Minerva anestesiologica
-
Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed procedures in critically ill patients receiving mechanical ventilation. Although many papers have compared different PDT techniques, few records on the outcome of tracheostomized patients after intensive care unit (ICU) discharge are available. ⋯ PDT-related early complications without clinical consequences were observed. Conversely, late complications were infrequent but had significant clinical implications. Although late decannulation is the major risk for complications, in 83.9% of cases tracheostomy is only a temporary measure.
-
Minerva anestesiologica · Nov 2009
Case ReportsPerineural infusion of 0.5% ropivacaine for successful treatment of phantom limb syndrome: a case report.
Phantom limb syndrome (PLS) comprises various disturbances, including pain in the missing limb and phantom sensations. This study is about the successful treatment of a PLS patient by prolonged infusion of local anesthetic through a perineural catheter. A 45-year-old man came to the Rizzoli Orthopedic Institute (Bologna, Italy) complaining of a painful right leg after trauma. ⋯ Follow-ups at 6, 12, 24, and 36 months confirmed that the PLS did not reappear. The results are limited to one patient but are encouraging, particularly due to the relevance of the pathology and the poor results of conventional treatments. More cases are obviously needed to support the efficacy of this therapy.
-
Minerva anestesiologica · Nov 2009
Postoperative pain survey in Italy (POPSI): a snapshot of current national practices.
Over the last several years, significant efforts have been directed towards improving the quality of postoperative pain management. As data are lacking on the organization and quality of these services in Italy, we surveyed current Italian practices. ⋯ A comparison to international survey data showed that postoperative pain management in Italy is still below the European standards. Additional efforts to overcome these hurdles and to reach an acceptable level of quality are required.
-
Minerva anestesiologica · Nov 2009
Randomized Controlled Trial Comparative StudyA comparison of epidural vs. paravertebral blockade in thoracic surgery.
Epidural analgesia is considered to be the best method of pain relief after major surgery despite its side-effects, which include hypotension, respiratory depression, urinary retention, incomplete or failed block, and, in rare cases, paraplegia. Paravertebral block is an alternative technique that may offer a comparable analgesic effect and a better side-effect profile. This study measured postoperative pain and respiratory function in patients randomized to receive either paravertebral block or epidural analgesia for pain control after thoracic surgery. ⋯ Epidural analgesia is more efficient than paravertebral continuous block at reducing pain after thoracic surgery.
-
Minerva anestesiologica · Nov 2009
ReviewWhat anesthesiologists should know about paracetamol (acetaminophen).
Paracetamol is widely used in the management of acute and chronic pain. The purpose of this review is to give anesthesiologists answers to some of the most common questions about paracetamol, specifically the following questions. What is the mechanism of action of paracetamol? Is paracetamol a NSAID? Which endogenous analgesic systems are influenced by paracetamol? Are the perceived concerns about paracetamol use real? What new research is there into paracetamol-induced liver failure? Is paracetamol safe for use by patients with liver disease or those taking anticoagulants? How effective is paracetamol for the management of postoperative pain? Does paracetamol have any opioid-sparing effects? Which formula has the best analgesic efficacy? Which route of administration has the better pharmacokinetic profile? Is the concentration of paracetamol in blood or cerebrospinal fluid relevant to the analgesic effect? Which starting dose should be administrated in intravenous infusion?