Minerva anestesiologica
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Xenon is an interesting anesthetic as it appears to lack negative inotropicy and vasodilatation, giving great advantages to both patients with limited cardiovascular reserve or those who require hemodynamic stability. It has low toxicity and is not teratogenic. Xenon gives rapid induction and recovery, due to its low blood/gas partition coefficient (0.15), and has a MAC of 63%. ⋯ It has been shown that, compared to other anesthetic regimens, Xenon anesthesia produces the highest regional blood flow in the brain, liver, kidney and intestine. In conclusion, the most important positive effects of Xenon are cardiovascular stability, cerebral protection and favourable pharmacokinetics. Negative points are high cost and the limited number of ventilators supplying Xenon.
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Auditory evoked potentials (AEPs) are an electrical manifestation of the brain response to an auditory stimulus. Mid-latency auditory evoked potentials (MLAEPs) and the coherent frequency of the AEP are the most promising for monitoring depth of anaesthesia. MLAEPs show graded changes with increasing anaesthetic concentration over the clinical concentration range. ⋯ However, AEPs aren't a perfect measure of anaesthesia depth. They can't predict patients movements during surgery and the signal may be affected by muscle artefacts, diathermy and other electrical operating theatre interferences. In conclusion, once reliability of the AEPs recording became proved and the signal acquisition improved it is likely to became a routine feature of clinical anaesthetic practice.
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Immediate hypersensitivity reactions to anaesthetic and associated agents used during the perioperative period have been reported with increasing frequency in most developed countries. Most reactions are of immunologic origin (IgE mediated, anaphylaxis) or related to direct stimulation of histamine release (anaphylactoid reactions). The incidence of anaphylaxis is estimated between 1 in 10000 and 1 in 20000 anaesthesia, and any drug administered in the perioperative period can potentially produce life-threatening immune-mediated hypersensitivity reactions. ⋯ In addition, since no specific treatment has been shown to reliably prevent the occurrence of anaphylaxis, allergy assessment must be performed in all high-risk patients. The need for proper epidemiological studies and the relative complexity of allergy investigation should be underscored. They represent an incentive for further development of allergo-anaesthesiology clinical networks to provide expert advice for anaesthetists and allergologists.
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Minerva anestesiologica · May 2004
ReviewPostoperative analgesia in infants and children: new developments.
Nowadays, postoperative pain control in infants and children is a big challenge. The only effective solution is a multidisciplinary work with accurate guidelines, starting from the preoperative period throughout the surgery and arriving at the postoperative period. The approach must be scientific, based on the recent studies and research. ⋯ In these last two years also our group performed several continuous peripheral nerve blocks particularly axillary, femoral and sciatic for major orthopedic surgery and trauma. In our institution, we use a bolus dose of 0.5-1 ml/kg (depending on the nerve to be blocked) of ropivacaine 0.2% or levobupivacaine 0.25% with clonidine 2 microg/kg and then in infants older than 6 months and children we use a continuous infusion of 0.1-0.3 ml/kg/h of 0.2% ropivacaine or 0.25% levobupivacaine with clonidine 3 microg/kg/24h for 48-72 hours. For older children doses and concentrations are usually the same used in adults.
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The measurement of nursing workload first began in the 1970s, because of the need for determining severity of illness and cost-effectiveness in the intensive care unit. In the following decades, the need for more specific tools for assessing nursing workload brought to the development of scoring systems more focused on nursing activities. We will briefly review the scoring systems validated since 1974. ⋯ It describes 81% of the nursing time, compared to 43% of TISS 28. In conclusion, many scoring systems have been proposed to describe nursing workload, both directly (as with TOSS and PRN) or through severity and complexity of treatment (TISS, TISS 28, NAS and NEMS). These scores represent the instruments to assess the correct use of ICU resources.