Minerva anestesiologica
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Minerva anestesiologica · Jul 2006
ReviewNew technology for noninvasive brain monitoring: continuous cerebral oximetry.
Although the central nervous system is the primary endpoint of most general anesthetics, it is still the least monitored organ in clinical anesthesiology. In the last decade, technological research has expanded the application of near-infrared spectroscopy to allow continuous, non-invasive, and bedside monitoring of cerebral oxygen saturation (rSO(2)) through the scalp and skull, providing accurate information on the balance between brain oxygen supply and demand. The aim of this review is to provide an overview on relevant technological issues of cerebral oximetry, describe a systematic approach to its use, and summarize current information on its possible impact on our daily practice. ⋯ In aged patients undergoing major abdominal surgery rSO(2) monitoring to guide the anesthesia plan has been reported to reduce the exposition to cerebral ischemia with less effects on cognitive decline and shorter hospital stay. In conclusion several clinical conditions routinely encountered in our daily practice have the potential to disrupt the balance between the brain oxygen supply and demand, exposing to the risk of intraoperative cerebral ischemia. These alterations in brain oxygen balance remain totally undiagnosed if we do not specifically monitor it; while the possibility of monitoring regional cerebral oxygen saturation through a simple and totally non-invasive device has the potential for optimizing our anesthesia plan to the real needs of our main targeted organ: the brain.
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Minerva anestesiologica · Jul 2006
Randomized Controlled TrialLevobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery.
Levobupivacaine, a new local anaesthetic, has been recently introduced into clinical practice because of its lower toxic effects for heart and central nervous system. It has been already investigated in epidural and loco-regional techniques, but more has to be known regarding its characteristics in spinal anaesthesia. The aim of our study was to compare clinical and anaesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in 60 patients undergoing major orthopaedic surgical procedures. ⋯ In conclusion, levobupivacaine results a valid alternative to racemic bupivacaine for spinal anaesthesia, the latter remaining a cheap and effective local anaesthetic yet. Notwithstanding the complete absence of any significant hemodynamic complications in the patients of group L, further and larger studies are needed in order to assess if levobupivacaine is preferable to bupivacaine for minimizing the possible cardiovascular impact of spinal anaesthesia.
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Minerva anestesiologica · Jul 2006
Randomized Controlled TrialThe effects of hydroxyethyl starch solution in critically ill patients.
In the treatment of the critically ill patients an adequate fluid therapy appears to be essential to optimize hemodynamics and to get a suitable tissue perfusion. In this study we have evaluated the effects of volume replacement, carried out with 2 different solutions: hydroxyethyl starch 6% (HAES) and albumin 20% (HA). ⋯ Since hydroxyethyl starch induced a hemodynamic and clinical improvement, these effects translated into an improvement of sensorium and a reduction of APACHE II score, without causing pulmonary edema, we can conclude that hydroxyethyl starch 6% ws 130,000 dalton ms 0.4 (Voluven) is an effective fluid for resuscitation of hypovolemic patients and represent an attractive alternative to albumin.
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Minerva anestesiologica · Jul 2006
Comparative StudyBalanced anestesia versus total intravenous anestesia for kidney transplantation.
An ideal anesthetic regimen for kidney transplantation should be able to assure haemodynamic stability to obtain an optimal graft reperfusion. The aim of this study was to compare 2 regimens of anesthesia for patients submitted to kidney transplantation. ⋯ For their pharmacokinetic properties, propofol, remifentanyl and cisatracurium allow to obtain a good control of the hemodynamic parameters and a fast and safe recovery of consciousness. Total intravenous anesthesia regimen seems to be an alternative to the balanced anesthesia for patients undergoing kidney transplantation.
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Minerva anestesiologica · Jul 2006
Case ReportsThiopental--ketamine association and low dose priming with rocuronium for rapid sequence in duction of anaesthesia for elective cesareum section.
Obstetric patients undergoing caesarean section under general anaesthesia require rapid induction due to high risk of aspiration. Rocuronium provides the shortest onset of action of nondepolarizing blocking agents. Onset time can be shortened by the priming principle. ⋯ Time from injection of the intubating does of rocuronium to recovery of 25% of single twitch was 26 min. Recovery index (T25-75) was, instead, of 3 min and 25 s. The combination of the induction agents thiopental and ketamine, associated with low dose priming with rocuronium, have guaranteed excellent intubating conditions in this clinical context.