Minerva anestesiologica
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Physician-patient relationship is the key-point for an optimal management of any medical procedure. Before performing any diagnostic or therapeutic procedure, clinical communication with patients is necessary. It should regard the nature and purpose of a proposed procedure including potential risks and benefits. ⋯ Cognitive impairment may limit the ability to actively participate in the process. In this context, physicians deal with three different situations on a daily basis: 1) patients with good cognitive functioning; 2) patients with various degrees of cognitive impairment; 3) patients with a legal guardian. The aim of this review was to discuss patterns of an accurate, empathetic and effective communication process that may be used during the informed consent process with a particular attention to the emerging problems in the practice of anesthesia in the elderly.
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Minerva anestesiologica · Feb 2012
The Bonfils fiberscope: a clinical evaluation of its learning curve and efficacy in difficult airway management.
This study evaluated the use of the Bonfils fiberscope by analyzing its learning curve, efficacy and safety during airway management. ⋯ The Bonfils fiberscope is an efficient, easy to use and safe device for endotracheal intubation.
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Minerva anestesiologica · Feb 2012
Case ReportsDifficult airway in a pediatric patient with Klippel-Feil syndrome and an unexpected lingual tonsil.
Klippel-Feil Syndrome (KFS) is a congenital defect characterized by the fusion of at least two cervical vertebrae. This article presents the case of a 12-year-old girl with KFS planned for scoliosis surgery. ⋯ Imaging tests showed lingual tonsil hypertrophy and a deviation of the tracheal axis, clarifying the causes of the failed intubation and suggesting new approaches for airway management. As far as we know, the association of KFS and lingual tonsil hypertrophy has not been reported before in the literature.
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Intrinsic positive end-expiratory pressure (auto-PEEP) is a common occurrence in patients with acute respiratory failure requiring mechanical ventilation. Auto-PEEP can cause severe respiratory and hemodynamic compromise. The presence of auto-PEEP should be suspected when airflow at end-exhalation is not zero. ⋯ Strategies that may reduce auto-PEEP include reduction of minute ventilation, use of small tidal volumes and prolongation of the time available for exhalation. In patients in whom auto-PEEP is caused by expiratory flow limitation, the application of low-levels of external PEEP can reduce dyspnea, reduce work of breathing, improve patient-ventilator interaction and cardiac function, all without worsening hyperinflation. Neurally adjusted ventilatory assist, a novel strategy of ventilatory assist, may improve patient-ventilator interaction in patients with auto-PEEP.