Minerva anestesiologica
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Minerva anestesiologica · Jun 2006
Review Multicenter StudyCaudal anesthesia in pediatrics: an update.
Caudal anesthesia is one of the most used-popular regional blocks in children. This technique is a useful adjunct during general anesthesia and for providing postoperative analgesia after infraumbilical operations. The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug. Although it is a versatile block, one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. The most frequently used method to further prolong postoperative analgesia following caudal block is to add different adjunct drugs to the local anesthetics solution. Only few studies evaluated quality and duration of caudal block against the volume of the local anaesthetic applied. After reviewing recent scientific literature, the authors compare the duration of postoperative analgesia in children scheduled for hypospadia repair when 2two different volumes and concentrations of a fixed dose of ropivacaine are used. ⋯ In children undergoing hypospadia repair, caudal block with a ''high volume, low concentration'' regimen produces prolonged analgesia and less motor block, compared to a ''low volume, high concentration'' regimen.
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Minerva anestesiologica · Jun 2006
Review Comparative StudyLow vs high positive end-expiratory pressure in the ventilatory management of acute lung injury.
Positive end-expiratory pressure (PEEP) has become an essential component of the care of many critically ill patients who require ventilatory support. The application of PEEP is expected to improve lung mechanics and gas exchange as it recruits lung volume. ⋯ Although the data from those animal studies and clinical trials could be seen as very convincing, there are insufficient data to propose an universal approach for the use of PEEP in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In this article I will review the basic mechanisms of PEEP and the current knowledge of the effects of PEEP on the evolution and outcome of ALI/ARDS.
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Minerva anestesiologica · Jun 2006
ReviewVolumetric capnography in the mechanically ventilated patient.
Expiratory capnogram provides qualitative information on the waveform patterns associated with mechanical ventilation and quantitative estimation of expired CO2. Volumetric capnography simultaneously measures expired CO2 and tidal volume and allows identification of CO2 from 3 sequential lung compartments: apparatus and anatomic dead space, from progressive emptying of alveoli and alveolar gas. Lung heterogeneity creates regional differences in CO2 concentration and sequential emptying contributes to the rise of the alveolar plateau and to the steeper the expired CO2 slope. ⋯ Calculations derived from volumetric capnography are useful to suspect pulmonary embolism at the bedside. Alveolar dead space is large in acute lung injury and when the effect of positive end-expiratory pressure (PEEP) is to recruit collapsed lung units resulting in an improvement of oxygenation, alveolar dead space may decrease, whereas PEEP-induced overdistension tends to increase alveolar dead space. Finally, measurement of physiologic dead space and alveolar ejection volume at admission or the trend during the first 48 hours of mechanical ventilation might provide useful information on outcome of critically ill patients with acute lung injury or acute respiratory distress syndrome.
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Minerva anestesiologica · Jun 2006
ReviewCritical bleeding in pregnancy: a novel therapeutic approach to bleeding.
In the developed countries the frequency of life threatening post-partum hemorrhages (PPH) is 1 in 1,000 deliveries with a risk of death of 1-2/100,000 deliveries. Hysterectomies for intractable bleeding are carried out in approximately 50% of the cases. The majority of PPH have obstetrical causes, most frequently atony of the uterus. Hereditary and acquired hemostatic defects are very rare. Guidelines of standard surgical and medical measures are available. In this paper we focus on the use of activated recombinant factor VII (rFVIIa) in PPH. ⋯ The bleeding can occur in a series of events conductive to metabolic complications, hypoxia, disseminate intravascular coagulation, organ damage and multiorgan failure, progressively exhaustive. The therapeutic intervention must be instituted as early as possible before successive complications ensue. These preliminary reports in PPH after failure of conventional standard therapy suggest that rFVIIa is an active agent but should be administered as early as possible before the consequences of severe and intractable bleeding.
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Minerva anestesiologica · Jun 2006
ReviewThe effect of alcohol abuse on ARDS and multiple organ dysfunction.
A history of alcohol abuse is very common and many times unrecognized in critically ill patients. The consequences of alcohol abuse are multifactorial, and it is associated with excessive morbidity and increased mortality. Alcohol causes acute and chronic dysfunction in multiple organ systems, and the underlying mechanisms responsible for organ injury are complex. ⋯ This increased susceptibility to developing acute lung injury has been evaluated by many investigators, and the common variable appears to be oxidative stress. In this article, we review the epidemiology of alcohol abuse and its association with ARDS. In addition, we provide an overview of the mechanisms thought to contribute to ARDS and multiple organ dysfunction.