Minerva anestesiologica
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Minerva anestesiologica · Apr 2006
Case ReportsPurpura fulminans during meningococcal sepsis treated with Drotrecogin alpha. A clinical case.
A male patient, 29 years old, was admitted to our unit with purpura fulminans, coagulation deficiency, renal failure and subsequent septic shock accompanied by respiratory insufficiency in the absence of meningeal signs. The serum levels of endogenous protein C, ATIII and calcium were well below the norm. The bacteriological examination revealed the presence of gram-negative diplococci. ⋯ Forty-eight hours after being admitted, the recombinant protein C infusion was started at a dose of 24 microg/kg/h for the duration of 96 h. The skin lesions regressed, starting from the ecchymosis and the edema of the face, trunk and auricular pavilions. A week after the onset of the symptomatology the chest X-ray appeared clear, the renal function had normalised, and the signs of shock had disappeared.
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The recent onset of orthogonal polarization spectral (OPS) imaging techniques has allowed the direct visualization of the microcirculation at the bedside of critically ill patients. A systematic review with particular emphasis on recent findings and implications in pathophysiological processes is presented. Using OPS techniques various investigators have observed microcirculatory alterations in critically ill patients, and especially in patients with severe sepsis and septic shock. ⋯ Microcirculation plays an important role in the pathogenesis of shock and organ dysfunction, especially in sepsis. The microcirculatory effects of various therapeutic interventions have still to be reported. OPS technique may become a valuable tool to monitor patients with circulatory failure.
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Minerva anestesiologica · Apr 2006
ReviewInterfacing spontaneous breathing and mechanical ventilation. New insights.
Mechanical ventilation (MV) with positive pressure insufflations of gas into the lung may be required to ensure sufficient oxygenation of blood and elimination of carbon dioxide in acute respiratory failure. Interfacing spontaneous breathing and mechanical ventilation has been used to improve gas exchange and may offer other advantages regarding integrity of lung tissue. Airway pressure release ventilation (APRV), or bilevel positive airway pressure (BiPAP), is a mechanical ventilatory mode with a low respiratory rate upon which spontaneous breaths can be superimposed during any time of the respiratory cycle. ⋯ Since blood flow goes preferentially to the dependent regions, the altered ventilation distribution results in improved matching of ventilation and perfusion, further enhancing or facilitating gas exchange. Moreover, there is less cyclic collapse, i.e. less re-collapse during expiration and reopening during inspiration than with MV alone. Further development of the interfacing technique can be expected, with synchronization and also dosing of the mechanical support and with triggering of the ventilator that is based on neural recordings rather than mechanical signals as pressure and flow.
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Minerva anestesiologica · Apr 2006
Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy.
The aim of this study was to evaluate the haemodynamic changes in patients undergoing cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) using an echo-Doppler device (Hemosonic 100). ⋯ These results suggest that the echo-Doppler device (Hemosonic 100) provided an easy-to-handle, non-invasive and reliable tool to monitor changes in cardiac parameters during IPHC.
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Minerva anestesiologica · Apr 2006
Randomized Controlled TrialLevobupivacaine and ropivacaine in the infraclavicular brachial plexus block.
Infraclavicular brachial plexus block were first described by Raj, yet this block remained underutilized despite theoretical advantages. The aim of this prospective, randomized study was to compare equipotent doses of levobupivacaine and ropivacaine. ⋯ The long duration of sensory block associated with the with good analgesia, less toxicity and the pharmacodynamic properties of levobupivacaine include this new local anaesthetic as a valid choice respect other local anaesthetic for infraclavicular plexus block.