Minerva anestesiologica
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Minerva anestesiologica · Jun 2010
Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence.
Inadequate emergence after anesthesia in the adult patient may be distinguished by the patients' activity level into two subtypes: emergence delirium and hypoactive emergence. The aim of this study was to determine the incidence of inadequate emergence in its different forms, to identify causative factors and to examine the possible influence on postoperative length of stay in the recovery room and in the hospital. ⋯ Inadequate emergence after anesthesia is a frequent complication. Preventable risk factors for emergence delirium were induction of anesthesia with etomidate, premedication with benzodiazepines and higher postoperative pain scores. Hypoactive emergence was less frequent than emergence delirium and was associated with a longer postoperative hospital stay.
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Minerva anestesiologica · Jun 2010
Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis.
The beneficial role of hemofiltration with immobilized polymyxin-B fiber (PMX) columns in sepsis, especially sepsis due to gram-negative bacteria, has previously been emphasized. Although the efficacy of PMX-B fiber-mediated hemofiltration in reducing plasma levels of cytokines has been reported, other studies did not confirm this observation. Here we report the effects of PMX-B fiber-mediated hemofiltration on outcome and cytokine plasma levels in patients with abdominal sepsis. ⋯ Hemofiltration with a PMX fiber column was able to reduce plasma levels of IL-6, IL-10 and TNF-a, especially in patients surviving at 28 days. Use of the technique was associated with lower norepinephrine support and an increased PaO2/FiO2 ratio.
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Minerva anestesiologica · Jun 2010
Nitrous oxide discretely up-regulates nNOS and p53 in neonatal rat brain.
Animal studies suggest that neuronal cell death often results from anesthetic administration during synaptogenesis. Volatile anesthetics are strongly involved in triggering neuronal apoptosis, whereas other inhalational agents (xenon) demonstrate protective effects. Nitrous oxide (N2O) has modest pro-apoptotic effects on its own and potent, synergistic toxic effects when combined with volatile agents. Recent findings suggest that, during periods of rapid brain development, the enhanced neurodegeneration triggered by anesthetic drugs may be caused by a compensatory increase in intracellular free calcium, a potent activator of neuronal nitric oxide synthase (nNOS). Anesthesia-induced neuro-apoptosis is also activated via the intrinsic and the extrinsic apoptotic pathways because both pathways involve p53, a key regulatory gene. The molecular events related to neuronal cell apoptosis are not completely understood. To gain further insight into the events underlying neuro-apoptosis, we analyzed the transcriptional consequences of N2O exposure on nNOS, iNOS and p53 mRNA levels. ⋯ Our preliminary data show that N2O induced a selective increase in nNOS and p53 transcription. These new findings provide evidence of pro-apoptotic action by N2O and may shed new insight on its toxic effects; however, further investigations are necessary.
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Minerva anestesiologica · May 2010
Case ReportsHypotonic and isotonic fluid overload as a complication of hysteroscopic procedures: two case reports.
Hysteroscopy is used extensively for both the diagnosis and treatment of intrauterine pathology. Although considered a safe procedure, complications such as cervical laceration, uterine perforation, absorption of irrigation solutions and, rarely, gas or air embolism may occur. ⋯ Hypotonic as well as isotonic distention media can cause serious complications. The authors focus on factors that may increase the risk of fluid overload, which should be known to both anesthesiologists and gynecologists.
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Neurally adjusted ventilatory assist (NAVA) is a form of partial ventilatory support wherein the machine applies positive pressure to the airway opening throughout each inspiration. In contrast to all other modes of ventilation, which adopt conventional pneumatic signals (flow, volume, and airway pressure) to drive and control the ventilator operation, NAVA utilizes the electrical activity of the diaphragm, which is the best available signal to estimate the respiratory drive and to trigger on and cycle off the delivery of the mechanical assistance and regulate its amount and intra-breath profile. ⋯ These investigations indicate that this novel mode is efficient in unloading the respiratory muscles and maintaining adequate gas exchange while improving the patient-ventilator interaction. This review article aims to summarize the results of the studies published to date on this topic.