Minerva anestesiologica
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This study was conceived to assess a pattern of Italian prehospital critical care team, especially referring to the advanced life support (ALS) rescue team. Function and management of ALS rescue team and its relationship with other members of the emergency medical system (intra hospital physician, basic life support team, general practitioner) are analysed; stress is laidon the knowledge, the background and the complexity of the emergency procedures. The benefit of 2 major prehospital options of the ALS team, composed by 1 physician and 1 nurse staffing or by 2 trained nurse staffing, is discussed; the importance of educational programs for ambulance teams, a comparison of cost-effectiveness and the number of emergency teams availability is underlined. The authors, finally emphasize the advantages of a territorial coverage with an integrated system of ambulances staffed with specially trained rescuers or technicians, ambulances with rescuers and nurses, and ALS teams staffed with emergency physician and 1 nurse (integrated or not with ambulances with 2 trained nurses), being perfectly capable to face up any background in pre-hospital emergency medicine setting.
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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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Minerva anestesiologica · May 2004
ReviewAnesthetic considerations in patients with chronic pulmonary diseases.
Increasing age and co-morbidities of patients admitted for surgery impose new challenges on the anesthesiologist. ⋯ Assessing the functional status of patients admitted to surgery remains a difficult task, and in patients identified at risk by clinical examination additional spirometry and blood gases may be helpful. If there are signs of respiratory failure, the anaesthetist should monitor the patient closely and invasively, yet there is no reason to deny any patient a substantially beneficial operation.
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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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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.