Minerva anestesiologica
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It is well established that general anesthesia, with or without paralysis, causes profound changes in respiratory function. From a clinical point of view, the more important consequence of this impairment is a decreased efficiency of gas exchange, with a decreased blood oxygenation. The main reason of this respiratory embarrassment is the intraoperative occurrence of atelectasis, mainly in the dependent lung regions. ⋯ As the anesthesia-induced atelectasis are also present in the postoperative period, this ventilatory approach may also be used to prevent this condition. In obese patients PEEP seems to have a major effectiveness than in normal subjects, with an improvement of lung volumes, respiratory mechanics, gas exchange and an occurrence of recruitment. However, further studies are necessary to define optimal value of PEEP and tidal volume for different types of patients.
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Minerva anestesiologica · Dec 1999
Editorial Review Comparative StudyDo we need new supraglottic devices? Clinical appraisal of the cuffed oropharyngeal airway (COPA)
The laryngeal mask airway (LMA) has been widely studied for both conventional and nonconventional uses, while the literature on the cuffed oropharyngeal airway (COPA) is still limited. The purpose of this manuscript was to review the initial appraisal of efficacy, safety, effects on hemodynamics and respiratory function, induction agents and drug requirements of this new supraglottic device. ⋯ More extensive clinical evaluations should be advocated to better understand the risk/benefit ratio of this new supraglottic device; however, it may be concluded that in healthy adults receiving general anesthesia for short procedures the COPA allows for an effective and safe control of the patient's airway and ventilation.
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Sepsis is a condition at high risk for the patients to develop organ(s) or system dysfunction/failure and represent a very limiting process for survival. Researchers and clinicians proposed standardization of terminology for sepsis and related problems to improve communication and to evaluate the efficacy of preventive measures and therapeutic interventions. Interrelationship among systemic inflammatory response syndrome (SIRS), infection and sepsis are surrounded by non infectious satellite events such as trauma, burns, pancreatitis, haemorrhagic shock, immune-mediated organ injury and infectious cause such as fungemia, parasitemia, viremia. ⋯ Multiple sources of sepsis is a phenomenon clearly associated with poor prognosis and all the sepsis trials managed in the last decades have failed on reducing mortality rate in enrolled patients. Development of scoring system routinely used at bedside represent an important method to establish cost-effectiveness in this exiting area of study and clinical management. Controversial results on sepsis need a sort of consensus at different level from researchers to clinician experiencing new strategies for prevention and more appropriately therapeutic approach for the management of this syndrome.
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A variety of drugs and techniques have been introduced into day surgery over recent years and, although the tide of development appears to have slowed, may of these will still be relatively new to many. Experience with the laryngeal mask continues to grow and it is now a firmly-established airway management tool in a wide variety of procedures. The cuffed oropharyngeal airway is an interesting recent arrival, but produces inferior airway control and is not a true alternative to the laryngeal mask. ⋯ The long-awaited "depth of anaesthesia" monitor may have arrived, offering the possibility of more finely titrated anaesthesia with earlier (but not intraoperative!) awakening. Reliability is as yet uncertain and a simple technique with spontaneous ventilation may achieve similar results at substantially lower cost. The relative place of all these developments will take several years to become apparent and the future remains interesting.