Perioperative hypothermia, defined as a core body temperature lower than 36řC, is associated with increased perioperative complications and prolonged hospitalization. The aim of this thesis is to analyze measures that are taken to prevent perioperative hypothermia at the Orthopedic Clinic of one Czech hospital and compare them with the current recommendations of the American Society of PeriAnesthesia Nurses, Association of Operating Room Nurses and the National Institute for Health and Care Excellence. The study included 223 patients who underwent a planned orthopedic surgery and who were more than 18 years old. As a method of data collection I chose studying the medical documentation. The obtained data were processed quantitatively. The recommended body temperature range 36.5-37.5řC before leaving an operating room had total of 60.55% of cases. Neither one patient has been no action in terms of prevention of hypothermia. Body temperature was taken in 22.4% of cases at the beginning of and during the surgery. Except for a cotton sheet, which was used in 100% of patients, no additional measures were taken in 18,4% of patients. Thermal insulation was used in 41,7% of patients, in-line warming system of infusion fluids in 65% of patients, forced air warming system in 17.9% of patients, and disposable...

The first part of the present dissertation shows mechanisms of keeping of body temperature in an optimum range as well as it divides and evaluates range of body temperature. My dissertation also deals with the ways of measurement of body temperature, methods of measurement and tools which are neccessary for measurement of body temperature. Another part presents characteristics of aneshtesia its division, ways of application and tools which are used for total anesthesia. It is also described an observation of body temperature during total anesthesia, negative consequences of hypothermia, regulations of body temperature during total anesthesia and prevention and treatment of hypothermia. There are descriptions of targets and hypothesis in the second part. There were made five hypothesis. The third part shows methods of collecting data itself. They are results of stucture observation of changes of body temperature of patiens in total anesthesia during surgery.The fourth part are charts and graphs showing results of measurements of body temperature of our patients in total anesthesia as well as results of the questionnaires based on answers from asked nurses. There are particular hypothesis and their results in discussion part. Hypothesis H1 was proved. Hyphothesis H2 is not possible to be disproved. Hyphothesis H3 was not proved. Hyphothesis H4 was proved and hyphotesis H5 was proved. We can deduce from the results that active use of tools for keeping body temperature in a physiological range can prevent decrease of body temperature. It is clear from the questionnaires that nurses are aware of complications connected to hypothermia. They actively use tools for keeping body temperature in physiological range. There is a summary in the conclusion of the dessertation whether all estimated targets were accomplished. As a result of the dissertation we can assume that using of tools for keeping body temperature of total anasthesia patients should be a standard. There should be also a standard to measure body temperature during an operation in total anasthesia itself.

1 Abstract The cluster of obesity, insulin resistance and other associated comorbidities represents a significant health risk for the affected individuals as well as the whole population. Chronic low-grade inflammation of adipose tissue is considered one of the main mechanisms respon- sible for the progression from simple obesity to a fully developed metabolic syndrome. The aim of our study was to explore two different approaches that could potentially ameliorate adipose tissue inflammation - therapeutic hypothermia and the adipocytokine clusterin. In the first part, we showed that a period of deep hypothermia associated with the an- oxic phase of cardiac surgery significantly delayed the onset of systemic inflammatory re- sponse induced by surgery. The relative gene expression of the studied genes was not altered during the hypothermic period, but was significantly increased in five out of ten studied genes (IL-6, MCP-1, TNF-α, HIF1-α, GLUT1) and decreased in two genes (IRS1, GPX1) at the end of surgery. We conclude that deep hypothermia delays the onset of local adipose tissue hy- poxia and inflammation. These results could partially explain the positive effects of therapeu- tic deep hypothermia on postoperative morbidity and mortality in cardiac surgery patients. In the second part, we examined plasma...

The thesis is focused on premature newborn thermomanagement. It is focused particularly on very premature and extremely premature newborns which suffer the highest level of thermolability. The theoretical part deals with the particularities of premature newborn thermoregulation, newborns' reactions to thermal stress, thermomanagement in the delivery room and providing a thermoneutral environment in the incubator. The thesis describes a method of servo-control mode of body temperature, which has not been utilised for premature newborns in Czech Republic. The aim of the thesis is to start using this method and compare it with the method of manual control. Based on the total time not meeting the standard, number of failures and other parameters to assess which method is more suitable for body temperature regulation. The research sample consists of 47 newborsn who were born between the 24th and 32nd gestational week. Quantitative data collection at one-minute intervals was conducted in the 72 hours after birth. The method choice was random. Statistically important differences between the two methods were measured regarding the total time not meeting the standards. The incidence of hyperthemia was higher during manual method, hypothermia when servo-control. Total failure amount was 19%. However, the...

Název: Hyperkapnie a difuse plynů ve sněhové lavině - (Změny funkčních parametrů jedinců v krizové situaci) Cíle práce: Cílem studie bylo kontinuální sledování kompenzačních mechanismů, zejména změn ventilačně-respiračních ukazatelů, v simulované sněhové lavině. Metoda: K získání dat byl použit experiment a nestandardizovaný dotazník. Výběr souboru byl vzhledem ke sledované problematice přísně selektivní. Výzkumu se účastnilo 22 probandů, ale po analýze dat bylo pro nesplnění požadovaných kritérií 11 osob vyřazeno. Soubor tedy tvořilo 11 zdravých mužů průměrného věku 25,3 let. Před vlastním experimentem byla pomocí osobního spirometru testována senzitivita na hyperkapnii a hypoxii (výdrž v apnoi) a dechová zdatnost (vitální kapacita plic s usilovným výdechem). Experimentální situaci představovalo jak dýchání do uzavřeného objemu (8 l), tak do vytvořené vzduchové kapsy ve sněhu (400 ml). Kontinuální záznamy oběhových funkcí (srdeční frekvence, krevní tlak) a ventilačně-respiračních parametrů (dechová frekvence, dechový objem, minutová ventilace, obsah O2 a CO2 ve vdechovaném a vydechovaném vzduchu, odpor při výdechu a saturace krve kyslíkem) byly snímány pacientským monitorem DATEX Ohmeda. Vzhledem k charakteru dat byla využita analýza rozptylu při opakovaném měření se dvěma faktory (dvoucestná...

Successfull cardiopulmonary resuscitation is an essential life-saving tool; nevertheless, general ischemia during cardiac arrest may trigger different pathways that could turn even into a fatal damage; this condition is called post-cardiac arrest syndrome. It has been repeatedly shown that oxidative stress (OS) plays one of the key roles in the development of ischemia-reperfusion injury. However, current evidence on the possible participation of OS in the pathogenesis of post-cardiac arrest syndrome is insufficient. We tested following hypotheses: (i) ischaemia-reperfusion injury after cardiac arrest is accompanied by OS and (ii) mild therapeutical hypothermia decreases OS cardiac arrest. In the experimental part of our work we studied the effects of hypothermia and normothermia on hemodynamic parameters, markers of organ damage and on the OS burden in porcine model of cardiac arrest. Furthermore, we compared the effects of hypothermia with ischaemic postconditioning and nitric oxide administration in the porcine model of extracorporeal cardiopulmonary resuscitation. We found protective effects of hypothermia on all major endpoints including OS in comparison with normothermia; moreover, hypothermia improved also selected variables compared to ischemic postconditioning and nitric oxide. In the...

Malignant ventricular arrhythmias are a common cause of sudden cardiac death. Moderate therapeutic hypothermia (MTH) is routinely used in post-resuscitation care for anticipated neuroprotective effects. However, the safety of MTH in terms of the electrical stability of the heart has not been satisfactorily proved yet. Also, the increased sympathetic tone in patients with heart failure contributes to a higher incidence of malignant ventricular arrhythmias. The aim of this work was to verify the safety of MTH as regards the inducibility of ventricular fibrillation (VF) in the pig biomodel, especially in relation to spontaneous changes in the kalemia and QT interval. Furthermore, we assumed that renal denervation (RDN) could reduce the inducibility of VF. In the first part of the thesis, the extracorporeal cooling was introduced in fully anesthetized swine (n = 6) to provide MTH. Inducibility of VF was studied by programmed ventricular stimulation (8 basic stimuli with up to 4 extrastimuli) three times in each biomodel under the following conditions: during normothermia (NT), after reaching the core temperature 32 řC (HT) and after another 60 minutes of stable hypothermia (HT60). VF inducibility, effective ventricular refractory period (ERP), QTc interval, and potassium plasma level were measured. In...

It was shown almost 50 years ago that hypothermic incubation of chicken embryos results in a reduction in the size of embryos and an increase in the heart weight, presumably by hypertrophy (increase in cell volume). The chicken embryos were incubated in normothermia (37.5 ř C) and hypothermia (33.5 ř C) from the eleventh embryonic day. On the 17th day, the embryos were weighed and then their hearts were weighed. In agreement with the previous results, hypothermic embryos were 29% smaller and their hearts 18% heavier. The heart-to-body weight ratio was 67% higher in the hypothermic group. The measured cell size was very similar in the target areas and it was also between the two groups. The left ventricle width was twofold that the right one and the difference was not significantly higher in the hypothermia model. Purkinje fibers, the terminal part of the conduction system, were smaller than the working cardiomyocytes. Purkinje fibers were slightly enlarged after hypothermic incubation. The proliferation rate was measured by immunohistochemical labeling of anti-phospho histone H3. The experimental group showed much higher proliferation rate; it reached statistical significance in the right ventricle. Thus, hypothermic incubation resulted in increased growth of embryonic heart based on hyperplasia...

Successfull cardiopulmonary resuscitation is an essential life-saving tool; nevertheless, general ischemia during cardiac arrest may trigger different pathways that could turn even into a fatal damage; this condition is called post-cardiac arrest syndrome. It has been repeatedly shown that oxidative stress (OS) plays one of the key roles in the development of ischemia-reperfusion injury. However, current evidence on the possible participation of OS in the pathogenesis of post-cardiac arrest syndrome is insufficient. We tested following hypotheses: (i) ischaemia-reperfusion injury after cardiac arrest is accompanied by OS and (ii) mild therapeutical hypothermia decreases OS cardiac arrest. In the experimental part of our work we studied the effects of hypothermia and normothermia on hemodynamic parameters, markers of organ damage and on the OS burden in porcine model of cardiac arrest. Furthermore, we compared the effects of hypothermia with ischaemic postconditioning and nitric oxide administration in the porcine model of extracorporeal cardiopulmonary resuscitation. We found protective effects of hypothermia on all major endpoints including OS in comparison with normothermia; moreover, hypothermia improved also selected variables compared to ischemic postconditioning and nitric oxide. In the...

Název: Hyperkapnie a difuse plynů ve sněhové lavině - (Změny funkčních parametrů jedinců v krizové situaci) Cíle práce: Cílem studie bylo kontinuální sledování kompenzačních mechanismů, zejména změn ventilačně-respiračních ukazatelů, v simulované sněhové lavině. Metoda: K získání dat byl použit experiment a nestandardizovaný dotazník. Výběr souboru byl vzhledem ke sledované problematice přísně selektivní. Výzkumu se účastnilo 22 probandů, ale po analýze dat bylo pro nesplnění požadovaných kritérií 11 osob vyřazeno. Soubor tedy tvořilo 11 zdravých mužů průměrného věku 25,3 let. Před vlastním experimentem byla pomocí osobního spirometru testována senzitivita na hyperkapnii a hypoxii (výdrž v apnoi) a dechová zdatnost (vitální kapacita plic s usilovným výdechem). Experimentální situaci představovalo jak dýchání do uzavřeného objemu (8 l), tak do vytvořené vzduchové kapsy ve sněhu (400 ml). Kontinuální záznamy oběhových funkcí (srdeční frekvence, krevní tlak) a ventilačně-respiračních parametrů (dechová frekvence, dechový objem, minutová ventilace, obsah O2 a CO2 ve vdechovaném a vydechovaném vzduchu, odpor při výdechu a saturace krve kyslíkem) byly snímány pacientským monitorem DATEX Ohmeda. Vzhledem k charakteru dat byla využita analýza rozptylu při opakovaném měření se dvěma faktory (dvoucestná...