. . . . "Postupy region\u00E1ln\u00ED anestezie by m\u011Bly b\u00FDt v\u017Edy prov\u00E1d\u011Bny na pracovi\u0161ti p\u0159im\u011B\u0159en\u011B vybaven\u00E9m person\u00E1ln\u011B i materi\u00E1ln\u011B. Okam\u017Eit\u011B dostupn\u00E9 mus\u00ED b\u00FDt l\u00E9ky, p\u0159\u00EDstroje a pom\u016Fcky nutn\u00E9 pro neodkladnou resuscitaci a monitoraci pacienta. P\u0159ed prov\u00E1d\u011Bn\u00EDm rozs\u00E1hlej\u0161\u00EDch blok\u00E1d mus\u00ED b\u00FDt pacient v\u00A0optim\u00E1ln\u00EDm stavu a mus\u00ED m\u00EDt p\u0159edem zaji\u0161t\u011Bn\u00FD p\u0159\u00EDstup do \u017Eiln\u00EDho \u0159e\u010Di\u0161t\u011B. L\u00E9ka\u0159, kter\u00FD prov\u00E1d\u00ED blok\u00E1du mus\u00ED postupovat tak, aby se vyhnul intravaskul\u00E1rn\u00EDmu pod\u00E1n\u00ED (viz kapitola 4.2) a mus\u00ED b\u00FDt adekv\u00E1tn\u011B vy\u0161kolen a obezn\u00E1men s diagn\u00F3zou a l\u00E9\u010Dbou ne\u017E\u00E1douc\u00EDch \u00FA\u010Dink\u016F, syst\u00E9mov\u00E9 toxicity a jin\u00FDch komplikac\u00ED (viz kapitola 4.8 a 4.9), jako je necht\u011Bn\u00E9 subarachnoid\u00E1ln\u00ED pod\u00E1n\u00ED, kter\u00E9 m\u016F\u017Ee vyvolat vysok\u00FD spin\u00E1ln\u00ED blok s\u00A0hypotenz\u00ED a z\u00E1stavou d\u00FDch\u00E1n\u00ED. K\u0159e\u010De se vyskytuj\u00ED nej\u010Dast\u011Bji p\u0159i blok\u00E1d\u011B brachi\u00E1ln\u00EDho plexu a epidur\u00E1ln\u00ED blok\u00E1d\u011B, nejsp\u00ED\u0161e p\u0159i n\u00E1hodn\u00E9m intravaskul\u00E1rn\u00EDm pod\u00E1n\u00ED nebo rychl\u00E9m vst\u0159eb\u00E1v\u00E1n\u00ED z\u00A0m\u00EDsta pod\u00E1n\u00ED.\nBlok\u00E1dy velk\u00FDch perifern\u00EDch nerv\u016F vy\u017Eaduj\u00ED aplikaci velk\u00E9ho objemu lok\u00E1ln\u00EDho anestetika do dob\u0159e prokrven\u00E9 oblasti, \u010Dasto v\u00A0bl\u00EDzkosti velk\u00FDch c\u00E9v, co\u017E zvy\u0161uje riziko intravaskul\u00E1rn\u00EDho pod\u00E1n\u00ED a/nebo rychl\u00E9ho vst\u0159eb\u00E1n\u00ED do ob\u011Bhu s\u00A0n\u00E1sledkem vysok\u00E9 plasmatick\u00E9 koncentrace l\u00E1tky.\nN\u011Bkter\u00E9 postupy lok\u00E1ln\u00ED anestezie, nap\u0159. aplikace v oblasti hlavy a krku, jsou spojeny s\u00A0vy\u0161\u0161\u00EDm rizikem z\u00E1va\u017En\u00FDch ne\u017E\u00E1douc\u00EDch \u00FA\u010Dink\u016F, bez ohledu na pou\u017Eit\u00E9 lok\u00E1ln\u00ED anestetikum. Je t\u0159eba v\u011Bnovat zvl\u00E1\u0161tn\u00ED pozornost tomu, aby nedo\u0161lo k\u00A0pod\u00E1n\u00ED do m\u00EDsta z\u00E1n\u011Btu.\nPacienti ve \u0161patn\u00E9m celkov\u00E9m stavu, a\u0165 ji\u017E v\u00A0d\u016Fsledku v\u011Bku nebo komplikuj\u00EDc\u00EDch onemocn\u011Bn\u00ED, jako jsou \u010D\u00E1ste\u010Dn\u00E9 nebo \u00FApln\u00E9 poruchy p\u0159evodn\u00EDho syst\u00E9mu srde\u010Dn\u00EDho, nemocn\u00ED se\u00A0z\u00E1va\u017En\u00FDm po\u0161kozen\u00EDm jater nebo ledvin, a\u010Dkoliv je u nich region\u00E1ln\u00ED anestezie \u010Dasto pou\u017E\u00EDv\u00E1na, vy\u017Eaduj\u00ED speci\u00E1ln\u00ED pozornost. \nPacienti, kter\u00FDm jsou pod\u00E1v\u00E1na antiarytmika t\u0159\u00EDdy III (nap\u0159. amiodaron), by m\u011Bli b\u00FDt pe\u010Dliv\u011B sledov\u00E1ni, pop\u0159\u00EDpad\u011B monitorov\u00E1no EKG, nebo\u0165 \u00FA\u010Dinky obou l\u00E9k\u016F na myokard se mohou s\u010D\u00EDtat. \nP\u0159i pou\u017Eit\u00ED p\u0159\u00EDpravku Ropivacaine k\u00A0epidur\u00E1ln\u00ED anestezii \u010Di perifern\u00ED nervov\u00E9 blok\u00E1d\u011B byly vz\u00E1cn\u011B hl\u00E1\u0161eny p\u0159\u00EDpady srde\u010Dn\u00ED z\u00E1stavy, zvl\u00E1\u0161t\u011B po n\u00E1hodn\u00E9 intravaskul\u00E1rn\u00ED aplikaci p\u0159\u00EDpravku u star\u0161\u00EDch pacient\u016F a u pacient\u016F s\u00A0onemocn\u011Bn\u00EDm srdce. Resuscitace byla v\u00A0n\u011Bkter\u00FDch p\u0159\u00EDpadech obt\u00ED\u017En\u00E1. Pokud dojde k\u00A0z\u00E1stav\u011B srdce, \u00FAsp\u011Bch se m\u016F\u017Ee dostavit a\u017E po prodlou\u017Een\u00E9 resuscitaci.\nRopivacain je metabolizov\u00E1n v\u00A0j\u00E1trech, a proto by m\u011Bl b\u00FDt pod\u00E1v\u00E1n obez\u0159etn\u011B u\u00A0pacient\u016F se z\u00E1va\u017En\u00FDm jatern\u00EDm onemocn\u011Bn\u00ED. Opakovan\u00E9 d\u00E1vky by m\u011Bly b\u00FDt sn\u00ED\u017Eeny pro riziko zpomalen\u00E9 eliminace. U\u00A0pacient\u016F s\u00A0insuficienc\u00ED ledvin nen\u00ED obvykle nutn\u00E9 m\u011Bnit d\u00E1vku p\u0159i jednor\u00E1zov\u00E9m pod\u00E1n\u00ED nebo kr\u00E1tkodob\u00E9 l\u00E9\u010Db\u011B. Acid\u00F3za a sn\u00ED\u017Een\u00E1 plazmatick\u00E1 koncentrace protein\u016F, \u010Dasto p\u0159\u00EDtomn\u00E1 u\u00A0pacient\u016F s\u00A0chronick\u00FDm selh\u00E1n\u00EDm ledvin, m\u016F\u017Ee zvy\u0161ovat riziko projev\u016F syst\u00E9mov\u00E9 toxicity.\nEpidur\u00E1ln\u00ED anestezie m\u016F\u017Ee u hypovolemick\u00FDch pacient\u016F vyvolat n\u00E1hlou hypotenzi nez\u00E1visle na pou\u017Eit\u00E9m lok\u00E1ln\u00EDm anestetiku. \nDlouhodob\u00E9 pod\u00E1v\u00E1n\u00ED Ropivacainu by se nem\u011Blo pou\u017E\u00EDvat u pacient\u016F sou\u010Dasn\u011B l\u00E9\u010Den\u00FDm siln\u00FDmi inhibitory CYP1A2, jako jsou fluvoxamin a enoxacin (viz kapitola 4.5).\nJe t\u0159eba po\u010D\u00EDtat s\u00A0mo\u017Enou zk\u0159\u00ED\u017Eenou alergi\u00ED s\u00A0ostatn\u00EDmi amidov\u00FDmi lok\u00E1ln\u00EDmi anestetiky.\nRopivacine Torrex obsahuje v\u00A01 ml 3 mg natria. To je t\u0159eba br\u00E1t v\u00A0\u00FAvahu u pacient\u016F, kte\u0159\u00ED maj\u00ED dietu s\u00A0omezen\u00EDm sod\u00EDku.\nRopivacine Torrex 2 mg/ml u pediatrick\u00FDch pacient\u016F\nNovorozenci vy\u017Eaduj\u00ED zv\u00FD\u0161enou pozornost s\u00A0ohledem na nezralost n\u011Bkter\u00FDch metabolick\u00FDch funkc\u00ED. Velk\u00E9 rozd\u00EDly v\u00A0plasmatick\u00FDch hladin\u00E1ch ropivacainu, kter\u00E9 byly pozorov\u00E1ny v\u00A0klinick\u00FDch tudi\u00EDch u novorozenc\u016F znamenaj\u00ED, \u017Ee tato v\u011Bkov\u00E1 skupina m\u00E1 zv\u00FD\u0161en\u00E9 riziko syst\u00E9mov\u00E9 toxicity, zvl\u00E1\u0161t\u011B, pokud je pou\u017E\u00EDv\u00E1na kontinu\u00E1ln\u00ED epidur\u00E1ln\u00ED infuze. Doporu\u010Den\u00E9 d\u00E1vky u novorozenc\u016F jsou zalo\u017Eeny na omezen\u00E9m po\u010Dtu klinick\u00FDch dat. Kdykoliv je ropivakain u t\u00E9to v\u011Bkov\u00E9 skupiny pou\u017Eit, je nezbytn\u00E9 pravideln\u011B monitorovat zn\u00E1mky syst\u00E9mov\u00E9 toxicity (t.j. zn\u00E1mky toxicity stran CNS, EKG, SpO2) a m\u00EDstn\u00ED neurotoxicity (nap\u0159. prodlou\u017Een\u00E9 zotavov\u00E1n\u00ED). Tato sledov\u00E1n\u00ED by m\u011Bla pokra\u010Dovat i po ukon\u010Den\u00ED infuze, proto\u017Ee eliminace u novorozenc\u016F prob\u00EDh\u00E1 pomalu. \n"@cs . . . . . "4.4\tZvl\u00E1\u0161tn\u00ED upozorn\u011Bn\u00ED a zvl\u00E1\u0161tn\u00ED opat\u0159en\u00ED pro pou\u017Eit\u00ED"@cs . "004.004" . . . . . . .