Minerva anestesiologica
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Minerva anestesiologica · Apr 2009
Randomized Controlled Trial Comparative StudyDoes anesthetic induction for Cesarean section with a combination of ketamine and thiopentone confer any benefits over thiopentone or ketamine alone? A prospective randomized study.
The aim of this study was to evaluate the benefit of a combination of thiopentone and ketamine over either of these drugs alone as an induction agent for Cesarean section. ⋯ We conclude that though there were no adverse events and a significantly lower analgesic requirement, the use of ketamine alone as an induction agent in Cesarean section should be avoided, as it causes significant maternal hemodynamic changes. The addition of a reduced dose of ketamine to thiopentone in the induction cocktail confers the benefit of reducing analgesic requirement without side effects. The treatment is safe and effective for the mother and child.
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Minerva anestesiologica · Apr 2009
Review Comparative StudyAlgorithms for difficult airway management: a review.
Difficult airway management and maintenance of oxygenation remain the two most challenging tasks for anesthetists, while also being controversial items in terms of clinically based-evidence to support relevant guidelines in the literature. Nevertheless, different expert groups and scientific societies from several countries have published guidelines dedicated to the management of difficult airways. These documents have been demonstrated to be useful in reducing airway management related critical accidents, despite their limited use in litigations and legal issues. The aim of this review is to compare different airway management guidelines published by the United States, United Kingdom, France, Italy, Germany, and Canada while trying to elucidate the main differences, weaknesses, and strengths for identifying critical concepts in the management of difficult airways.
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The authors illustrate some relevant emerging topics in pediatric anesthesia. Endotracheal cuffed tubes have entered into routine clinical practice in younger patients. Concerns about tracheal stenosis were overcome when manufactures began to produce a new class of high volume, low pressure endotracheal tubes. ⋯ The utility of ultrasonography in peripheral nervous blocking has also been demonstrated. Better knowledge of the pathophysiology of both hypovolemic shock and coagulation dysfunction helped made it possible to face and successfully perform even major surgical procedures and treat more dramatic trauma. The introduction of devices to monitor anesthesia depth helped clinicians to better understand the pharmacodynamic effects of anesthetics, resulting in the maintenance of a more stable level of narcosis and the reduction of the incidence of awareness.
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Minerva anestesiologica · Apr 2009
Comparative Study Controlled Clinical TrialBehavior of B-type natriuretic peptide during mechanical ventilation and spontaneous breathing after extubation.
The behavior of B-type natriuretic peptide (BNP) is assessed during mechanical ventilation (MV) and spontaneous breathing after extubation in critical patients. ⋯ The underlying disease of an ICU patient seems to play a relevant role for BNP production and is probably linked to different aspects of therapeutic approach required by the patient. Our data suggest a cut-off value of BNP higher than the usual is necessary to discriminate mechanically-ventilated patients without CHF. This study should be repeated with an enlarged population.