{"id":944324,"date":"2015-11-10T18:23:50","date_gmt":"2015-11-10T16:23:50","guid":{"rendered":"http:\/\/www.ssaki.eu\/?page_id=944324"},"modified":"2015-11-10T18:26:09","modified_gmt":"2015-11-10T16:26:09","slug":"navrh-pripravy-alergickych-pacientov-na-vysetrenia-kontrastnymi-latkami-a-operacie","status":"publish","type":"page","link":"https:\/\/www.ssaki.eu\/?page_id=944324","title":{"rendered":"N\u00e1vrh pr\u00edpravy alergick\u00fdch pacientov na vy\u0161etrenia kontrastn\u00fdmi l\u00e1tkami a oper\u00e1cie"},"content":{"rendered":"

Alergick\u00e9 ochorenia celosvetovo narastaj\u00fa. V s\u00fa\u010dasnosti postihuj\u00fa 40% popul\u00e1cie civilizovan\u00fdch kraj\u00edn. Naj\u010dastej\u0161ie alergick\u00e9 choroby ako alergick\u00e1 n\u00e1dcha, astma, potravinov\u00e1, liekov\u00e1 alergia, atopick\u00fd ekz\u00e9m a alergia na bodnutie blanokr\u00eddlym hmyzom s\u00fa zn\u00e1me nielen zdravotn\u00edckej, ale aj laickej verejnosti. Najob\u00e1vanej\u0161\u00edm prejavom alergie je jej syst\u00e9mov\u00e1 forma – anafylaxia. Tieto diagn\u00f3zy dop\u013a\u0148aj\u00fa eozinofilov\u00e9 choroby (napr. \u010doraz \u010dastej\u0161ie sa vyskytuj\u00faca eozinofilov\u00e1 ezofagit\u00edda), histam\u00ednov\u00e1 intolerancia a mastocyt\u00f3za). Ke\u010f\u017ee alergici s\u00fa v\u0161eobecne hypersenzit\u00edvni pacienti a na r\u00f4zne podnety (chemick\u00e9 – farmakologick\u00e9, fyzik\u00e1lne, infek\u010dn\u00e9…) m\u00f4\u017eu reagova\u0165 inak (zvy\u010dajne intenz\u00edvnej\u0161ie) ako nealergick\u00e1 popul\u00e1cia, pred r\u00f4znymi z\u00e1krokmi (diagnostick\u00e9 postupy – napr. vy\u0161etrenie pomocou kontastnej l\u00e1tky, opera\u010dn\u00fd z\u00e1krok…) b\u00fdva potrebn\u00e1 antialergick\u00e1 pr\u00edprava. V pr\u00edprave t\u00fdchto pacientov je potrebn\u00e9 pou\u017ei\u0165 jednotn\u00fd postup, aby sme predch\u00e1dzali \u017eivot ohrozuj\u00facej anafylaktickej reakcii.<\/p>\n

Pacienta pripravujeme pred celkovou anest\u00e9zou a pred vy\u0161etreniami kontrastn\u00fdmi l\u00e1tkami. Obzvl\u00e1\u0161\u0165 rizikov\u00fdch pacientov m\u00f4\u017eeme pripravi\u0165 aj pred lok\u00e1lnou a region\u00e1lnou (epidur\u00e1lnou) anest\u00e9zou.<\/strong><\/p>\n

Pred anest\u00e9zou:
\n\u2022 Pacient informuje lek\u00e1ra o svojom alergickom ochoren\u00ed
\n\u2022 U v\u0161etk\u00fdch pacientov je optim\u00e1lne ur\u010di\u0165 stupe\u0148 rizika, multidisciplin\u00e1rnym konz\u00edliom (alergol\u00f3g, anesteziol\u00f3g, a pod\u013ea typu choroby, resp. anamn\u00e9zy + dermatol\u00f3g, pneumol\u00f3g, ORL, gastroenterol\u00f3g hematol\u00f3g…)
\n\u2022 Individu\u00e1lne riziko ur\u010duje periopera\u010dn\u00fd mana\u017ement: premedik\u00e1ciu, anestetick\u00fa techniku, postoperat\u00edvnu analg\u00e9ziu a vynechanie potrebn\u00fdch liekov pred, po\u010das a po z\u00e1kroku
\n\u2022 Pacienta s anamn\u00e9zou predch\u00e1dzaj\u00facej reakcie na anestetik\u00e1 (aj pri suspekcii) m\u00e1 pred oper\u00e1ciou vy\u0161etri\u0165 alergol\u00f3g – imunol\u00f3g, ktor\u00fd zv\u00e1\u017ei potrebn\u00e9 vy\u0161etrenia in vitro a in vivo a navrhne vhodn\u00fd (alternat\u00edvny) postup.<\/p>\n

Premedik\u00e1cia:<\/strong>
\n\u2022 H1-antihistaminik\u00e1 I. ev. II. gener\u00e1cie p.o. (redukcia histam\u00ednov\u00e9ho efektu) de\u0148 pred z\u00e1krokom, u rizikov\u00fdch pacientov alergol\u00f3g zv\u00e1\u017ei pr\u00edpravu 48 h pred z\u00e1krokom (pokra\u010duje sa zvy\u010dajne aj v de\u0148 z\u00e1kroku a e\u0161te 48 h po \u0148om)
\n\u2022 Kortikostroidy: Prednizon 1mg \/kg\/de\u0148 12, 6 a 1 hodinu pred z\u00e1krokom
\n\u2022 Hydrocortison 100mg a Bisulepin hydrochlorid (Dithiaden) inj. 1hod. pred z\u00e1krokom, pod\u013ea veku a v\u00e1hy (0,5 do 6 rokov a 1,0mg \/6-14rokov = 1\/2-1 amp.)<\/p>\n

V de\u0148 anest\u00e9zy a chirurgick\u00e9ho z\u00e1kroku:
\n\u2022 Vynecha\u0165 suspektn\u00e9 alergizuj\u00face lieky
\n\u2022 U pacientov s mechanick\u00fdm sp\u00fa\u0161\u0165a\u010dom alergickej reakcie a mastocyt\u00f3zou vyl\u00fa\u010di\u0165: chladenie, otep\u013eovanie, tlak -tourniketom a prologovan\u00fa anest\u00e9zu<\/p>\n

Vypracovala: Dr.Koss\u00e1rov\u00e1<\/p>\n

Literat\u00fara z Allergy 70\/2015…<\/p>\n

VEREJN\u00c1 DISKUSIA<\/h1>\n

V pr\u00edpade, \u017ee navrhujete zmenu textu, pros\u00edm nap\u00ed\u0161te n\u00e1m \u010das\u0165, ktor\u00fa chcete vypusti\u0165 a z\u00e1rove\u0148 zadajte nov\u00fd text. \u010eakujeme<\/h1>\n

[si-contact-form form=’9′]<\/p>\n","protected":false},"excerpt":{"rendered":"

Alergick\u00e9 ochorenia celosvetovo narastaj\u00fa. V s\u00fa\u010dasnosti postihuj\u00fa 40% popul\u00e1cie civilizovan\u00fdch kraj\u00edn. Naj\u010dastej\u0161ie alergick\u00e9 choroby ako alergick\u00e1 n\u00e1dcha, astma, potravinov\u00e1, liekov\u00e1 alergia, atopick\u00fd ekz\u00e9m a alergia na bodnutie blanokr\u00eddlym hmyzom s\u00fa zn\u00e1me nielen zdravotn\u00edckej, ale...<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-944324","page","type-page","status-publish","hentry"],"yoast_head":"\nN\u00e1vrh pr\u00edpravy alergick\u00fdch pacientov na vy\u0161etrenia kontrastn\u00fdmi l\u00e1tkami a oper\u00e1cie - Slovensk\u00e1 spolo\u010dnos\u0165 alergol\u00f3gie a klinickej imunol\u00f3gie<\/title>\n<meta name=\"description\" content=\"Sme odborn\u00e1 splo\u010dnos\u0165, ktor\u00e1 zdru\u017euje klinick\u00fdch imunol\u00f3gov a alergol\u00f3gov, ako aj in\u00fdch odborn\u00edkov so z\u00e1ujmom o tento odbor. 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