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Beta-blockers are used for several decades also for the suppression of symptoms of the adrenergic stress in the perioperative period. While their benefit is considered indisputable there is no consensus on the most suitable patients' population where benefits would prevail over the risks most significantly. Present trends suggest the shift from the frequent widespread use to the more targeted medication, where the general status of the patient as well as the nature of the operation is being considered. Individual dose should be targeted to the specific therapeutic end-points. While the non-therapeutic use of beta-blockers by lay public is possible there is growing interest in their therapeutic use in severely septic patients. Favourable clinical experience results mostly from their use in the burned patients, where the natural course of the illness has many similarities with the protracted course of severe sepsis. Favourable influence of beta-blockers on monotonous tachycardia with minimal reflex variability of heart rate and on the resulting mortality has been demonstrated. Clinical experience has accumulated up to date reflecting the use of propranolol mostly; the experience with the more cardioselective beta-blockers is mostly experimental. Although there are legitimate worries about possible circulatory depression by beta-blockers empirical data do not support this. There are very encouraging data available about the favourable effect of beta-blockers on the outcome of the traumatised patients, especially patients suffering from a brain trauma.

Background: Nitric oxide (NO) is a selective pulmonary vasodilator effective in the treatment of pulmonary hypertension and hypoxemic respiratory failure. Reports in the Czech literature on the results of its therapeutic use are still scarce., Methods and Results: Effects of inhaled NO on the changes of PaO2/FiO2 were assessed in the retrospective study. Records of artificially ventilated patients suffering from acute respiratory distress syndrome (ARDS) were reviewed. Daily highest NO dose, the highest PaO2/FiO2 ratio, duration of NO administration and death or survival of the patient was noted. Survivors and nonsurvivors, as well as responders (rise of PaO2/FiO2 by at least 20%) and non-responders were compared using Mann-Whitney and ANOVA test, alpha = 0.05. 16 patients were entered into the study, 13 (81%) responded positively to NO administration, the mortality was 56%. Comparing the age, NO dose, duration of its administration and APACHE II score in survivors and non-survivors, in respondents and non-respondents no differences were found. After NO administration the PaO2/FiO2 rose both in survivors and non-survivors (p < 0.0005). In survivors the response of oxygenation was more pronounced, although the difference did not reach the statistical significance (p = 0.07). On the days 1-3 the PaO2/FiO2 ratio was higher in survivors (p < 0.05)., Conclusions: Despite the transient increase in oxygenation after NO administration, mortality of patients with ARDS remained high. NO administration could not be considered the standard method of treatment of patients with ARDS in intensive care.

Methods and Results: From the group of 110 neonates born with transposition of the great arteries during 1991-1994 that were referred for the treatment to Kardiocentrum, University Hospital Prague-Motol, 46 neonates with simple transposition were operated on according to the criteria for anatomical correction (arterial switch) at the mean age of 9 days (4-20 days). Fourteen infants with transposition and large ventricular septal defect were corrected with arterial switch at the mean age of 2.5 months (5 weeks-9 months). Fifty neonates that did not meet criteria for arterial switch procedure were indicated for correction at the atrial level (Senning procedure) that has been performed at the mean age of 5 months (1-10 months). Out of 46 operated neonates 10 died following the operation and one child died 2 months later after surgery. There were 2 death out of last 20 neonates (10%). Thirty five children surviving 1-4 years after anatomical arterial correction of transposition are without complaints in excellent condition, NYHA class I., Conclusions: The procedure of the anatomical correction at the level of the great arteries (arterial switch) according to Jatene, that has been successfully introduced at Kardiocentrum, University Hospital Prague-Motol, has been reproducible and became the method of choice for operations of transposition of the great arteries in neonates with the suitable anatomy.