Minerva anestesiologica
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Minerva anestesiologica · Jan 2014
The effects of intrathecal and systemic adjuvants on subarachnoid block.
Various intrathecal and systemic adjuvants to local anaesthetics have been found to improve the quality and extend the duration of spinal block. Intrathecal opioids are the most frequently used; the lipophilic fentanyl and sufentanil enhance and moderately prolong the sensory block, whereas the hydrophilic morphine significantly prolongs spinal analgesia. Nausea/vomiting, pruritus, urinary retention and respiratory depression are possible side effects. ⋯ Opioids enhance, alpha-2 agonists and ketamine prolong the block, magnesium sulphate reduces postoperative analgesic consumption and nimodipine may delay the regression of sensory block. Nitrous oxide inhalation has also been found to enhance the level of sensory spinal block. Even though opioids are the most popular adjuvants to spinal local anaesthetics, a variety of drugs given intrathecally or systemically, can accelerate, improve and extend the spinal block.
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Minerva anestesiologica · Jan 2014
Clinical Characteristics, Hospital outcome and Prognostic Factors of Patients with Ventilator-related Pneumothorax.
Mechanical ventilation is a common cause of iatrogenic pneumothorax in intensive care units (ICU). Most of the patients with ventilator-related pneumothorax (VRP) have underlying lung diseases and is associated with increased morbidity and mortality. The prognostic factors of VRP are not clear. The objective of this study was to find the possible prognostic factors. ⋯ VRP patients with tension pneumothorax or PaO2/FiO2<200 had a higher risk of death. APACHE II scores were associated with mortality in the VRP patients with PaO2/FiO2≥200 mmHg.
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Anesthesiologists are increasingly turning to videolaryngoscopes (VLs) for normal and difficult endotracheal intubations. As children grow the airway is in constant transition. This means that a device that works well in an older child may fail in an infant. Are VLs ideal in all children? What are the pitfalls and strengths of these devices? When are they indicated? How should their efficacy be assessed? Can they play a role in teaching standard laryngoscopy? This article explores these questions and reviews the literature relating to VLs use in children.