Minerva anestesiologica
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Minerva anestesiologica · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialTranexamic acid in primary CABG surgery: high vs low dose.
Prophylactic administration of tranexamic acid decreases bleeding and transfusions after cardiac procedures but it is still unclear what the best dose and the most appropriate timing to get the best results are. ⋯ For elective, first time coronary artery bypass surgery, both dosages of tranexamic acid are equally effective. Theoretically, it seems safer to administer it when patients are protected from thrombus formation by full heparinization.
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Minerva anestesiologica · Mar 2004
Comparative Study Clinical TrialSpinal anaesthesia using hyperbaric 0.75% vs hyperbaric 1% bupivacaine: a double blind comparison.
The aim of this study was to compare the anesthetic effects, potency and postoperative outcome of 0.75% and 1% concentrations of hyperbaric bupivacaine in selective spinal anesthesia. ⋯ No statistically significant differences between the 2 groups for demographic data were found. Group B revealed a faster onset and a more adequate dermatomeric extension (4.1+/-0.8 min vs 6.5+/-1.2 min). Both concentrations guaranteed good hemodynamic stability. Motor offset times were 115.8+/-145 min and 142+/-4.8 min respectively in groups A and B. Sensitive offset times were 197.5+/-12 min and 168+/-5.2 min respectively in groups A and B. No statistically relevant differences were noticed for intraoperative Bromage, sensitive block or for postoperative motor and sensitive offset time, diuresis time and deambulation time. There are no advantages of 1% hyperbaric bupivacaine over 0.75% for selective spinal anesthesia, while several disadvantages presented shorter duration of postoperative analgesia and higher incidence of headache.
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Minerva anestesiologica · Jan 2004
Therapeutic Intervention Scoring System-28 as a tool of post ICU outcome prognosis and prevention.
To examine the effects of severity upon discharge from Intensive Care Unit (ICU) status, as assessed by the Therapeutic Intervention Scoring System-28 (TISS-28) on subsequent post ICU outcome. ⋯ Patients discharged from ICU have post ICU hospital length of stay and prognosis related to their age, time of hospitalization in ICU and their severity status upon discharge from the ICU. We believe that, based on the TISS-28 scoring system, high risk patients can be identified and either ideally transferred to a HDU or discharged from ICU when further improvement has been achieved. TIS-28 is a valuable tool in post ICU outcome prediction and subsequently, in hospital mortality reduction. At the same time, through TISS-28 use, each hospital can locally identify the quality of care provided outside the ICU, given the outcomes measured in groups of patients at various severity levels.
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Minerva anestesiologica · Jan 2004
Cytopathologic examination of epidural catheter for postoperative analgesia. Pathophysiology and clinical management.
The authors performed a prospective study in a series of patients undergoing combined general and epidural anaesthesia for major abdominal surgery in order to define if the epidural catheter inserted for postoperative analgesia induced in the short-term (7-8 postoperative days) any cytopathologically appreciable inflammatory response. ⋯ We were unable to detect any cytopathologically appreciable inflammatory response at the tip of the epidural catheter which could have suggested the occurrence of inflammation in the epidural tissues. Given the positive results of prophylactic epidural administration of small doses of corticosteroids in the reduction of postepidural anaesthesia back pain and their direct membrane action on nociceptive C-fibers, this kind of backache seems to be related to the stimulations of such nociceptors more than to a catheter-related inflammatory response of epidural tissues with possible evolution in peridural fibrosis, as reported following surgical intervention for lumbosacral disease.
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Minerva anestesiologica · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesic transition after remifentanil-based anesthesia in neurosurgery. A comparison of sufentanil and tramadol.
Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia. ⋯ At the emergence much better control of the transition phase in patients treated with sufentanil: smooth recovery with better tolerability of the endotracheal tube; efficacious analgesia along with cardiocirculatory stability.