Minerva anestesiologica
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Minerva anestesiologica · Feb 2010
The pharmacodynamic effects of rocuronium during general anesthesia in patients with type 2 diabetes mellitus.
The aim of this prospective study was to investigate whether the neuromuscular response to rocuronium is affected by the presence of type 2 diabetes mellitus. ⋯ The present study has proven that the rocuronium-induced neuromuscular block was not affected in patients with type 2 diabetes mellitus during isoflurane based general anesthesia.
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Minerva anestesiologica · Feb 2010
Case ReportsAnesthetic management for right upper extremity amputation due to recidivous cutaneous carcinoma and acute postoperative pain control in patients affected by epidermolysis bullosa.
A 22-year-old male who was affected by epidermolysis bullosa (EB) and xeroderma pigmentosa (with structural and pathological changes that preclude orotracheal intubation) underwent right upper extremity amputation and ipsilateral axillary lymphadenectomy. The patient was operated without intubation, thereby assuring an optimal state of acute postoperative pain control by regional anesthesia. Intravenous administration of ketamine and remifentanil plus low-dose sevoflurane resulted in anesthesia with spontaneous breathing by the patient. Moreover, the intraoperative brachial plexus nerve block before amputation followed by positioning of an epidural catheter to deliver continuous infusion of local anesthetics close to the cut nerves during surgery obtained a very good level of acute postoperative pain control.
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Minerva anestesiologica · Feb 2010
Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries.
Local anesthetic toxicity remains one of the most dreaded complications of the intravenous regional anesthesia (IVRA) technique. It results from the sudden release of a large amount of local anesthetic (LA) into the systemic circulation. This release can occur when the tourniquet deflates accidentally during the procedure or when it is deflated intentionally at the end of the procedure to terminate the anesthesia. The forearm tourniquet IVRA technique may offer distinct advantages over the conventional upper arm tourniquet IVRA technique. Use of a forearm tourniquet allows the dosage of local anesthetic to be decreased to almost half of what is required with an upper arm tourniquet, and the incidence of tourniquet pain has been reported to be less with forearm tourniquet. In this study, authors assessed the clinical efficacy of administering IVRA with lidocaine plus ketorolac using either a forearm or upper arm tourniquet. ⋯ In conclusion, forearm IVRA provides effective perioperative anesthesia and analgesia. The technique results in a similar clinical profile as upper arm IVRA while using half the dose of both lidocaine and ketorolac.
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Minerva anestesiologica · Feb 2010
Transcatheter implantation of an aortic valve: anesthesiological management.
Transcatheter aortic valve implantation (TAVI) is an emergent alternative technique to surgery in high-risk patients with aortic stenosis. Here, we describe the anesthesiological management of patients undergoing TAVI at our institution over an 18-month period. ⋯ TAVI is feasible in high-risk patients who would not be able to undergo surgical valve replacement. Hemodynamic management is the main concern of intraoperative anesthesiological management. General or local anesthesia plus sedation are both valid alternative techniques that can be titrated according to patient characteristics. Close postoperative monitoring in the ICU is required.