Minerva anestesiologica
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Inhalation agents represent a basic drug used in modern balanced anesthesia. In the present review, the pharmacokinetics, effectiveness and clinical effects of inhalation agents on different systems are discussed. ⋯ The cardioprotective effect of halogenated agents and the actual role of nitrous oxide and xenon are discussed. The different mechanisms of action of the inhalation agents and the evolution from a unitary theory of inhaled anesthetics to a multiple mechanism concept are presented.
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Minerva anestesiologica · Mar 2010
Case ReportsImportance of perioperative monitoring of cerebral tissue saturation in elderly patients: an interesting case.
The authors describe the case of an elderly diabetic patient with a hip fracture who developed neurocognitive dysfunction and dysarthria preoperatively. Upon arrival in the operating room, the monitoring of cerebral oxygenation by near-infrared spectroscopy (NIRS) showed cerebral desaturation (44% on the left hemisphere and 46% on the right). ⋯ The patient's cerebral saturation was 60% on the left and 58% on the right hemisphere after the end of surgery and he was in normal neurological status. Observations underlined the importance of preoperative evaluation of cerebral tissue oxygenation by non-invasive cerebral NIRS in elderly diabetic patients who develop hypovolemia and anemia due to major fracture.
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Minerva anestesiologica · Mar 2010
Randomized Controlled Trial Comparative StudyAttenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol.
This study was designed to compare the effectiveness of remifentanil vs. a lidocaine-esmolol combination in blunting the hemodynamic response to laryngoscopy and intubation during rapid sequence induction using thiopental and rocuronium in normotensive patients. ⋯ The results of this study show that remifentanil 1 mg/kg is more effective than the combination of lidocaine 1.5 mg/kg and esmolol 1 mg/kg for attenuating the hemodynamic responses to rapid sequence intubation.
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Minerva anestesiologica · Mar 2010
Case ReportsAnesthetic management of an adult patient with Cornelia de Lange Syndrome.
Cornelia de Lange Syndrome is a well-known congenital disease characterized by multiple malformations that make anesthetic management a challenge. Since few individuals survive the earliest stage of life, papers describing the details of anesthetic management are mainly reported in the pediatric population. These individuals who move into adulthood develop physical changes that should be taken into consideration. ⋯ Fiber optic intubation was performed under slight sedation after three unsuccessful attempts. Dental crowding, prominent upper central incisors that were more pronounced than in most children, a short and stiff neck, and poor patient cooperation due to mental retardation and occasional autistic behavior made airway management difficult. This case should alert anesthesiologists to the greater difficulties of managing patients with Cornelia de Lange Syndrome when they become adults.