Minerva anestesiologica
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Minerva anestesiologica · Jan 2014
Determination of respiratory system mechanics during inspiration and expiration by FLow-controlled EXpiration (FLEX): A pilot study in anesthetized pigs.
Differences between inspiratory and expiratory lung mechanics result in the hysteresis of the pressure volume-loop. While hysteresis area is a global parameter describing the difference between inspiration and expiration in mechanics under quasi-static conditions, a detailed analysis of this difference under the dynamic conditions of mechanical ventilation is feasible once inspiratory and expiratory compliance (Cin/Cex) are determined separately. This requires uncoupling of expiratory flow rate and volume (V). ⋯ The relation between inspiratory and expiratory compliance profiles is associated with the hysteresis area and behaves PEEP dependent. Analysing the Cin-Cex-relation might therefore potentially offer a new approach to titrate PEEP and tidal volume.
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Comparative StudyPilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph®) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy.
This study aims at investigating the effect of a single pre-operative oral administration of morphine sulphate (Oramorph®) on pain after laparoscopic cholecystectomy (LC). ⋯ Within a multimodal approach, a single preoperative oral administration of 30 mg of morphine sulphate in patients undergoing LC did not improve pain at rest, but improved NRS on movement during the first 3 hours after awakening. Group P required a higher mean dose of tramadol compared to Group M, although not significantly. The safety profile of Oramorph® allowed fast extubation and awakening times as well as prompt home discharge within 6 hours from surgery.
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Comparative StudyTotal Intravenous Anesthesia using Remifentanil in Extracorporeal Shock Wave Lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial.
Extracorporeal Shock Wave Lithotripsy is usually performed in day surgery setting, consequently people who undergo to this procedure need a safe and fast recovery. Conscious sedation with remifentanil can relieve from pain and keep patients in touch with anaesthesiologists. Few publications tell about infusion rates administered to perform this procedure7. The aim of this study is to assess which is the most appropriate infusion rate. ⋯ According with previous results remifentanil at the infusion rate of 0.05 µg/kg/min provides an effective analgesia, causing a lower incidence of side effect than 0.1 µg/kg/min, granting a fast and safe recovery.
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Comparative StudySupplemental single shot femoral nerve block for total hip arthroplasty - Impact on early postoperative care, pain management and lung function.
Peripheral regional anesthesia is beneficial in the management of postoperative pain in hip surgery, and can also reduce post-operative care unit (PACU) stay. Its opioid-sparing actions may also be beneficial for respiratory mechanics and pulmonary function. The aim of our pilot study was to evaluate the effect of a supplemental single shot femoral block for elective total hip arthroplasty on early respiratory function and postoperative management within the first 24 postoperative hours. ⋯ Supplemental single shot femoral nerve block for total hip arthroplasty resulted in earlier PACU discharge capability, improved lung function during the first six hours and better pain control within the first 24 postoperative hours.
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Coagulation is a complex cascade whose intact functioning is essential in helping control hemorrhage after injury. While traditionally ascribed to the combined effects of acidosis, hypothermia, factor consumption and factor dilution, coagulopathy is also directly related to injury as well as hypofibrinogenemia and hyperfibrinolysis. ⋯ Both conditions offer opportunities for therapeutic intervention, and inhibition or abrogation of hyperfibrinolysis in particular may significantly improve survival in patients with injury and massive hemorrhage. Herein, we explore the underpinnings of trauma associated coagulopathy, the basic science behind the role of fibrinogen in acute traumatic coagulopathy, and the rationale behind and the data derived from management of hypofibrinogenemia as well as hyperfibrinolysis.