Minerva anestesiologica
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Minerva anestesiologica · May 2003
Review[Anesthesia for neurosurgery in children: techniques and monitoring].
Pediatric neuroanesthesia can be seen as a specific branch of anesthesia half way in between pediatric anesthesia and neuroanesthesia. As a matter of fact, we must keep well in mind the peculiarities of the pediatric patient and the different pharmadynamic and pharmacochinetic properties of the anesthetic drugs, particularly in neonates and infants. Other relevant problems are: 1) high complexity of surgical procedures implying a difficult anesthesiological management; 2) complex blood loss management either if we want to apply a blood sparing technique strategy or if we consider the problems related to diagnosis and treatment of coagulative disorders caused by intraoperative massive blood loss; 3) management of patients with latex allergy for the high incidence, in pediatric neuroanesthesia, of patients belonging to high risk groups; 4) need of repeated radiological examinations implying several anesthesiological procedures. In this article aspects related to the anesthesiological techniques and to the hemodynamic and neurophysiological monitoring of pediatric neurosurgical patients were also discussed.
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Minerva anestesiologica · May 2003
ReviewGuidelines on anticoagulants and the use of locoregional anesthesia.
Growing numbers of patients are treated with hemostasis altering drugs, as thromboembolic diseases are a major cause of mortality in our western society. The insertion of epidural or subarachnoidal needles and/or catheters in such patients carries the inherent risk of the development of a compressing vertebral canal hematoma. This is especially true in patients treated with thrombolytic agents or oral anticoagulants. ⋯ The available data do not allow making firm recommendations on the safe use of major neuraxial blocks. In contrast, the isolated use of acetyl-salicylic acid or non-steroidal anti-inflammatory drugs is no longer considered contraindicated, but their combination with of heparin remains controversial. Intraoperative heparinization, perioperative thromboprophylactic use of unfractionated heparin or low molecular weight heparins are possible if: 1) a minimum time interval between the regional anesthetic block and the administration of the previous or next dose of anticoagulant is respected and; 2) the specified dose limitations of the heparin compound used are not exceeded; and 3) indwelling catheters are removed only after the disappearance of any remaining anticoagulant effect.
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Minerva anestesiologica · May 2003
ReviewUpper respiratory tract infections and pediatric anesthesia.
Anesthesia for the child with an upper respiratory infection (URI) presents a challenge for the pediatric anesthesiologist. Differences in study design have made interpretation and comparison very difficult. ⋯ More recent research, however, suggests that children with uncomplicated infections can undergo elective procedures without significant increase in adverse anesthetic outcomes. This presentation summarizes the evolving literature about cancellation of surgery for the child with an upper respiratory infection, perioperative outcomes and anesthetic management.
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Minerva anestesiologica · May 2003
Review[Anesthesia for non-cardiac surgery in children with congenital heart diseases].
The incidence of congenital heart diseases accounts for 8-10 over 1000 liveborn. In Italy about 4000-4500 babies each year are born with congenital heart diseases; 50% of those babies (2000-2200) need cardiac surgery shortly after birth or within the first few months of life. Of the remaining 50%, half undergoes cardiac surgery later on in life and half does not necessitate any surgery; 30% of all cardiac operations consist of palliative procedures and the remaining 70% consist of one-stage corrective procedures. ⋯ Accurate investigation of patient's clinical history is strongly suggested. Moreover knowledge and familiarity with the modifications of the physiology, occurring in congenital heart disease patients, are mandatory for the choice of the more appropriate anesthesiologic strategy for each patient, in order to optimise the risk-benefits ratio and achieve a less traumatic impact on the cardio-circulatory and respiratory equilibrium. With the aim of achieving better results, interaction between anesthesiologist, cardiologist, pediatrician, surgeon and sometime neonatologist and cardiac surgeon, is strongly recommended in the evaluation of risks, and in decision making of strategies and timing of treatment.
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Ketamine is an NMDA receptors antagonist, with a potent anaesthetic effect. NMDA receptors are involved in nociceptive modulation, in the wind-up phenomenon, in peripheral receptive fields expansion, in primary and secondary hyperalgesia, in neuronal plasticity. Ketamine effects are well-known: it produces a state of "dissociative anaesthesia", amnesia, and, at the same time, it mantains the respiratory drive effective and supports the sistemic arterial blood pressure. ⋯ The suggested doses are: Epidural or caudal route (as an ajuvant for local anaesthetic agents, in the treatment of postoperative pain): 0.5 mg/kg. Sedative/analgesic effect (for algesic procedures): 1-2 mg/kg i.v. Continuous infusion (intensive care unit): 0.5 mg/kg/h, with a range from 20-30 microg/kg/min to 80 microg/kg/min, depending on the age of the patient.