Minerva anestesiologica
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Sevoflurane and Desflurane are relatively new halogenated agents which make induction and control of depth of anaesthesia easier, recovery rapid and of good quality and they have less side-effects and toxicity. In children sevoflurane could replace halothane because it provides smooth and rapid induction with less cardiovascular depression and arrhythmias. Desflurane is not used because of its pungent odour. In adults sevoflurane could be preferred to desflurane because it allows rapid induction and laryngeal mask insertion or tracheal intubation without myorelaxants, a similar time of recovery, no clinical evidence for renal and hepatic toxicity, no more costs for anaesthesia for a lower MAC.
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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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The use of enteral formulas supplemented with immunonutrients has been demonstrated to modulate gut function, inflammatory and immune response after trauma in both experimental and clinical settings. Most studies have focused on glutamine, arginine, w-3 fatty acids and nucleotides. ⋯ Data collected in two different recent metaanalysis consistently confirmed that enteral formulas enriched with, arginine, w-3 fatty acids and nucleotides reduced infectious complications and hospital stay after planned surgery, and decreased infectious complications, hospital stay and ventilator days in the critically ill. Mortality seems not to be affected by enteral administration of immunonutrients.
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The Bispectral Index or "BIS" is a single number, composed from different EEG features, using multivariate statistical methods. It was designed for monitoring the depth of hypnosis during anaesthesia and sedation. ⋯ Unlike univariate measures, such as Spectral Edge Frequency or Median Frequency, the Bispectral Index is drug independent and changes with increasing doses of hypnotics in an almost linear way. Though sophisticated technology, the A-2000 BIS monitor and the BIS sensor are easy to use and also allow non-experts to monitor the depth of hypnosis and sedation on a routine basis.