Minerva anestesiologica
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Ambulatory surgery has grown dramatically in the past 3 decades; however, advances in postoperative pain treatment have not kept pace with the proliferation of outpatient procedures. Two techniques that may offer a solution to part of this problem are long acting peripheral nerve blocks (PNB) and outpatient continuous peripheral nerve blocks (CPNB), but the safety of sending patients home with blocked extremities has also remained controversial. Unfortunately, only a few large, prospective studies have examined this issue directly. ⋯ In conclusion, PNB and perineural catheter techniques are an exciting aspect of ambulatory anesthesia and acute pain management that has undergone rapid development in recent years. Successful application of these techniques will require a substantial educational investment by anesthesiologists and anesthesiologists in training. The rewards in reduced postoperative pain, improved patient satisfaction, and anesthesiologist professional development make this endeavor worthy of our attention.
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The stiff-person syndrome is a rare and disabling disorder, characterized by muscle rigidity with superimposed painful spasms involving axial and limb musculature. The clinical symptoms are continuous contraction of agonist and antagonist muscles caused by involuntary motor-unit firing at rest and the spasms that are precipitated by tactile stimuli, passive strach, volitional movement of affected or unaffected muscles, startling noises and emotional stimuli. Both the rigidity and the spasms are relieved by sleep, general anaesthesia, myoneural blockade and peripheral nerve blockade. ⋯ The stiff-person syndrome is clinically elusive but potentially treatable and should be considered in patients with unexplained stiffness and spasms. Drugs that enhance GABA neurotransmission, such as diazepam, vigabatrin and baclofen, provide modest relief of clinical symptoms. Immunomodulatory agents such as steroids, plasmapheresis and intravenous immunoglobulin, seem to offer substantial improvement.
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Minerva anestesiologica · Nov 2002
Eight months of emergency services by ambulance (with doctor on board) of the Emergency Department of Prato, Italy.
The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. ⋯ Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.
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Minerva anestesiologica · Nov 2002
Case Reports[Tracheal intubation in a case of idiopathic pulmonary fibrosis using remifentanil and propofol without muscle relaxants].
The anesthetic management of a 58 year-old-male suffering from idiopathic pulmonary fibrosis associated with a previous experience of altered dose-response relationship to muscle relaxants is reported. He underwent a gastroendoscopic surgical procedure. After intravenous atropine, remifentanil 3.0 microg kg(-1) was injected over 90 sec. ⋯ The intubating conditions were good, a 30 per cent reduction in MAP was observed after propofol administration. The patient regained consciousness 5 minutes after the end of remifentanil administration and his trachea was extubated without any troubles. Recovery was uneventful without the need of long-term intensive therapy.
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Analgesia and sedation are indispensable in patients admitted to intensive care for the following, principal reasons: to control their state of anxiety, induce amnesia, improve their adaptation to mechanical ventilation, make invasive manoeuvres tolerable. The purpose of the present retrospective analysis is to assess the effectiveness of remifentanil in a total of 1085 patients admitted to our Resuscitation and Intensive Care Department in 1997-2001. ⋯ Of the various sedation modalities employed, we prefer the one which uses remifentanil as the sole drug because a good level of sedation is obtained, there is no accumulation, little interference with cardiovascular parameters and lower costs in comparison with the others.