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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Patients in the Intensive Care Unit (ICU) experience qualitative and quantitative sleep disruption leading to sleep deprivation and adverse sequelae. Patient-related factors, environmental factors, and health-support techniques contribute to sleep disruption. This quality improvement study examines potential factors contributing to poor sleep in the ICU. ⋯ Patients commonly report poor sleep in the ICU related to environmental factors that are potentially modifiable.
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Minerva anestesiologica · Apr 2012
Echocardiographic evaluation and N-terminal pro-brain natriuretic peptide measurement of patients hospitalized for heart failure during weaning from mechanical ventilation.
Weaning patients with heart failure who have required mechanical ventilation remains challenging. We evaluated echocardiographic indexes and N-terminal pro-brain natriuretic peptide (NT-proBNP) as markers of acute cardiac dysfunction before and after spontaneous breathing trials (SBT) in such patients to assess their ability to predict subsequent successful extubation. ⋯ Neither NT-proBNP level nor the studied echocardiographic indices before SBT were able to predict SBT outcome in patients presenting with severe heart failure. Failure to increase the cardiac index and increases in both E/Ea ratio and NT-proBNP levels were seen at end-SBT in patients who failed the SBT, and may reflect failure of myocardial reserve to cope with the stress of SBT.
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Minerva anestesiologica · Apr 2012
Ultrasound identification of nerve cords in the infraclavicular fossa: a clinical study.
This study aimed to analyze nerve trunk anatomy in the infraclavicular fossa and to correlate these data with the most common anthropometric parameters. ⋯ Sono-anatomic study of the infraclavicular region adds important data that is useful when conducting nerve blocks to improve safety and likelihood of success.
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The drugs and techniques used in contemporary anaesthesia may provoke numerous side effects, including cardiac rhythm disturbances. The prolongation of the repolarization time, reflected by the QT interval in a surface electrocardiogram, is one of the mechanisms that lead to the occurrence of arrhythmias. In the paper, we present the primary mechanism that is responsible for QT interval prolongation and subsequent torsade de pointes ventricular tachycardia. The influence of anesthetics, regional anesthesia and perioperative supportive therapy on cardiac repolarization is described.