Minerva anestesiologica
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Minerva anestesiologica · Mar 2006
ReviewResidual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period.
The residual effects of neuromuscular blocking agents may persist into the early postoperative recovery period, even when neuromuscular blockade is carefully monitored and reversed in the operating room. Recent data suggest that mild degrees of residual paresis (train-of-four TOF ratios of 0.7-0.9) may be associated with significant impairment of respiratory and pharyngeal muscle function. Therefore, the new gold standard reflecting acceptable neuromuscular recovery is a TOF ratio > or =0.9. ⋯ Several techniques may be used to reduce the risk of postoperative residual paresis, which include avoidance of long-acting muscle relaxants, use of neuromuscular monitoring in the operating room, routine reversal of neuromuscular blockade at a TOF count of 2-3, and early administration of reversal agents. Careful management of neuromuscular blockade may limit the occurrence of adverse events associated with residual postoperative paralysis. Large-scale outcome studies are needed to clearly define the impact of residual neuromuscular block on major morbidity and mortality in surgical patients.
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Minerva anestesiologica · Jan 2006
Randomized Controlled TrialComplications of epidural and combined spinal-epidural analgesia in labour.
The practice of relieving pain during childbirth with epidural or combined spinal-epidural analgesia is very widespread in the major Western countries, and is increasing in Italy. There are, however, numerous complications of this practice for both the woman and the mechanism of the labour. The aim of our study was to evaluate the short and long term complications of these techniques in a randomised sample of women. ⋯ The short-term complications of the analgesic techniques used during labour were not very relevant with respect to the subjects' satisfaction (excellent in 66% of the women in the group managed with epidural analgesia and 73% among those treated with the combined spinal-epidural technique). There was not a statistically significant difference in the percentage of cesarean deliveries in the 3 groups. Epidural and spinal-epidural analgesia to relieve pain during labour can, therefore, be considered safe and reliable.
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Minerva anestesiologica · Jan 2006
Randomized Controlled Trial Comparative StudyPatient-controlled analgesia with tramadol versus tramadol plus ketorolac.
In this double-blinded, randomized controlled trial, we compared the clinical advantages and disadvantages of patient-controlled-analgesia (PCA) with continuous infusion (CI) with tramadol alone versus a combination of tramadol plus ketorolac in the management of postoperative pain after major abdominal surgery. ⋯ We concluded that the combination of ketorolac plus tramadol in the same PCA device was an effective and safe treatment for postoperative analgesia in abdominal surgery.
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Pulmonary capillary pressure (Pcap) is the predominant force that drives fluid out of the pulmonary capillaries into the interstitium. Increasing hydrostatic capillary pressure is directly proportional to the lung's transvascular filtration rate, and in the extreme leads to pulmonary edema. In the pulmonary circulation, blood flow arises from the transpulmonary pressure gradient, defined as the difference between pulmonary artery (diastolic) pressure and left atrial pressure. ⋯ In the presence of a normal PAOP and an increased pressure gradient between Pcap and PAOP, the tendency for fluid leakage in the capillaries and subsequent edema development may substantially be underestimated. Tho-roughly validated methods have been developed to assess Pcap in humans. At the bedside, measurement of Pcap can easily be determined by analyzing a pressure transient after an acute pulmonary artery occlusion with the balloon of a Swan-Ganz catheter.
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Minerva anestesiologica · Jan 2006
ReviewStandards of care for ambulatory surgery. Are we up to speed.
Ambulatory surgeries are becoming increasingly more common in daily anesthesia practice, placing greater demands on anesthesia providers to offer timely and thorough preoperative evaluation and preparation, optimal patient and surgical selection, and efficient, safe, and timely postanesthesia care, all of which necessitate an active participation of an anesthesiologist in all aspects of the organization and coordination of perioperative management. Numerous studies over the last couple of decades have introduced various organizational models for pre-anesthesia screening, with a goal of improving patient satisfaction, controlling the cost, and decreasing surgical delays. Having recognized the importance of anesthesia selection regarding patient comfort and the duration of post-anesthesia recovery in the ambulatory setting, many anesthesiologists have focused their attention on studying various anesthesia modalities and techniques with new emphasis on preemptive interventions (e.g. preoperative antiemetics, continuous peripheral nerve blocks). Finally, a concept of bypassing traditional recovery period in the post-anesthesia recovery rooms (''fast tracking'') that had been scrutinized over the last decade has been accepted as cost effective and safe, providing adequate patient selection.