Minerva anestesiologica
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Minerva anestesiologica · Jan 2002
[Impact of an integrated treatment approach of the severely injured patients (ISS =/> 16) on hospital mortality and quality of care].
Outcome of severely injured patients is sharply influenced by the level of prehospital and hospital organization. ⋯ The implementation of written protocols for trauma care, the organization of trauma teams, educational programs including ATLS and PTC-IRC Courses and a strategy of early stabilization of limb fractures are associated with a dramatic decrease in hospital mortality for major trauma.
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Minerva anestesiologica · Jan 2002
["Small volume resuscitation" in hypovolemic rats. Effects on microcirculation].
Numerous publications have analysed the hemodynamic effects of "small volume resuscitation" during the initial phases of hemorrhagic shock. Nevertheless nowadays the information about microcirculatory effects are poor. The aim of this study was to estimate the change of tissue perfusion in hypovolemic rats, before and after infusion of Ringer's lactate (RL), hypertonic saline solution (HS) or blood. ⋯ Neither RL nor HS seem as efficient as blood to restore the microcirculatory blood flow in the mesocecum of the rats submitted to hemorrhagic hypovolemia.
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Minerva anestesiologica · Dec 2001
ReviewThe esophageal tracheal combitube as a non-invasive alternative to endotracheal intubation. A review.
The esophageal tracheal combitube (ETC) is a supraglottic airway device that functions as an effective alternative to ventilation via mask and tracheal intubation and is therefore a valuable tool in difficult and emergency airway management. The Com-bitube has proven to be a valuable tool for securing the airways and providing adequate ventilation. Its advantages are that it is easy to insert quickly, it may be inserted blindly or with the aid of a laryngoscope, and it provides adequate ventilation and oxygenation in both esophageal and tracheal position. ⋯ Unfortunately, a pediatric size is not commercially available. Training in the use of the combitube under controlled conditions is prerequisite to being expert in an emergency situation. The combitube is another non-surgical airway in the armamentarium of the anaesthesiologist or emergency provider in case of foreseen or unforeseen difficult airways in patients who can neither be intubated or mask ventilated.
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The possibility to control the spread of intrathecal drugs, restricting the distribution of spinal block to the operated side is still controversial. Various authors reported that we can not predict the distribution of spinal block; however, other authors described how to restrict spinal block at the operated side in patients receiving surgical procedures involving one lower limb. Therefore, we reviewed clinical studies on this topic trying to outline the feasibility and potential clinical benefits of unilateral spinal anesthesia. ⋯ The small amount of local anesthetic solution injected, as well as the reduced extent of spinal block, also provide a favourable profile of the resolution of spinal block, which can be useful in the ambulatory setting. With simple technical skill we can reliably provide a preferential distribution of spinal block to the operated side. This results in a minimal delay in preparation time, but provides less hemodynamic side effects with higher cardiovascular stability, and increased autonomy after surgery with better patient acceptance.
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Minerva anestesiologica · Dec 2001
Case Reports[Technical difficulties in epidural blocks and spinal bleeding complications].
The clinical cases of two patients with neurological complications following neuroaxial blocks are reported. The events took place in different institutions where thousands of central blocks were yearly performed. In both instances the blocking procedures presented technical difficulties needing repeated lumbar punctures. ⋯ The authors emphasise the risks of mechanical trauma of epidural or spinal anesthesia both during positioning or removal of an epidural catheter. The problem related to the compatibility between central blocks and antithrombotic/anticoagulant prophylaxis/therapy is now of primary concern and has led to publications about guide lines on this topic. If central block is carried out in patients with bleeding diathesis it is mandatory to co-ordinate multidisciplinary assistance for early detection of significant symptoms of the above described complications and subsequent treatment.