Minerva anestesiologica
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Minerva anestesiologica · May 2010
Randomized Controlled TrialTime course of endogenous nitric oxide inhibitors in severe sepsis in humans.
Asymmetric and symmetric dimethylarginines (ADMA and SDMA, respectively) are protein breakdown markers; both compete with arginine for cellular transport and both are excreted in urine. Moreover, ADMA is a non-selective inhibitor of nitric oxide (NO) synthase that is metabolized by a specific hydrolase in which the activity during stress remains controversial. While an increase in ADMA is known to be associated with adverse events, little is known about SDMA. We investigated plasma ADMA and SDMA levels during ICU stay to reveal the time course of endogenous NO inhibition in patients with sepsis. ⋯ ADMA catabolism appears to be activated by inflammation; its increase during the advanced septic phase in surviving patients may suggest an endogenous inhibition of NO synthesis during the full-blown septic phase. In severe sepsis, SDMA, but not ADMA, appears to be a marker of alterations in vital functions and mortality.
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Following successful resuscitation from cardiac arrest, neurological impairment as well as other types of organ dysfunction still cause significant morbidity and mortality. The whole-body ischemia-reperfusion response that occurs during cardiac arrest and subsequent restoration of systemic circulation results in a series of pathophysiological processes that have been termed the post-cardiac arrest syndrome. The components of the post-cardiac arrest syndrome comprise post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, the systemic ischemia-reperfusion response and persistent precipitating pathology. ⋯ Particular attention should be given to evidence of cardiac ischemia and referral for urgent angiography and percutaneous coronary intervention, if appropriate, should be available to all. Optimizing neurological recovery will involve seizure control, management of hyperglycemia and therapeutic hypothermia. Prognostication following cardiac arrest remains difficult, but there are diagnostic tests that may be used with some degree of accuracy.
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Minerva anestesiologica · May 2010
Case ReportsThe use of an i-gel supraglottic airway for the airway management of a patient with subglottic stenosis: a case report.
The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologist. Although many anesthesiologists would prefer the use of a narrow endotracheal tube in this patient population, the use of laryngeal mask airways has also been described. We report the case of a patient who was managed using an i-gel supraglottic airway due to a difficulty with inserting an endotracheal tube during a previous procedure. ⋯ Furthermore, the vocal cords were successfully visualized using a fiberscope, allowing the possibility of eventual fiberoptic intubation, if it had been necessary. The presence of subglottic stenosis was also confirmed using the fiberscope. Thus, the i-gel airway device has multiple features that makes it suitable for use in situations where a narrow endotracheal tube is inadvisable or too difficult to use.
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Minerva anestesiologica · May 2010
Randomized Controlled TrialEpidural volume expansion: is there a ceiling effect?
The optimal volume of epidural saline administration on spinal anesthesia is not clear. The aim of this study was therefore to evaluate the block characteristics of 5, 10, 15, and 20 mL epidural saline after spinal anesthesia. ⋯ The present results indicate that a ceiling effect was observed on the duration of spinal analgesia using plain bupivacaine with epidural saline loading (maximum--15 mL).
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Minerva anestesiologica · May 2010
Randomized Controlled TrialEpidural analgesia with ropivacaine and sufentanil is associated with transient fetal heart rate changes.
Fetal heart rate (FHR) changes have been reported after regional labor analgesia. In this prospective single-blinded study, we aimed to assess whether epidural analgesia with ropivacaine and sufentanil is associated with significant changes in fetal heart rate. ⋯ Epidural analgesia with ropivacaine and sufentanil is associated with fetal heart rate changes. These modifications are transient and should be considered when evaluating fetal heart rate monitoring during labor to prevent inappropriate obstetric management decisions to proceed with operative labor.