Minerva anestesiologica
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Minerva anestesiologica · Jun 2005
ReviewUse of levobupivacaine for the treatment of postoperative pain after thoracotomies.
Continuous thoracic epidural analgesia with an opiod-local anaesthetic mixture is the most appropriate strategy to control postoperative pain in thoracic surgery. Levobupivacaine, the pure S(-) enantiomer of racemic bupivacaine, has less cardiotoxic and neurotoxic potential but similar anaesthetic properties of its native agent. There are no studies in thoracic surgery that had established the minimal efficient concentration of this anaesthetic when used with an epidural opioid. ⋯ Preliminary results showed that patients of each group reported similar VAS at rest although a better pain control during cough resulted in group A. Patients receiving levobupivacaine at 0.125% presented low incidence of nausea, vomiting and pruritus probably because of the smaller amount of rescue morphine administered. At the concentration of 0.125% epidural levobupivacaine in combination with sufentanil allowed to obtain a good pain control with no adverse effects and motor block at all.
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Patients with chronic airflow obstruction and difficult weaning from mechanical ventilation are at increased risk for intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Non-invasive positive-pressure ventilation (NPPV) may revert most of the pathophysiologic mechanisms associated with weaning failure in these patients. Several randomised controlled trials have shown that the use of NPPV in order to advance extubation in difficult to wean patients can result in reduced periods of endotracheal intubation, complication rates and survival. ⋯ In addition the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. It remains to be seen whether NPPV has a role in other patients' groups and situations. The technique is however a usual addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.
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For several decades, bupivacaine has enjoyed great clinical popularity as the first choice local anesthetic in pediatrics. However, introduction of ropivacaine and levobupivacaine, the two newer and presumably safer (thought to be less cardio- and neurotoxic than bupivacaine) local anesthetics, has challenged the position of bupivacaine as a gold standard for prolonged duration of analgesia. This review article summarized the metabolism, the criteria of choice and the safety use of new agents.