Minerva anestesiologica
-
Thermal disturbances are very common perioperatively, especially if paediatric patients are involved. This article consider some aspects of hypothermia during and after surgery under anaesthesia in paediatric patients and how to prevent such disturbances.
-
Minerva anestesiologica · Jun 2005
ReviewThe use of positive end-expiratory pressure in the management of the acute respiratory distress syndrome.
Clinical and experimental research on the effects of positive end-expiratory pressure (PEEP) has produced a plethora of information during the last two decades. The application of PEEP is expected to increase PaO2; however, it is generally agreed that simply using increased PaO2 as the end point is inappropriate. Four mechanisms have been proposed to explain the improved pulmonary function and gas exchange with PEEP: 1) increased functional residual capacity; 2) alveolar recruitment; 3) redistribution of extravascular lung water; and 4) improved ventilation-perfusion matching. ⋯ The greater the alveolar collapse and pulmonary edema, the more the compliance curve of the respiratory system shifts downward and to the right. As PEEP is applied and alveoli recruited, the pressure-volume curve shifts upward and to the left. Despite its intuitive benefit, there were very few controlled studies of the effects of PEEP on ARDS outcome and no prospective randomised controlled trial of PEEP has been ever carried out in patients with acute lung injury and/ or ARDS to evaluate its efficacy until recently.
-
Minerva anestesiologica · Jun 2005
ReviewMorbidity and mortality related to anesthesia outside the operating room.
Morbidity and mortality related to sedation or anesthesia outside the operating room has not been investigated so far, but it is assumed to be a relevant problem because the increasing needs for sedation/analgesia in remote locations for a wide range of diagnostic and operative procedures (endoscopy, radiology, magnetic resonance...) and the lack of monitoring, inadequate training of personnel,insufficient staffing. Many complications could occur to patients, like anaphylactic shock,accidental hypothermia,difficult airway maintenance, aspiration,nausea and vomiting, and anesthesiologists, like exposure to pollution, radiation, electromagnetic fields, falls and trauma. Recent guidelines and personal experience are presented and discussed.
-
For several decades, bupivacaine has enjoyed great clinical popularity as the first choice local anesthetic in pediatrics. However, introduction of ropivacaine and levobupivacaine, the two newer and presumably safer (thought to be less cardio- and neurotoxic than bupivacaine) local anesthetics, has challenged the position of bupivacaine as a gold standard for prolonged duration of analgesia. This review article summarized the metabolism, the criteria of choice and the safety use of new agents.
-
The magnetic resonance imaging suite is a challenging environment for the anaesthesiologists, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner and patient-related factors. ⋯ A well-equipped anesthesia machine, standard monitoring (electrocardiogram, oxygen saturation and non-invasive blood pressure), trained personnel and adequate planning should be standard for all out of the operating room procedures. Finally, rigorous discharge criteria are recommended to detect residual sedation.