Minerva anestesiologica
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Minerva anestesiologica · Jan 2011
ReviewLung recruitment maneuvers during acute respiratory distress syndrome: is it useful?
Although significant advances have been made in approaches to manage the acute respiratory distress syndrome (ARDS), reported overall mortality for ARDS is still high. Recruitment maneuvers (RM) have been recommended by some as potential adjuncts to lung protective ventilatory approaches in ARDS. ⋯ Specifically, the ability of RM to open the lung, the safety of RM, and their affect on outcome are addressed. Finally, a specific approach to performing RM with the use of a decremental PEEP trial is outlined.
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Subarachnoid hemorrhage (SAH) remains a serious condition with high mortality and disability. In the past decades, there have been improvements in the techniques to secure aneurysms both surgical and endovascular techniques aimed at reducing the risk of future bleeding events. ⋯ Intracranial and extracranial complications following SAH are common and impact long-term outcomes. Intensive care management of patients with SAH offers the opportunity to reduce morbidity by reducing secondary insults and preventing complications.
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Minerva anestesiologica · Jan 2011
Study of the OPRM1 A118G genetic polymorphism associated with postoperative nausea and vomiting induced by fentanyl intravenous analgesia.
Genetic polymorphisms of the μ-opioid receptor gene OPRM1 A118G have been shown to influence opioid efficacy. The association of the OPRM1 A118G genetic polymorphism with side effects, such as nausea and vomiting, caused by opioids during analgesia has not been well-represented by the literature . This study aimed to investigate whether the genetic polymorphism of OPRM1 A118G contributed to the variability in nausea and vomiting during fentanyl analgesia in patients undergoing total abdominal hysterectomy or myomectomy. ⋯ OPRM1 A118G has no effect on the individual variation of postoperative nausea and vomiting, the side effects of fentanyl analgesia, in Chinese women undergoing gynecologic surgery.
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Minerva anestesiologica · Jan 2011
ReviewIntraneural injections and regional anesthesia: the known and the unknown.
Peripheral nerve injury is a rare complication of regional anesthesia. Intraneural injections were once considered harbingers of neural injury with practitioners focusing on their avoidance. ⋯ We also now have a better understanding of the multifactorial nature of neurologic injury based on the nerve anatomy, site of needle insertion, bevel type, location of the needle tip, pressure achieved during injection, and underlying patient factors. Using ultrasound guidance during nerve blocks has revealed that not all intraneural injections result in injury, and its use will continue to provide insight into the mechanism of anesthetic-related nerve injury.
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Minerva anestesiologica · Jan 2011
Case ReportsLipid therapy for serotonin syndrome after intoxication with venlafaxine, lamotrigine and diazepam.
A 44-year-old woman developed coma and seizure activity after intentional ingestion of 200 mg diazepam, 20 g lamotrigine and 4.5 g venlafaxine. In our intensive care unit a distinct rigidity and hyperreflexia was observed. This status was not influenced by haemodialysis which was initiated directly after admission. ⋯ Eight hours after the start of haemodialysis a 150 mL (2.5 mL/kg) intravenous bolus of 20% lipid emulsion was given. Soon after administration of the lipid infusion the distinct rigidity and hyperreflexia disappeared. The further course was uneventful.