Minerva anestesiologica
-
Minerva anestesiologica · Jun 1999
ReviewInterventional neuroradiology. Recent developments and anaesthesiologic aspects.
To summarise recent developments in interventional neuroradiology (INR) and to discuss related anaesthesiologic considerations. ⋯ The role of the anaesthetist in INR consists in providing patient comfort by analgesia and sedation, adequate monitoring, maintenance of vital functions and (if required) the management of systemic heparinisation. The patient's underlying condition, the duration and the kind of intervention have to be considered to decide on the anaesthetic management. Most of the procedures can safely be performed under light sedation, which allows continuous neurological evaluation of the patient. Knowledge of the risks and hazards of the different procedures and close collaboration with the neuroradiologist form the basis for appropriate management in case of a potentially fatal ischaemic or haemorrhagic complication that may occur in 1 to 8% of interventions. For prompt control of airway, respiration and blood pressure in these emergencies experienced anaesthesia staff is required.
-
Acute respiratory failure is accompanied by a severe gas exchange impairment that is signified by a large shunt and no or only little of additional ventilation-perfusion mismatch. The shunt is caused by perfusion of collapsed and consolidated lung tissue that is mainly located in the lower, dependent lung region. ⋯ Spontaneous breathing seems to improve gas exchange, and in proportion to its share of total ventilation, when added to mechanical ventilation. A shift from total mechanical ventilation to partial or fully spontaneous breathing may be the road of the future and should be tested further.
-
Minerva anestesiologica · Jun 1999
Review[Therapeutic applications of hypothermia in intensive care].
A brief review about the effects of hypothermia is presented, with regards to the difference between accidental hypothermia and controlled mild hypothermia (Core temperature = 33-35 degrees C). Mild hypothermia does not seem to affect the cardiac performance, while recent experimental reports show potential protective effects on the cardiac muscle during acute infarction. Mild hypothermia improve the outcome of brain function after cardiac arrest and head injury, while experimental reports show a potential protective effect of local spinal cord cooling during ischemic injury. ⋯ In this setting a mild induced hypothermia potentially may decrease the side effects of therapeutic hypoventilation (permissive hypercapnia) both on haemodynamics and brain circulation. Preliminary data are presented about five ALI/ARDS patients, enclosed in a randomized trial, who were mechanically ventilated and cooled with an air-sheet: three patients died because of underlying disease and two patients survived with complete recovery. Mild controlled hypothermia seems to provide new interesting clinic uses.
-
Regional anaesthesia is useful in day surgery when properly applied. Most commonly used techniques are IVRA, axillary block, local/infiltration plus monitored anaesthesia care. Spinal anaesthesia is also frequently used in DS. ⋯ The use of monitored anaesthesia care as an adjunct to RA increases patient acceptability and satisfaction with different blocks. In most cases there is less pain after operation if RA was used when compared to GA but control of pain is important at the time when the block wears off. Patient information and cooperation as well as timely discharge of patients home is important for successful RA in DS.
-
A variety of drugs and techniques have been introduced into day surgery over recent years and, although the tide of development appears to have slowed, may of these will still be relatively new to many. Experience with the laryngeal mask continues to grow and it is now a firmly-established airway management tool in a wide variety of procedures. The cuffed oropharyngeal airway is an interesting recent arrival, but produces inferior airway control and is not a true alternative to the laryngeal mask. ⋯ The long-awaited "depth of anaesthesia" monitor may have arrived, offering the possibility of more finely titrated anaesthesia with earlier (but not intraoperative!) awakening. Reliability is as yet uncertain and a simple technique with spontaneous ventilation may achieve similar results at substantially lower cost. The relative place of all these developments will take several years to become apparent and the future remains interesting.