Minerva anestesiologica
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Minerva anestesiologica · May 2002
ReviewUse and nursing of the helmet in delivering non invasive ventilation.
Continuous positive end-expiratory pressure (CPAP) and Pressure Support Ventilation (PSV) are commonly used for the therapy of several forms of respiratory failure. CPAP and PSV can be delivered both during invasive respiratory treatment, by means of an endotracheal tube or tracheostomy, and during non invasive respiratory treatment. Non Invasive Ventilation (NIV) is commonly used for the therapy of several forms of respiratory failure (COPD, Weaning period from Invasive Mechanical Ventilation, Cardiogenic Edema,.) and the helmet could be a good new device to deliver it with a better compliance instead the common facial mask without increasing the nurses' workload.
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Minerva anestesiologica · May 2002
ReviewExcitation and delirium during sevoflurane anesthesia in pediatric patients.
Due to its hemodynamic properties and ease of administration (quick induction, rare cough or laryngospasm), Sevoflurane has rapidly become the agent of induction of choice in pediatric patients. However, it can induce troublesome excitation phenomena during induction and awakening and it could have an epileptogenic effect. The mechanisms and strategies to reduce those drawbacks are reviewed.
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Minerva anestesiologica · May 2002
ReviewAirway closure, atelectasis and gas exchange during anaesthesia.
Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are collapse of lung tissue (atelectasis) and airway closure. ⋯ A major cause of atelectasis is the pre-oxygenation during induction of anaesthesia. Lowering the inspired O2 concentration to 80% suffices to avoid almost all atelectasis. Airway closure and low VA/Q can only be prevented by raising the FRC level by PEEP or by other means.
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Minerva anestesiologica · May 2002
ReviewAntithrombin III. Key factor in extracorporeal circulation.
Antithrombin III plays many different roles during cardiac operations with cardiopulmonary bypass. Basically, it acts as the natural inhibitor of thrombin, which, in presence of heparin, blocks the thrombin action and avoids gross thrombus formation inside the extracorporeal circulation circuit. ⋯ Moreover, patients pre-treated with heparin reach the operating theater with reduced levels of circulating antithrombin III; this may lead to the heparin resistance phenomenon and may further increase the risk for postoperative thrombotic complications. Finally, the anti-inflammatory properties of antithrombin III in the setting of the "whole body inflammatory reaction" induced by the cardiopulmonary bypass represents a new and unexplored field of research.
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Minerva anestesiologica · May 2002
ReviewAntithrombin III in Sepsis. New evidences and open questions.
Antithrombin III (ATIII) has been found to be a marker for DIC and to be of prognostic significance in septic patients. Several studies have shown that administration of ATIII in patients with sepsis related DIC is effective in shortening the duration of DIC. ⋯ However the concomitant use of heparin, which does not seem to have an additional beneficial effect, may have obscured the efficacy of ATIII. More studies are needed to understand mechanism of action of ATIII and better define patient population that may benefit from ATIII.