Minerva anestesiologica
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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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Minerva anestesiologica · May 2003
ReviewPostanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management.
Postanaesthetic shivering is one of the leading causes of discomfort for patients recovering from general anesthesia. During EMG records, the distinguishing factor from shivering in fully awake patients is the existence of clonus similar to that recorded in patients with spinal cord transection. They coexist with the classic waxing and waning signals associated with cutaneous vasoconstriction (thermoregulatory shivering). ⋯ Prevention mainly entails preventing hypothermia by actively rewarming the patient. Postoperative skin surface rewarming is a way of obtaining the threshold shivering temperature while raising the skin temperature and improving the patient's comfort. However, it is less efficient than certain drugs such as meperidine, nefopam or tramadol, which act by reducing the shivering threshold temperature.
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Minerva anestesiologica · May 2003
ReviewNew approaches for the prevention of airway infection in ventilated patients. Lessons learned from laboratory animal studies at the National Institutes of Health.
Despite early diagnosis and appropriate antibiotic therapy, ventilator-associated pneumonia (VAP) remains the leading cause of death from hospital-acquired infection in ventilator-dependent patients. Strategies to prevent bacterial colonization of the trachea and lungs are the key to decrease mortality, hospital length of stay, and cost. ⋯ Aspiration may occur during 1) intubation, 2) mechanical ventilation through leakage around the tracheal tube cuff, 3) suctioning of the tracheal tube when bacteria can detach from the biofilm within the tube, or 4) areosolization of bacterial biofilm during mechanical ventilation through the tracheal tube or the ventilator circuit biofilm. From experimental studies in sheep, we drew 3 relevant conclusions: 1) The tracheal tube and neck should be oriented horizontal/below horizontal to prevent aspiration of colonized secretions and subsequent bacterial colonization of the lower respiratory tract. 2) Continuous aspiration of subglottic secretions (CASS) can lower bacterial colonization of the respiratory tract, but at the price of severe tracheal mucosal damage at the level of the suction port. 3) Coating the interior of the tracheal tube with bactericidal agents can prevent bacterial colonization of the tube surface and of the entire respiratory circuit, during 24 hours of mechanical ventilation.
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Minerva anestesiologica · May 2003
ReviewAnaesthesia for non obstetric surgery in pregnant patients.
Female sex constitutes a great part of population and most women are young in childbearing age and expected to be submitted to emergency or urgent obstetric surgery following traumas or diseases which require immediate treatment. Anesthetic considerations for non obstetric surgery during pregnancy include concern for the safety of 2 patients, the mother and fetus, which will be discussed together with the prevention of preterm labor.
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Minerva anestesiologica · May 2003
Review[Prevention of cardiovascular accidents during locoregional anesthesia].
Cardiovascular complications can be divided into 2 big categories involving the cardiovascular system in locoregional anaesthesia: those of local anaesthetics with direct effect on sympathetic fibres, which regulate the cardiovascular activity and those who derives from alteration of the normal cardiac function due to the toxic effect of the drugs. While the first are referred to the extension of a central block, the second considers the overdose caused by accidental intravenous injection. This is more frequent in peripheral blocks then in central blocks. ⋯ The prevention of those complications should foresee through an accurate anamnesis the subjective conditions of risk: so we have to choose the best individual technique and dose of anaesthetics; the use of qualitative correct material, the ENS as a support to identify nerve structures and the application of more recent and safe drugs represented by the compound of S(-) enantiomers, Ropivacaine and Levobupivacaine. Which are described to be less cardiotoxic but with the same characteristics as Bupivacaine. Finally don't forget respect the classical rules of security during locoregional anaesthesia.