Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2012
ReviewThe use of opioid adjuvants in perioperative multimodal analgesia.
Postoperative analgesia plays a crucial role in day-case surgery. Patients expect effective pain relief after surgery, without side effects, and this may not always be possible when more complicated procedures are performed in ambulatory settings. ⋯ Multimodal analgesia, combining different groups of analgesics, both opioid and non-opioid, with different mechanisms of action, and targets in central and peripheral nervous systems with minimal side effects may be an answer. In this review, we present and discuss the current status of knowledge, with special reference to the role of adjuvants to opioids in acute postoperative pain.
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Anaesthesiol Intensive Ther · Jan 2012
Case ReportsNeuromuscular block reversal with sugammadex in a morbidly obese patient with myasthenia gravis.
Myasthenia gravis is a rare immunological illness that impairs neuromuscular transmission. Myasthenic patients are usually hypersensitive to non-depolarising muscle relaxants, and reversal with neostigmine is rarely effective. We report the successful reversal of rocuroniuminduced neuromuscular block in a morbidly obese myasthenic patient. ⋯ Sugammadex can be successfully used in myasthenic patients, allowing for the safe use of muscle relaxants in these patients.
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Anaesthesiol Intensive Ther · Jan 2012
Case ReportsTapia's syndrome after arthroscopic shoulder stabilisation under general anaesthesia and LMA.
Anaesthetic complications, albeit rare, still occur and may be severe and unanticipated, with significant morbidity. Extracranial ipsilateral palsy of the recurrent laryngeal and the hypoglossal nerves is known as the Tapia's syndrome. Damage to these nerves may result from displacement of the head during mask ventilation, endotracheal intubation, bronchoscopy or the use of a laryngeal mask airway (LMA). We describe unilateral paralysis of the muscles of the tongue and ipsilateral vocal cord due to a lesion of cranial nerves X and XII that occurred following LMA anaesthesia combined with plexus block. ⋯ This rare complication reminds us not only of the importance of positioning during anaesthesia and surgery, but also of the need for careful and correct airway management. It could be probably prevented by careful insertion of an appropriate size LMA, and the use of low intracuff pressures and/or volumes.
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Pneumorrhachis (PR) means the presence of air in the spinal canal; it is an exceptional, but important radiographic finding, which may be associated with different aetiologies and pathways of air entry into the spinal canal. ⋯ PR can be epidural or subdural, iatrogenic or traumatic. It is usually asymptomatic, but can be also associated with marked morbidity, especially when it is subdural in the cervical region. It can be regarded as a predictor of the severity of head injury. Pneumorrhachis does not usually require surgical intervention.