Minerva anestesiologica
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Minerva anestesiologica · Sep 2007
ReviewMethodologies for the treatment of acute and chronic nononcologic pain in children.
Pain represents the most feared symptom of illness but for many years it has been underestimated in children. Only recently has analgesic treatment become an integral part in the assistance of ill children with acute pain, such as postoperative pain, and with chronic pain. Postoperative pain is a complication of surgery: postoperative pain prevention should replace the current theory and practice of postoperative treatment through the creation of ''pain services'' and adequate pain prevention planning. ⋯ Nonmedical interventions such as distraction, muscular relaxation, and guided imagination for pain control are psychological techniques showing very good results in those children who must undergo various procedures. The medical treatment must guarantee both sedation and effective analgesia. Our medical approach includes local anaesthesia, conscious sedation, deep sedation, and general anaesthesia.
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Minerva anestesiologica · Sep 2007
Case ReportsPostraumatic ARDS: how to place patients who may offer technical problems in a prone position.
Ventilation in the prone position is a valid choice in the treatment of trauma patients with acute respiratory distress syndrome (ARDS). Two cases of trauma patients with ARDS treated in the prone position are described. The technique was very easy to use and safe. The prone position technique proved very useful in the treatment of post-traumatic ARDS in these 2 cases.
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Minerva anestesiologica · Sep 2007
Case ReportsAnesthesia and myotonic dystrophy (Steinert's syndrome). The role of total intravenous anesthesia with propofol, cisatracurium and remifentanyl. Case report.
Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. ⋯ A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.
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Minerva anestesiologica · Sep 2007
The clinical assessment of Glidescope in orotracheal intubation under general anesthesia.
The aims of this study were to further evaluate the efficacy and safety of the GlideScope as a device to aid orotracheal intubation, and to further determine whether the GlideScope can provide a better laryngeal view in patients predicted to have a difficult laryngoscopy compared to the Macintosh laryngoscope. ⋯ The orotracheal intubation using a GlideScope had advantages of easy and simple operation, excellent laryngeal view, and the ability to provide an improved laryngeal view in the patients with a difficult laryngoscopy. The general anesthesia of clinical standard depth was able to suppress the pressor response, but not temporary tachycardiac response to the orotracheal intubation using a GlideScope.
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Minerva anestesiologica · Sep 2007
Intra-abdominal hypertension is not reliable as an early predictor of mortality in the intensive care unit.
The aim of this study was to assess the prevalence of intra-abdominal hypertension and its prognostic value in critical patients. ⋯ Intra-abdominal pressure does not have prognostic value at ICU admission, but may predict bad outcomes later during the ICU stay. Intra-abdominal hypertension is a frequent and rarely recognized event in the ICU which can be monitored by the bladder pressure method throughout the period of hospitalization.