Minerva anestesiologica
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Anaesthetic management in asthmatic patients has been focused on avoiding bronchoconstriction and inducing bronchodilation. However, the definition of asthma has changed over the past decade. Asthma has been defined as a clinical syndrome characterized by an inflammatory process that extends beyond the central airways to the distal airways and lung parenchyma. ⋯ Sevoflurane has shown controversial results in asthmatic patients. Vecuronium, rocuronium, cisatracurium, and pancuronium do not induce bronchospasm, while atracurium and mivacurium can dose-dependently release histamine and should be cautiously administered in those patients. Further knowledge about the sites of action of anaesthetic agents in the lung, allied with our understanding of asthma pathophysiology, will establish the best anaesthetic approach for people with asthma.
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Minerva anestesiologica · Jun 2007
Randomized Controlled TrialPostoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone.
The incidence of postoperative nausea and vomiting (PONV) is high after laparoscopic surgery. A number of drugs have been used for prevention; in some studies a single dexamethasone dose before induction of anaesthesia has been effective. ⋯ Although only a small number of patients were tested, we confirm the efficacy of dexamethasone therapy for reduction of PONV. We suggest routine use of a single dose of dexamethasone for the prevention of PONV in laparoscopic cholecystectomy.
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Minerva anestesiologica · Jun 2007
Randomized Controlled TrialShort term analgesia based sedation in the Intensive Care Unit: morphine vs remifentanil + morphine.
The aim of the study was the evaluation of postoperative short term analgesia-based sedation provided by a continuous i.v. morphine vs morphine+remifentanil infusion in the ICU. ⋯ The combination of morphine + remifentanil provided better analgesia and sedation than morphine alone, with a lower incidence of side effects and a similar hemodynamic profile and patient satisfaction. The adherence to a clear analgesia based sedation protocol probably represents the most important issue carrying out analgosedation; however, the continuous infusion of a short acting drug, although more expensive, allows better titration and adjustment of the desired level of analgesia and sedation, avoiding the risk of undersedation as well as oversedation with a potential reduction of otherwise unnecessary ICU stays and, consequently, a decrease in comprehensive costs.