Minerva anestesiologica
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The awake craniotomy technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management of supratentorial tumors, arteriovenous malformation, deep brain stimulation, and mycotic aneurysms near critical brain regions. This surgical approach aims to maximize lesion resection while sparing important areas of the brain (motor, somatosensory, and language areas). Awake craniotomy offers great advantages with respect to patient outcome. In this type of procedure, the anesthetist's goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Many authors have described different anesthetic care protocols for awake craniotomy based on monitored or general anesthesia; however, there is still no consensus as to the best anesthetic technique. The most commonly used drugs for awake craniotomies are propofol and remifentanil, but dexmedetomidine is beginning to be used more commonly outside of Europe. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake craniotomy ⋯ Additional studies are necessary in order to optimize the procedure, reduce complications, and improve patient tolerance. The aim of this review is to present a thorough report of the literature, with particular attention to neuro-oncology surgery.
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Minerva anestesiologica · Jul 2008
Randomized Controlled Trial Multicenter Study Comparative StudyLevobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgery.
To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine plus fentanyl in patients undergoing lower limb surgery. ⋯ Although both interventions showed similar anaesthetic effects, a higher proportion of patients receiving levobupivacaine lacked MB.
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Minerva anestesiologica · Jul 2008
ReviewHypothermia in adult neurocritical patients: a very ''hot'' strategy not to be hibernated yet!
Therapeutic moderate hypothermia (32-34 degrees C) is currently recommended for patients with out-of-hospital cardiac arrest (OHCA) and for newborns exhibiting neonatal hypoxic/ischemic encephalopathy. Hypothermia as neuroprotective strategy has been extensively studied in other scenarios, mainly for traumatic brain injury. Despite a negative result reported by a multicenter trial conducted in 2001 by Clifton et al. regarding the use of hypothermia on head injury patients, several studies in both clinical and laboratory settings have continued to report positive outcomes with hypothermia use in neurocritical care. ⋯ However, new research may indicate what target populations can benefit most from this therapy. Furthermore, issues of timing (when and for how long hypothermia is applied) seem to be the primary drivers of the most unambiguous findings in this matter. For the time being, we conclude that further studies are needed to assess how to better administer this possibly beneficial therapy, and who might benefit most from the technique.
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Minerva anestesiologica · Jul 2008
ReviewHotly debated topics in obstetric anesthesiology 2008: a theory of relativity.
This paper reviews and discusses three controversial subjects regarding treatment of intraoperative nausea and other complications experienced by patients undergoing cesarean delivery under spinal anesthesia: (1) the administration of supplemental oxygen, (2) prophylactic vasopressors and (3) the use of low-dose combined spinal epidural anesthesia (CSE). While not universally acknowledged, recent data suggest that the routine administration of supplemental oxygen to normal-weight, healthy patients undergoing elective cesarean delivery is unnecessary, especially when spinal hypotension is minimized. Supplemental oxygen administration does not prevent intraoperative or postoperative nausea and vomiting. ⋯ High-dose phenylephrine infusion in conjunction with rapid co-hydration is efficient, but is unfortunately associated with a relatively high incidence of maternal bradycardia. Oxygen, fluid administration and prophylactic vasopressors may not be the solution to hypotension, nausea and vomiting associated with spinal anesthesia during cesarean delivery. Lower dose spinal anesthesia as part of a CSE technique reduces the incidence of maternal hypotension, and in our opinion is the best option currently available.