Minerva anestesiologica
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Minerva anestesiologica · Sep 2001
Regional anaesthesia in vascular surgery: a multidisciplinary approach to accelerate recovery and postoperative discharge.
A multimodal, rehabilitative, fast discharge approach to abdominal aortic surgery is analyzed. The approach was developed in two phases during the years 1997-2000: in the first phase (1997) patients had thoracic epidural anesthesia plus TIVA and analgesia. ⋯ Preliminary results on 44 patients show no mortality, low postoperative morbility (cardiac complications 2,2%, peripheral embolization 2,2%, no pulmonary complications), no ICU stay and fast hospital discharge (median: 3,5 days, range: 2-8 days) without complications. We conclude that preliminary data support the safety and the need for further improvement of a multimodal, aggressive rehabilitative approach in abdominal vascular surgery.
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Describe early discharge of patients treated with continuous perineural analgesia after orthopaedic surgery. ⋯ Continuous, post-operative, perineural analgesia at home is safe and effective, less expensive with high patient satisfaction.
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Minerva anestesiologica · Sep 2001
Case Reports[Severe and prolonged post-dural puncture headache: from pathological basis to therapeutic role and correct timing for epidural blood patch].
Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.
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Minerva anestesiologica · Sep 2001
Reduction of operating and recovery room times and overnight hospital stays with interscalene blocks as sole anesthetic technique for rotator cuff surgery.
The effort to decrease hospital stays and to increase operating room efficacy has become an important consideration in the practice of anesthesia. ⋯ This study confirms that the interscalene block as sole anesthesia technique is safe and effective and can contribute to shorten the hospital length of stay of patients undergoing shoulder rotator cuff surgery.
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Minerva anestesiologica · Sep 2001
[Patient controlled regional analgesia (PCRA) in surgery of stiff elbow: elastomeric vs electronic pump].
Aim of this study is to confront an elastomeric pump at regular infusion controlled by the patient with an electronic pump with self-administration for analgesia, by continuous infraclavicular brachial plexus block, as support for the intensive postoperative physiotherapy. ⋯ PCRA quality is higher with ropivacaine 0,4% during the first phase of recovery. The elastomeric pump instead, insufficient in the first phase, is useful for analgesia at home.