Minerva anestesiologica
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Minerva anestesiologica · May 2000
ReviewThe measurement of the pressure-volume curves with computerized methods.
The authors analyze the physiological basis, technical aspects and clinical usefulness of several methods for pressure-volume curves determinations in mechanically ventilatory, acute respiratory failure patients.
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Due to pharmacokinetic and pharmacodynamic reasons, the elderly are at particular risk of incurring unwanted side effects of drugs commonly used in anaesthesia. The bispectral index (BIS) is an EEG-derived value that measures the sedative component of the anaesthetic state. The BIS could be useful in guiding titration of anaesthetic drugs in the elderly. ⋯ The BIS is a useful guidance for titration of anaesthetic drugs in the elderly. The presence of senile dementia may be a confounding factor in the interpretation of the BIS values during anaesthesia.
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Minerva anestesiologica · May 2000
ReviewMeasurement of pressure-volume curves in patients on mechanical ventilation. Methods and significance.
In critically ill patients measurements of pressure volume curves has been suggested as a method for assessing the severity of lung injury and for monitoring the evolution of the lung disease; it can also guide the ventilatory adjustments to optimize the mechanical ventilation. The static pressure-volume curves are impaired in acute respiratory distress syndrome (ARDS). ⋯ The combined application of positive end expiratory pressure (PEEP) to the level of alveolar recruitment and low tidal volume (< 6 ml/kg) ameliorates the lung function and decrease mortality in ARDS patients. Routine monitoring with continuous technique is easy and develops good therapeutic practice.
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Minerva anestesiologica · May 2000
ReviewTime to reconsider the pre-oxygenation during induction of anaesthesia.
Atelectasis is a frequent finding in paralysed and mechanically ventilated patients. Atelectasis, causing shunt, impairs oxygenation and could contribute to postoperative pulmonary complications. Pre-oxygenation used during anaesthesia induction causes atelectasis. A lowering of oxygen fraction from 100% to 80% does not shorten the safety time of apnoea period, particularly useful for a difficult intubation, but it reduces drastically the atelectasis incidence.
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Minerva anestesiologica · May 2000
ReviewWhy should I change my practice of anaesthesia: neuromuscular blocking agents.
Recently, four neuromuscular blocking agents have been introduced into clinical practice. The drug companies claim that these new drugs offer several important advantages. But is this true? Do the new neuromuscular blocking agents add anything to our clinical practice, and will their introduction really benefit our patients? Or will it only benefit the economy of the companies? ⋯ In this lecture I shall try to update you on these new drugs and give you my personal bias on when to use the different (new and old) neuromuscular blocking agents.