00e9 dosp\u011bl\u00e9 osoby).<\/p>\n\n\n\n

U d\u011bt\u00ed dle stupn\u011b spolupr\u00e1ce: bu\u010f stejn\u011b jako dosp\u011bl\u00fd (kanylace \u017e\u00edly s pou\u017eit\u00edm znecitlivuj\u00edc\u00edho p\u0159\u00edpravku v m\u00edst\u011b vpichu),nebo kap\u00e1tkem nas\u00e1ln\u011b.<\/p>\n\n\n\n

U v\u0161ech kategori\u00ed lze midazolam (jednoduch\u00e1 forma SPV) kombinovat s ketaminem<\/strong>(celkov\u00e9 anestetikum).Pak lze hovo\u0159it o tzv. analgosedaci.<\/strong>Ketamin m\u016f\u017ee u v\u0161ech v\u011bkov\u00fdch kategori\u00ed vhodn\u011b zvolen\u00fdm d\u00e1vkov\u00e1n\u00edm doplnit zuba\u0159em proveden\u00e9 lok\u00e1ln\u00ed znecitliv\u011bn\u00ed .<\/p>\n\n\n\n

Kontraindikace SPV:<\/strong> rizikov\u00ed polymorbidn\u00ed klienti ve stavu destabilizace n\u011bkter\u00e9ho z chronick\u00fdch onemocn\u011bn\u00ed,extr\u00e9mn\u00ed obezita (u t\u011bchto dvou stav\u016f lze individu\u00e1ln\u011b rozhodnout),nep\u0159eru\u0161en\u00e1 l\u00e9\u010dba antidepres\u00edvy skupiny MAO,drogov\u00e1 a alkoholick\u00e1 z\u00e1vislost.Ze soci\u00e1ln\u00edch kontraindikac\u00ed je to nespolupracuj\u00edc\u00ed pacient (odm\u00edt\u00e1 v\u00fdkon,nen\u00ed schopen ani ochoten plnit doporu\u010den\u00ed),pacient nem\u00e1 k dispozici dosp\u011blou zodpov\u011bdnou osobu,jeho dom\u00e1cnost nen\u00ed vybavena telefonem.<\/p>\n\n\n\n

Analgosedace p\u0159i v\u011bdom\u00ed<\/strong><\/em><\/p>\n\n\n\n

Metoda se u\u017e\u00edv\u00e1 stejnou technikou a za stejn\u00fdch podm\u00ednek.Je dopln\u011bna titra\u010dn\u011b d\u00e1vkovan\u00fdm ketaminem (Narcamon,Calypsol),kter\u00fd v analgetick\u00fdch,nitro\u017eiln\u011b nebo nas\u00e1ln\u011b podan\u00fdch d\u00e1vk\u00e1ch dopln\u00ed sedaci o analgezii bez potencov\u00e1n\u00ed \u00fa\u010dinku midazolamu.Metoda se \u2013 podobn\u011b jako jednodu\u0161\u0161\u00ed sedace – osv\u011bd\u010dila zvl\u00e1\u0161t\u011b u d\u011bt\u00ed.Dosp\u011bl\u00ed obvykle bez pot\u00ed\u017e\u00ed sn\u00e1\u0161ej\u00ed tzv.lok\u00e1ln\u00ed analgezii podanou v m\u00edst\u011b z\u00e1kroku (tzv. \u201eobst\u0159iky\u201c \u010di \u201eopichy\u201c lok\u00e1ln\u00edm anestetikem) operat\u00e9rem.<\/p>\n\n\n\n

V obou p\u0159\u00edpadech ( sedace i analgosedace) z\u016fst\u00e1v\u00e1 klient v kontaktu s operat\u00e9rem (zuba\u0159em) i s anesteziologem a v optim\u00e1ln\u00edm p\u0159\u00edpad\u011b bez pod\u00e1n\u00ed antidota (flumazenil) odch\u00e1z\u00ed za doprovodu odpov\u011bdn\u00e9 osoby do dom\u00e1c\u00edho prost\u0159ed\u00ed.<\/p>\n\n\n\n

Pozn.: sou\u010d\u00e1st\u00ed obou metod je p\u0159ed\u00e1n\u00ed tzv.pou\u010den\u00e9ho souhlasu <\/em>a doporu\u010den\u00ed po v\u00fdkonu<\/em> klientovi (v p\u0159\u00edpad\u011b nezletil\u00fdch klient\u016f jejich z\u00e1konn\u00e9mu z\u00e1stupci),co\u017e tito stvrd\u00ed sv\u00fdm podpisem.<\/p>\n\n\n\n

P\u0159edopera\u010dn\u00ed anesteziologick\u00e9 vy\u0161et\u0159en\u00ed a p\u0159\u00edprava<\/strong><\/em><\/p>\n\n\n\n

Ka\u017ed\u00fd pacient (klient) mus\u00ed b\u00fdt p\u0159ed anestezi\u00ed prohl\u00e9dnut anesteziologem a jeho stav je klinicky posouzen a zhodnocen.Toto vy\u0161et\u0159en\u00ed obvykle prob\u00edh\u00e1 vp\u0159edve\u010der opera\u010dn\u00edho v\u00fdkonu na nemocni\u010dn\u00edm l\u016f\u017eku ,tedy v obdob\u00ed pro operanta zna\u010dn\u011b stresuj\u00edc\u00edm.P\u0159edesl\u00e1n\u00ed tohoto vy\u0161et\u0159en\u00ed do obdob\u00ed p\u0159\u00edpravy k v\u00fdkonu (n\u011bkolik dn\u016f) znamen\u00e1 zna\u010dnou m\u00edru odleh\u010den\u00ed cel\u00e9ho procesu p\u0159edopera\u010dn\u00ed p\u0159\u00edpravy.Tento postup prokazateln\u011b vede ke zmen\u0161en\u00ed p\u0159edopera\u010dn\u00edho i opera\u010dn\u00edho rizika pro pacienta.Anesteziologick\u00e9 p\u0159edopera\u010dn\u00ed vy\u0161et\u0159en\u00ed a p\u0159\u00edprava zahrnuje velmi \u0161irokou \u0161k\u00e1lu \u00fakon\u016f,z nich\u017e nejd\u016fle\u017eit\u011bj\u0161\u00ed je : anamn\u00e9za (p\u0159edchorob\u00ed),laboratorn\u00ed v\u00fdsledky,EKG,RTG plic,fyzik\u00e1ln\u00ed vy\u0161et\u0159en\u00ed,ur\u010den\u00ed anesteziologick\u00e9ho rizika a rizika vlastn\u00edho v\u00fdkonu,p\u0159\u00edpadn\u00e9 odklady a p\u0159esuny operac\u00ed,volba anesteziologick\u00e9ho postupu ( celkov\u00e1 \u010di m\u00edstn\u00ed anestezie,optim\u00e1ln\u00ed poloha p\u0159i v\u00fdkonu,inhala\u010dn\u00ed nebo nitro\u017eiln\u00ed anestezie,region\u00e1ln\u00ed \u2013 svodn\u00e1 anestezie,centr\u00e1ln\u00ed blok\u00e1dy),v neposledn\u00ed \u0159ad\u011b pak pou\u010den\u00ed a informace pro klienta s \u00fa\u010delem zm\u00edrn\u011bn\u00ed p\u0159irozen\u00e9ho strachu a obav z nadch\u00e1zej\u00edc\u00edho v\u00fdkonu.<\/p>\n\n\n\n

Kurzy a \u0161kolen\u00ed<\/strong><\/em><\/p>\n\n\n\n

Kurzy a \u0161kolen\u00ed se zdravotnickou tematikou jsou obvykle p\u0159edepsanou sou\u010d\u00e1st\u00ed vzd\u011bl\u00e1v\u00e1n\u00ed \u010d\u00e1sti zam\u011bstnanc\u016f v\u011bt\u0161iny st\u00e1tn\u00edch podnik\u016f a organizac\u00ed,v\u011bt\u0161iny pr\u016fmyslov\u00fdch podnik\u016f s rizikov\u00fdm provozem , \u0159ad\u00ed se sem tak\u0159ka v\u0161echny v\u011bt\u0161\u00ed pracovn\u00ed kolektivy.Anesteziologick\u00e1 ordinace zaji\u0161\u0165uje po dohod\u011b kurzy a \u0161kolen\u00ed jak\u00e9hokoliv rozsahu co se \u0161\u00ed\u0159e z\u00e1b\u011bru i \u010dasu t\u00fd\u010de. Sazby viz cen\u00edk.<\/p>\n\n\n\n

Zaji\u0161\u0165ov\u00e1n\u00ed zdravotnick\u00e9ho (anesteziologick\u00e9ho) dozoru<\/strong><\/em><\/p>\n\n\n\n

Po\u0159adatel\u00e9 v\u0161ech v\u011bt\u0161\u00edch kulturn\u00edch ,sportovn\u00edch a jin\u00fdch spole\u010densk\u00fdch ud\u00e1lost\u00ed s velk\u00fdm shrom\u00e1\u017ed\u011bn\u00edm (koncentrac\u00ed) osob jsou povinni zaji\u0161\u0165ovat zdravotnick\u00fd (l\u00e9ka\u0159sk\u00fd) dozor z d\u016fvodu zv\u00fd\u0161en\u00e9ho rizika vzniku \u00farazu \u010di n\u00e1hl\u00e9ho onemocn\u011bn\u00ed.Anesteziologick\u00e1 ordinace zaji\u0161\u0165uje ve spolupr\u00e1ci se Zdravotnickou z\u00e1chrannou slu\u017ebou T\u00e1bor kompletn\u00ed l\u00e9ka\u0159sk\u00fd dozor s pos\u00e1dkami typu RLP (rychl\u00e1 l\u00e9ka\u0159sk\u00e1 pomoc \u2013 \u0159idi\u010d+sestra+l\u00e9ka\u0159) a RZP (rychl\u00e1 zdravotnick\u00e1 pomoc – \u0159idi\u010d+sestra).Sazby viz cen\u00edk.<\/p>\n\n\n\n

Institut rodinn\u00e9ho l\u00e9ka\u0159e<\/strong><\/em><\/p>\n\n\n\n

Anesteziologick\u00e1 ordinace nab\u00edz\u00ed sice historickou,le\u010d st\u00e1le nep\u0159ekonanou mo\u017enost z\u00edskat vlastn\u00edho smluvn\u00edho rodinn\u00e9ho nebo osobn\u00edho l\u00e9ka\u0159e.V\u00fdhody jsou historicky nezpochybniteln\u00e9.Mo\u017enost takov\u00e9ho l\u00e9ka\u0159e,pohybuj\u00edc\u00edho se nejbl\u00ed\u017ee \u017eivotn\u00edmu prostoru pacienta a cel\u00e9 jeho rodiny ,spo\u010d\u00edv\u00e1 p\u0159edev\u0161\u00edm v psychoterapeutick\u00e9m vlivu na prevenci a zdrav\u00fd \u017eivotn\u00ed styl jeho klient\u016f,nem\u00e9n\u011b v\u0161ak i  ve zkvalitn\u011bn\u00ed diagnosticko-terapeutick\u00e9 orientace v anamn\u00e9ze a celkov\u00e9m charakteru \u017eivotn\u00edho stylu klienta a jeho vz\u00e1jemn\u00fdch rodinn\u00fdch vazeb. L\u00e9ka\u0159 po z\u00edsk\u00e1n\u00ed d\u016fv\u011bry klienta a \u010dlen\u016f jeho rodiny je k dispozici podle individu\u00e1ln\u00edch smluvn\u00edch podm\u00ednek nep\u0159etr\u017eit\u011b,\u010d\u00edm\u017e jsou eliminov\u00e1ny jak\u00e9koliv z\u00e1brany k vz\u00e1jemn\u00e9mu kontaktu z obou stran.Sazby viz cen\u00edk.<\/p>\n\n\n\n

Druh\u00fd n\u00e1zor<\/strong><\/em><\/p>\n\n\n\n

Vcelku jednoduch\u00e1 slu\u017eba ,reaguj\u00edc\u00ed na nov\u011b se objevuj\u00edc\u00ed trend : \u0159ada pacient\u016f vn\u00edm\u00e1 sv\u00e9 onemocn\u011bn\u00ed mnohem odpov\u011bdn\u011bji ne\u017e v minulosti,st\u00e1le jsou v\u0161ak \u010dasto v\u00e1z\u00e1ni obavami z projev\u016f nelibosti \u201esv\u00e9ho\u201c l\u00e9ka\u0159e,jeho\u017e n\u00e1klonnost by mohli ztratit,kdyby zjistil,\u017ee jeho rozhodnut\u00ed ,n\u00e1zor nebo l\u00e9\u010dbu konzultoval klient u jin\u00e9ho l\u00e9ka\u0159e.Dnes by m\u011bl \u201erozumn\u00fd\u201c a modern\u00ed l\u00e9ka\u0159 tuto svobodnou v\u016fli sv\u00e9ho klienta bez v\u00fdhrad respektovat,nepova\u017eovat za projev ned\u016fv\u011bry ,n\u00fdbr\u017e za legitimn\u00ed a zodpov\u011bdn\u00e9 chov\u00e1n\u00ed klienta.Slu\u017eba zde prob\u00edh\u00e1 bezplatn\u011b prost\u0159ednictv\u00edm elektronick\u00e9 po\u0161ty (viz kontakt),p\u0159i osobn\u00ed konzultaci viz cen\u00edk.<\/p>\n","protected":false},"excerpt":{"rendered":"

Anestezie S pou\u017eit\u00edm nejmodern\u011bj\u0161\u00edch anesteziologick\u00fdch metod je prov\u00e1d\u011bna tzv. celkov\u00e1 anestezie ,tj. uveden\u00ed klienta do stavu um\u011ble vyvolan\u00e9ho monitorovan\u00e9ho bezv\u011bdom\u00ed pomoc\u00ed anesteziologick\u00fdch plyn\u016f \u010di nitro\u017eiln\u00edch anestetik.Tento stav je pr\u016fb\u011b\u017en\u011b udr\u017eov\u00e1n b\u011bhem Continue Reading →<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-32","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=\/wp\/v2\/pages\/32","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=32"}],"version-history":[{"count":2,"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=\/wp\/v2\/pages\/32\/revisions"}],"predecessor-version":[{"id":35,"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=\/wp\/v2\/pages\/32\/revisions\/35"}],"wp:attachment":[{"href":"https:\/\/anesteziologie-tabor.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=32"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}