Minerva anestesiologica
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Minerva anestesiologica · Dec 2009
Relationship between A-line Autoregressive Index, Spectral Entropy and steady state predicted site-effect effective concentrations at 05-50-95 of propofol at different clinical endpoints.
Target controlled infusion intravenous anesthesia is a growing phenomenon. Nowadays, many anesthesiologists feel the need to monitor depth of anesthesia during total intravenous anesthesia, even though it is not a standard technique worldwide. Spectral Entropy (SE) is a relatively new depth of anesthesia index. The aim of this study was to investigate whether predicted site-effect propofol concentrations, A-line Autoregressive Index (AAI) and SE values are useful for predicting loss of verbal contact (LVC) and loss of consciousness (LOC) during steady-state conditions. ⋯ LOC and LVC occur within a defined range of predicted site-effect concentrations. More emphasis should be given to site-effect concentrations. SE and AAI have similar values at different endpoints and similar correlation with Ceprop. AAI and SE are both useful tools in predicting both LVC and LOC.
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Nearly 40 years ago, cricoid pressure (CP) was introduced into anesthetic practice based on a single small case series that lacked essential information. No randomized controlled trials have since documented any benefit of CP. In addition, numerous surveys have shown that most anesthetists lack adequate theoretical and practical knowledge regarding all aspects of CP. ⋯ However, by using CP we may well be endangering more lives by causing airway problems than we are saving in the hope of preventing pulmonary aspiration. It is dangerous to consider CP to be an effective and reliable measure in reducing the risk of pulmonary aspiration and to become complacent about the many factors that contribute to regurgitation and aspiration. Ensuring optimal positioning and a rapid onset of anesthesia and muscle relaxation to decrease the risk of coughing, straining or regurgitation during the induction of anesthesia are likely more important in the prevention of pulmonary aspiration than CP.
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Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed procedures in critically ill patients receiving mechanical ventilation. Although many papers have compared different PDT techniques, few records on the outcome of tracheostomized patients after intensive care unit (ICU) discharge are available. ⋯ PDT-related early complications without clinical consequences were observed. Conversely, late complications were infrequent but had significant clinical implications. Although late decannulation is the major risk for complications, in 83.9% of cases tracheostomy is only a temporary measure.
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Minerva anestesiologica · Nov 2009
Case ReportsPerineural infusion of 0.5% ropivacaine for successful treatment of phantom limb syndrome: a case report.
Phantom limb syndrome (PLS) comprises various disturbances, including pain in the missing limb and phantom sensations. This study is about the successful treatment of a PLS patient by prolonged infusion of local anesthetic through a perineural catheter. A 45-year-old man came to the Rizzoli Orthopedic Institute (Bologna, Italy) complaining of a painful right leg after trauma. ⋯ Follow-ups at 6, 12, 24, and 36 months confirmed that the PLS did not reappear. The results are limited to one patient but are encouraging, particularly due to the relevance of the pathology and the poor results of conventional treatments. More cases are obviously needed to support the efficacy of this therapy.
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Minerva anestesiologica · Nov 2009
Postoperative pain survey in Italy (POPSI): a snapshot of current national practices.
Over the last several years, significant efforts have been directed towards improving the quality of postoperative pain management. As data are lacking on the organization and quality of these services in Italy, we surveyed current Italian practices. ⋯ A comparison to international survey data showed that postoperative pain management in Italy is still below the European standards. Additional efforts to overcome these hurdles and to reach an acceptable level of quality are required.