Minerva anestesiologica
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Minerva anestesiologica · Jul 2002
Randomized Controlled Trial Clinical TrialTwo doses of oral ketamine, given with midazolam, for premedication in children.
Oral premedication is common practice in paediatric anaesthesia. The aim of this study was to assess the quality of premedication using oral ketamine, with midazolam. ⋯ Two mgxkg-1 of ketamine given orally with midazolam improve anxiolysis and sedation and achieve more success of premedication, better acceptance of parental separation and better acceptance of face mask for induction of anaesthesia.
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Steroids, drugs with potent antiinflammatory properties on the damaged nervous roots, have been especially used as adjuvants of local anesthetics, by spinal route, in the treatments of low-back pain. Spinal route was chosen to obtain a higher local concentration of drug, with few systemic side effects and to improve drug's action mechanism. Steroids seem to interact with GABA receptors and thus control neural excitability through a stabilising effect on membranes, modification of nervous conduction and membrane hyperpolarization, in supraspinal and spinal site. ⋯ Steroidal toxicity seems to be related to the polyethylenic glycole vehicle. Anyway, slow release formulations contain less concentrated polyethylenic glycole. The epidural administration, a correct dilution of steroid with local anesthetics solution and/or saline solution, and a limited number of injections (no more than three) allows a significant reduction of steroid neurotoxicity.
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Minerva anestesiologica · Jul 2002
Randomized Controlled Trial Comparative Study Clinical TrialLevobupivacaina, bupivacaina racemica e ropivacaina nel blocco del plesso brachiale.
To compare clinical profiles of levobupivacaine, racemic bupivacaine and ropivacaine at equipotent doses in axillary brachial plexus block in the orthopaedic surgery of wrist and hand. ⋯ In our experience levobupivacaine has been demonstrated to be a good substitute for racemic bupivacaine. Compared to ropivacaine, levobupivacaine induces a longer duration of postsurgery analgesia and, in our opinion, this datum seems to be the most significant.
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Minerva anestesiologica · Jul 2002
0.25% levo-bupivacaine for interscalene block during shoulder surgery. A survey on 20 patients.
Interscalene brachial plexus block (ISB) is an alternative procedure to general anaesthesia for shoulder surgery, and consents the anaesthetist to easily control postoperative pain that, indeed, is known to be intense and often requires strong analgesic administration. The introduction of regional anaesthesia for this type of surgery, contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. The aim of this study was to determine the effects of 40 ml of 0.25% levo-bupivacaine, a local anaesthetic derived from the racemic mixture of bupivacaine, on the speed of onset, quality and duration of ISB. ⋯ Levobupivacaine is a newly developed local anaesthetic derived from a bupivacaine racemic mixture from which the right isomer has been eliminated. Levo-bupivacaine, compared to racemic mixture, is acknowledged to be less cardiotoxic, faster at equal dosage, and ensures a longer analgesic interval. Zero point twenty-five percent concentration was preferred in this study in order to inject large volumes (40 ml) with a minimal anaesthetic amount (100 mg), resulting in short time for obtaining loss of sensibility, optimal intraoperative conditions and long lasting block with adequate postoperative analgesia.