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BackgroundHyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The aim of this animal study was to compare the short-term effects of equivolemic, equiosmolar solutions of mannitol and hypertonic saline (HTS) on cerebral cortical microcirculation in a rabbit craniotomy model.MethodsRabbits (weight, 2.0–3.0 kg) were anesthetized, ventilated mechanically, and subjected to a craniotomy. The animals were allocated randomly to receive a 3.75 ml/kg intravenous infusion of either 3.2 % HTS (group HTS, n = 8) or 20 % mannitol (group MTL, n = 8). Microcirculation in the cerebral cortex was evaluated using sidestream dark-field (SDF) imaging before and 20 min after the end of the 15-min HTS infusion. Global hemodynamic data were recorded, and blood samples for laboratory analysis were obtained at the time of SDF image recording.ResultsNo differences in the microcirculatory parameters were observed between the groups before the use of osmotherapy. After osmotherapy, lower proportions of perfused small vessel density (P = 0.0474), perfused vessel density (P = 0.0457), and microvascular flow index (P = 0.0207) were observed in the MTL group compared with those in the HTS group.ConclusionsOur findings suggest that an equivolemic, equiosmolar HTS solution better preserves perfusion of cortical brain microcirculation compared to MTL in a rabbit craniotomy model.

Oddělení dětské chirurgie a traumatologie, FN Hradec Králové 2 Centrum dětské traumatologie, Neurochirurchická klinika LF UK a FN, Hradec Králové Úrazy zad a páteře jsou heterogenní skupina poranění, se kterou se setkávají lékaři dětských pacientů téměř každý den. Článek je shrnutím přístupu k vyšetření a ošetření nejběžnějších poranění páteře z pohledu chirurgických pracovišť Fakultní nemocnice v Hradci Králové. Současně se snaží navrhnout racionální postup u takto zraněných dětí.Klíčová slova: zlomeniny obratlů, hrudní a bederní páteř, zobrazovací vyšetření. Back injures and spinal fracturesBack and spine injuries are aheterogeneous group of injuries encountered by physicians of pediatric patients almost every day. The article summarizes the approach to examination and treatment of the most common spinal injuries from the perspective of surgical departments of the University Hospital in Hradec Kralove. At the same time, it seeks to propose arational approach to such injured children.

Background and Objectives: The effect of individualized hemodynamic management on the intraoperative use of fluids and other hemodynamic interventions in patients undergoing spinal surgery in the prone position is controversial. This study aimed to evaluate how the use of individualized hemodynamic management based on extended continuous non-invasive hemodynamic monitoring modifies intraoperative hemodynamic interventions compared to conventional hemodynamic monitoring with intermittent non-invasive blood pressure measurements. Methods: Fifty adult patients (American Society of Anesthesiologists physical status I–III) who underwent spinal procedures in the prone position and were then managed with a restrictive fluid strategy were prospectively randomized into intervention and control groups. In the intervention group, individualized hemodynamic management followed a goal-directed protocol based on continuously non-invasively measured blood pressure, heart rate, cardiac output, systemic vascular resistance, and stroke volume variation. In the control group, patients were monitored using intermittent non-invasive blood pressure monitoring, and the choice of hemodynamic intervention was left to the discretion of the attending anesthesiologist. Results: In the intervention group, more hypotensive episodes (3 (2–4) vs. 1 (0–2), p = 0.0001), higher intraoperative dose of ephedrine (0 (0–10) vs. 0 (0–0) mg, p = 0.0008), and more positive fluid balance (680 (510–937) vs. 270 (196–377) ml, p < 0.0001) were recorded. Intraoperative norepinephrine dose and postoperative outcomes did not differ between the groups. Conclusions: Individualized hemodynamic management based on data from extended non-invasive hemodynamic monitoring significantly modified intraoperative hemodynamic management and was associated with a higher number of hemodynamic interventions and a more positive fluid balance.