Minerva anestesiologica
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Minerva anestesiologica · Nov 2003
Case ReportsHigh frequency percussive ventilation (HFPV). Case reports.
Treatment of acute respiratory failure is still a hot issue in intensive care everyday practice: in the last few years high frequency ventilation techniques have been employed as a therapy for adult respiratory distress syndrome (ARDS) and acute respiratory failure (ARF). We applied high frequency percussive ventilation (HFPV) to 3 patients affected by ARDS or ARF, who did not improve after 24 hours of conventional mechanical ventilation (CMV). All our patient underwent 12 hours of HFPV, and showed an improvement of both respiratory exchange and radiological imaging. Even if the pathogenesis of ARF was quite different, in all patient we registered a good response and no complications.
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Minerva anestesiologica · Oct 2003
Clinical TrialUse of sedative and analgesic drugs in the first week of ICU stay in high-level-of-care.
The aim of this study was to update the current practice of pharmacological sedation and analgesia in Italian intensive care units. ⋯ Diagnosis influences the pattern of sedation-analgesia during high-level-of-care period. Sedation prevalence is reasonably prescribed in trauma groups while it remains low in ALI/ARDS, post-operative, cerebrovascular, COPD and hearth failure. Particularly opioid use remains limited in post-operative patients. This surveys shows a poorly standardised sedation approach to the different phases of the therapy: induction, short and long-term sedation phase.
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Spinal and peridural anaesthesia has several advantages over general anaesthesia due to their low influence to endocrine and metabolic activity and their capacity to reduce postoperative surgical complications, intraoperative bleeding and deep venous thromboembolism incidence. Nevertheless, these anaesthesiologic techniques have a high risk of severe neurological events in patients treated with anticoagulant therapies and prophylaxis. However, this complication is rarely found in literature. ⋯ Anaesthetists must know the use and pharmacological properties of anticoagulant drugs in order to be able of giving up or modifying them during perioperative time, evaluating the risk of bleeding episodes and thrombotic events. An analysis of the literature has been made in order to establish favourable conditions, risk factors, international guide-lines and the real incidence of haemorrhagic complications associated to central blocks in patients being treated with drugs that modify their coagulative status. The survey of the literature and the international guide-lines shows that neuraxial anaesthesia should be performed in selected patients, respecting the free intervals of anticoagulant drugs, carrying out a correct postoperative neurological monitoring and evaluating, case by case, the risks and benefits of the procedure.
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Minerva anestesiologica · Oct 2003
Randomized Controlled Trial Clinical TrialPerioperative thoracic epidural analgesia in aortic surgery: role of levobupivacaine.
Perioperative pain management in patients undergoing surgery is an essential target in order to improve intraoperative outcome and reduce postoperative complications occurrence. The combination of a local anesthetic with an opiate for epidural administration can ensure both analgesic effect (opiate) and neuroendocrine protection (local anesthetic). Levobupivacaine, S(-)-enantiomer form of bupivacaine, produces a sensitive-motor blockade similar to the racemate, with less cardiotoxicity; also ropivacaine is not cardiotoxic, but it has less anesthetic efficacy than levobupivacaine; both anesthetics could be administered through the epidural catheter in order to ensure adequate analgesia without any hemodynamic effects. Aim of our study was to evaluate a thoracic epidural analgesia for abdominal aortic surgery. ⋯ The combination of fentanyl with levobupivacaine or ropivacaine for use in thoracic epidural administration ensured both analgesic and neuroendocrine effect; significative differences between the 2 local anesthetics cannot be demonstrated, even if levobupivacaine, which presents a higher anesthetic efficacy, requires lower dosages.