Minerva anestesiologica
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Minerva anestesiologica · Apr 2012
ReviewMyths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade.
Fink & Hollman describe and refute several commonly-held myths regarding neuromuscular pharmacology. Their evidence-supported arguments are:
- Intubating patients without muscle relaxants is less safe and sub-optimal.
- Even if you know muscle relaxant pharmacokinetics, it is sufficiently unpredictable that neuromuscular monitoring and reversal is still necessary.
- Post-operative residual curarization (PORC) is clinically significant with real consequences.
- Postoperative residual curarization (PORC) is common.
- Postoperative residual curarisation (PORC) (TOFR < 0.9) can only be diagnosed with a quantitative neuromuscular monitor. Clinical tests are insufficient and poorly sensitive.
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Minerva anestesiologica · Apr 2012
Use of pulse pressure variation to estimate changes in preload during experimental acute normovolemic hemodilution.
Acute normovolemic hemodilution (ANH) is an alternative to blood transfusion in surgeries involving blood loss. This experimental study was designed to evaluate whether pulse pressure variation (PPV) would be an adequate tool for monitoring changes in preload during ANH, as assessed by transesophageal echocardiography. ⋯ Changes in preload during ANH were detected by changes in PPV. ∆PPV was superior to ∆PAOP and ∆CVP to this end.
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Minerva anestesiologica · Apr 2012
Case ReportsAcute liver failure due to acute fatty liver of pregnancy.
Acute fatty liver of pregnancy (AFLP) is a rare but serious liver disease and typically occurs during the third trimester. It carries the risk for significant perinatal and maternal mortality. Therefore an early diagnosis and delivery, followed by close monitoring and optimized management of the impaired liver function with all associated problems are necessary to prevent maternal and foetal death. This case report focuses on the management of acute liver failure due to AFLP in a 31 year old women treated in our intensive care unit (ICU) after an emergency C-section.