Minerva anestesiologica
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Minerva anestesiologica · Nov 2009
Randomized Controlled Trial Comparative StudyA comparison of epidural vs. paravertebral blockade in thoracic surgery.
Epidural analgesia is considered to be the best method of pain relief after major surgery despite its side-effects, which include hypotension, respiratory depression, urinary retention, incomplete or failed block, and, in rare cases, paraplegia. Paravertebral block is an alternative technique that may offer a comparable analgesic effect and a better side-effect profile. This study measured postoperative pain and respiratory function in patients randomized to receive either paravertebral block or epidural analgesia for pain control after thoracic surgery. ⋯ Epidural analgesia is more efficient than paravertebral continuous block at reducing pain after thoracic surgery.
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Minerva anestesiologica · Nov 2009
ReviewWhat anesthesiologists should know about paracetamol (acetaminophen).
Paracetamol is widely used in the management of acute and chronic pain. The purpose of this review is to give anesthesiologists answers to some of the most common questions about paracetamol, specifically the following questions. What is the mechanism of action of paracetamol? Is paracetamol a NSAID? Which endogenous analgesic systems are influenced by paracetamol? Are the perceived concerns about paracetamol use real? What new research is there into paracetamol-induced liver failure? Is paracetamol safe for use by patients with liver disease or those taking anticoagulants? How effective is paracetamol for the management of postoperative pain? Does paracetamol have any opioid-sparing effects? Which formula has the best analgesic efficacy? Which route of administration has the better pharmacokinetic profile? Is the concentration of paracetamol in blood or cerebrospinal fluid relevant to the analgesic effect? Which starting dose should be administrated in intravenous infusion?
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Minerva anestesiologica · Nov 2009
Case ReportsDexmedetomidine as sole sedative during percutaneous carotid artery stenting in a patient with severe chronic obstructive pulmonary disease.
Carotid artery ballooning and stenting is a percutaneous interventional therapy for the treatment of patients with atherosclerotic occlusive disease of the carotid artery. Patients with severe comorbidities are usually considered candidates for this procedure. ⋯ This article describes the case of a patient with severe chronic obstructive pulmonary disease and severe carotid stenosis, who underwent carotid stenting under monitored anesthesia care with dexmedetomidine. Only one episode of bradycardia and hypotension was observed, and this was successfully treated with glycopyrrolate.
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Anesthesia is considered a leading discipline in the field of patient safety. Nevertheless, complications still occur and can be devastating. A substantial portion of anesthesia-related adverse events are preventable since risk factors can be detected and eliminated. ⋯ Cost cutting and production pressure in medical care are potential threats to safety. A shared knowledge of the best standards of care and of the potential consequences of unscrupulous actions could make the daily management of conflicting interests easier. A correctly applied RM can be a powerful, highly beneficial aid to our practice.
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Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the international literature underlining the safety and efficacy of this technique. Safer drugs and dedicated pediatric tools are the keys to this success. Indeed, if we compare the drugs available to pediatric anesthesiologists for use in performing a block years ago with those in use today, it can be seen that progress in this area has been tremendous. ⋯ Real-time ultrasound guidance for peripheral regional anesthesia is not a foolproof technique. New data have emerged suggesting that the novice ultrasonographer may often commit repeated errors, the two most common being failure to visualize the needle during advancement and unintentional probe movement. For this reason, the American Society of Regional Anesthesia and the European Society of Regional Anesthesia created a Joint Committee, and a document was produced ''to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of ultrasound-guided regional anesthesia services".