Introduction. Epidural analgesia (EA) has significant contraindications including coagulation disorders and parturient refusal. One alternative is intravenous self-administered analgesia using the ultra short-acting opioid remifentanil (rPCA). We compared the efficiency and safety of standard epidural analgesia with parturient-controlled intravenous analgesia using remifentanil as well as personal satisfaction. Materials and Methods. We enrolled twelve ASA I classified women with singleton pregnancy who delivered vaginally in the period 3/2010-5/2010 and who received rPCA (n=12) in standard analgesic protocol: 20 μg boluses using PCA pump with a lockout interval of 3 min. The control group consisted of 12 pregnant women who received EA (n=12): 0.125% bupivacaine with sufentanil 0.5 μg/mL in top-up boluses every hour until delivery. Data were acquired from standard Acute Pain Service (APS) form and patient medical records (demographic, labour course parameters), Visual Analogue Scale (VAS), Bromage Scale (BS) and adverse effects of analgesia.Results. There were no demographic or labour course parameter differences between groups (P>0.05). The differences in VAS decrease (P=0.056) and parturient satisfaction (P=0.24) during the whole analgesia administration were statistically insignificant. The main limitation of the study was small sample and enrolment of healthy singleton pregnant women only. Conclusion. Remifentanil use in obstetric analgesia is a viable alternative to EA, especially in cases of EA contraindications and parturient disapproval.

BackgroundMedical Faculties Network (MEFANET) has established itself as the authority for setting standards for medical educators in the Czech Republic and Slovakia, 2 independent countries with similar languages that once comprised a federation and that still retain the same curricular structure for medical education. One of the basic goals of the network is to advance medical teaching and learning with the use of modern information and communication technologies.ObjectiveWe present the education portal AKUTNE.CZ as an important part of the MEFANET’s content. Our focus is primarily on simulation-based tools for teaching and learning acute medicine issues.MethodsThree fundamental elements of the MEFANET e-publishing system are described: (1) medical disciplines linker, (2) authentication/authorization framework, and (3) multidimensional quality assessment. A new set of tools for technology-enhanced learning have been introduced recently: Sandbox (works in progress), WikiLectures (collaborative content authoring), Moodle-MEFANET (central learning management system), and Serious Games (virtual casuistics and interactive algorithms). The latest development in MEFANET is designed for indexing metadata about simulation-based learning objects, also known as electronic virtual patients or virtual clinical cases. The simulations assume the form of interactive algorithms for teaching and learning acute medicine. An anonymous questionnaire of 10 items was used to explore students’ attitudes and interests in using the interactive algorithms as part of their medical or health care studies. Data collection was conducted over 10 days in February 2013.ResultsIn total, 25 interactive algorithms in the Czech and English languages have been developed and published on the AKUTNE.CZ education portal to allow the users to test and improve their knowledge and skills in the field of acute medicine. In the feedback survey, 62 participants completed the online questionnaire (13.5%) from the total 460 addressed. Positive attitudes toward the interactive algorithms outnumbered negative trends.ConclusionsThe peer-reviewed algorithms were used for conducting problem-based learning sessions in general medicine (first aid, anesthesiology and pain management, emergency medicine) and in nursing (emergency medicine for midwives, obstetric analgesia, and anesthesia for midwifes). The feedback from the survey suggests that the students found the interactive algorithms as effective learning tools, facilitating enhanced knowledge in the field of acute medicine. The interactive algorithms, as a software platform, are open to academic use worldwide. The existing algorithms, in the form of simulation-based learning objects, can be incorporated into any educational website (subject to the approval of the authors).

EditordNeuromuscular blocking agents (NMBAs) are used during anaesthesia for airway management and to improve surgical conditions, 1 although the surgical procedures that necessitate neuromuscular block in children are less common than in adult patients. 2 It is recommended that the train-of-four ratio (TOFR) should recover to >0.9 before tracheal extubation when measured by accelerometry. There is increasing evidence in adults that residual neuromuscular block (RNB) in the postoperative period with a TOFR <0.9 increases morbidity and mortality. 3 Nevertheless, RNB remains common in the postoperative period (26e88%). 4e6 We designed a trial in paediatric patients with the primary outcome as the incidence of RNB measured just before extubation in the operating room (OR). The secondary outcome was the incidence of the RNB in the PACU. The trial was designed as a monocentric prospective observational cohort trial, registered at www.clinicaltrials.gov (NCT02939911), and approved by the local ethics committee (etickakomise@ fnbrno.cz, 10/2016). All patients 29 weeks and <19 yr of age undergoing surgery in a tertiary paediatric anaesthesia centre involving NMBA use between January 1, 2017 and December 31, 2017 were eligible for inclusion. Patients were excluded for weight <3000 g, neuromuscular disease, haemodynamic impairment, planned/unplanned postoperative mechanical ventilation, continuous perioperative neuromuscular block measurement, or when succinylcholine was the only NMBA used during surgery. The NMBAs available for use during enrolment were rocuronium, mivacurium, cisatracurium, atracurium, and succinylcholine. The level of neuromuscular block was measured just before tracheal extubation on the decision of the anaesthetist in the OR and after arrival in the PACU using accelerometry (TOF-Watch®SX; Organon, Inc., West Orange, NJ, USA). Accelerometry was carried out using ulnar nerve stimulation with measurement of contraction of the adductor pollicis muscle. The train-of-four (TOF) count, TOFR, and in the case of deep neuromuscular block, posttetanic count (PTC) were measured twice just before extubation in the OR and in the PACU. RNB was defined as a TOFR of <0.9 on the first measurement in the OR and PACU. The timing of the second measurement in the OR depended on the anaesthetist, allowing the clinician to possibly administer pharmacological reversal of RNB after recording the TOFR. In the PACU, the TOF or TOFR was measured immediately after arrival (first and second measurement). Data were described using descriptive analytic methods [mean, standard deviation (SD), median]. The incidence of RNB was described as the absolute and relative incidence with the 95% confidence intervals (CI). The relationship between RNB and the measured variables was described using logistic regression calculated odds ratio with the 95% CI and the P-value for the specific regression model with statistical significance defined as P<0.05.For the 291 patients included in the study. the NMBAs used were rocuronium (49%), cisatracur...

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