Minerva anestesiologica
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Minerva anestesiologica · Sep 2009
Case ReportsRecurrent lung collapse due to unidentified phrenic nerve injury after cardiac surgery.
Partial or complete recurrent lung collapse after cardiac surgery is one cause of failure to wean from ventilator support, and frequently leads to multiple reintubations and prolonging intensive care unit and hospital stays. A 79-year-old female underwent uneventful coronary artery bypass surgery and was extubated on the first postoperative day (POD). On POD 2, a routine portable chest X-ray (CXR) revealed complete opacification of the left hemithorax. ⋯ The patient gradually became stronger, and as the airway edema subsided, she was able to be managed on the regular nursing floor with intermittent CPAP mask treatments and mucolytics. Although uncommon, one documented cause of failure to wean from mechanical ventilation is diaphragmatic dysfunction. This finding is often delayed because it requires a sniff test in an extubated patient to make the diagnosis.
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Minerva anestesiologica · Sep 2009
Randomized Controlled Trial Comparative StudyA comparison of morphine concentrations for patient-controlled epidural analgesia following gynecological surgery.
To compare the analgesic efficacy of a lower (12.5 mg/mL) vs. higher (25 mg/mL) concentration of morphine with 0.2% ropivacaine for patient-controlled epidural analgesia (PCEA) following gynecological surgery. ⋯ PCEA using 0.2% ropivacaine and 12.5 mg/mL morphine compared with 0.2% ropivacaine and 25 mg/mL morphine provides equianalgesia with no differences in bolus administration. With respect to the analgesic efficacy and the potential risk for side effects, PCEA using 0.2% ropivacaine and 12.5 mg/ml morphine is a better choice for postoperative gynecological patients.
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Ultrasonographic scanning of the lung is gaining ever-growing recognition as a diagnostic and monitoring imaging technique. Its role in trauma assessment has already been established as an extension of the focused assessment of trauma with sonography for the diagnosis of pneumothorax. As more centers are discovering the advantages of ultrasound and conducting experimental and comparative studies, its use for diagnosing many other lung pathologies is becoming even more important. ⋯ Here, we review all possible applications of lung ultrasonography used thus far in Intensive Care Units, where a readily available and biologically non-invasive imaging technique may make the difference in diagnosis. In addition, we describe how the non-invasive nature of ultrasonography allows it to be used as a monitoring device of disease progression vs the healing process. We also provide a detailed explanation of the methods and materials necessary and a few indications towards unanswered questions in this field of research.
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Minerva anestesiologica · Sep 2009
Randomized Controlled TrialEffect of locally administered lornoxicam in the management of low back pain after lumbar epidural anesthesia: a double-blind, randomized, controlled study.
Low back pain after lumbar epidural anesthesia remains an important clinical problem. Possible causes of the back pain associated with epidural anaesthesia are localized trauma, aseptic periosteitis, tendonitis, inflammation of the ligaments, and osteochondritis. Lornoxicam is a new nonsteroidal anti-inflammatory drug (NSAID) that has been shown to be effective and well tolerated in the treatment of postoperative pain. The use of locally administered lornoxicam for the relief of low back pain following lumbar epidural anesthesia has not yet been studied. Thus, the aim of the present study was to investigate the efficacy of lornoxicam in the management of pain after lumbar epidural anesthesia. ⋯ Our study demonstrated that local administration of Lornoxicam before epidural anesthesia for pilonidal sinus surgery decreased the frequency and severity of low back pain following lumbar epidural anesthesia with lidocaine. In conclusion, local administration of lornoxicam during epidural anesthesia may present a useful option for the relief of post-epidural low back pain.