Minerva anestesiologica
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Following successful resuscitation from cardiac arrest, neurological impairment as well as other types of organ dysfunction still cause significant morbidity and mortality. The whole-body ischemia-reperfusion response that occurs during cardiac arrest and subsequent restoration of systemic circulation results in a series of pathophysiological processes that have been termed the post-cardiac arrest syndrome. The components of the post-cardiac arrest syndrome comprise post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, the systemic ischemia-reperfusion response and persistent precipitating pathology. ⋯ Particular attention should be given to evidence of cardiac ischemia and referral for urgent angiography and percutaneous coronary intervention, if appropriate, should be available to all. Optimizing neurological recovery will involve seizure control, management of hyperglycemia and therapeutic hypothermia. Prognostication following cardiac arrest remains difficult, but there are diagnostic tests that may be used with some degree of accuracy.
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Minerva anestesiologica · May 2010
Randomized Controlled TrialEpidural analgesia with ropivacaine and sufentanil is associated with transient fetal heart rate changes.
Fetal heart rate (FHR) changes have been reported after regional labor analgesia. In this prospective single-blinded study, we aimed to assess whether epidural analgesia with ropivacaine and sufentanil is associated with significant changes in fetal heart rate. ⋯ Epidural analgesia with ropivacaine and sufentanil is associated with fetal heart rate changes. These modifications are transient and should be considered when evaluating fetal heart rate monitoring during labor to prevent inappropriate obstetric management decisions to proceed with operative labor.
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Minerva anestesiologica · May 2010
Case ReportsKidney instant monitoring (K.IN.G): a new analyzer to monitor kidney function.
The key role of the kidney in the regulation of body fluids and acid-base status is well known. Nonetheless, urine analysis has not received great attention in critically ill patients, likely due to the common practice of only analyzing 24-hour collected specimens. We hypothesized that the kidney may react more rapidly to minimal hemodynamic and acid-base status variations than can be assessed by a 24-hour analysis. Accordingly, we developed and tested a urine analyzer, allowing quasi-continuous urinary analysis. ⋯ The K.IN.G analyzer, allowing quasi-continuous monitoring of urinary pH and principal electrolyte levels, may represent a novel tool for clinical and research purposes.
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Minerva anestesiologica · May 2010
Case ReportsThe use of an i-gel supraglottic airway for the airway management of a patient with subglottic stenosis: a case report.
The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologist. Although many anesthesiologists would prefer the use of a narrow endotracheal tube in this patient population, the use of laryngeal mask airways has also been described. We report the case of a patient who was managed using an i-gel supraglottic airway due to a difficulty with inserting an endotracheal tube during a previous procedure. ⋯ Furthermore, the vocal cords were successfully visualized using a fiberscope, allowing the possibility of eventual fiberoptic intubation, if it had been necessary. The presence of subglottic stenosis was also confirmed using the fiberscope. Thus, the i-gel airway device has multiple features that makes it suitable for use in situations where a narrow endotracheal tube is inadvisable or too difficult to use.
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Minerva anestesiologica · May 2010
Letter Case ReportsInsertion of the i-gel airway in prone position.