Minerva anestesiologica
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Minerva anestesiologica · Dec 2010
Case ReportsAcute subdural intracranial hematoma after combined spinal-epidural analgesia in labor.
Intracranial subdural hematoma is a rare, but well-described complication of epidural and spinal anesthesia, as documented by more than a decade of publications. Non-postural headache and vomiting are warning signs. A headache lasting more than 5 days should arouse suspicion of intracranial hemorrhage, whether or not it is associated with the appearance of neurological signs or the deterioration of neurological status. ⋯ We report the case of a patient who suffered from severe neurological deterioration and manifested signs of brain herniation due to the development of an acute intracranial subdural hematoma after CSE analgesia for labor. An emergency craniotomy was performed to remove the subdural hematoma and the patient recovered well. Close observation of patients undergoing CSE analgesia or anesthesia complaining of prolonged non-postural headaches, with or without neurological symptoms, is recommended.
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Minerva anestesiologica · Dec 2010
Case ReportsParesis of cranial nerve VI (N. abducens) after thoracic dural perforation.
Epidural anesthesia is associated with the risk of unintended dural perforation and concomitant leakage of cerebrospinal fluid (CSF) from the subarachnoidal space. This may remain asymptomatic or trigger post-dural puncture headache (PDPH). ⋯ Herein, diagnosis of N. abducens paresis was probably delayed because the optical symptoms, such as blurred and double vision, were attributed to optical hallucinations caused by a concomitant (S)-ketamine infusion. In all patients with optical symptoms such as blurred or double vision a paresis of the abducens nerve should be considered.
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Traumatic brain injury (TBI) in children is frequent, sometimes lethal, and may have life-long consequences in survivors. Prevention at school and in sports, including both kids and families, is of paramount importance. ⋯ This non-systematic review suggests that rational organization of rescue and transport to designated hospitals, linked with early diagnosis/removal of surgical masses and comprehensive monitoring and intensive care, offer the best chances for reducing mortality and morbidity in severe cases. After the acute phase rehabilitation and families play a fundamental role.
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Minerva anestesiologica · Dec 2010
ReviewOROS® hydromorphone in chronic pain management: when drug delivery technology matches clinical needs.
The osmotic-controlled release oral delivery system (OROS®) is an innovative drug delivery technology that uses osmotic pressure as the driving force to deliver pharmacotherapies in many therapeutic areas. In chronic pain management requiring long-term therapy, pharmaceutical technologies that ensure the controlled release of analgesic medications are imperative. In addition, once-daily formulations ensure better patient compliance to prescribed therapies. ⋯ These studies support the clinical utility of the 5:1 ratio used for the conversion of oral morphine to oral OROS® hydromorphone. Furthermore, once-daily OROS® hydromorphone has been shown to be effective in patients with chronic cancer and non-cancer pain, and it provides similar pain relief to SR morphine and ER oxycodone. In chronic pain management, OROS® products can result in more stable drug concentrations, reduced dosing frequency and an improved safety profile.