Minerva anestesiologica
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Minerva anestesiologica · May 2001
Randomized Controlled Trial Clinical TrialImproving postoperative analgesia after axillary brachial plexus anesthesia with 0.75% ropivacaine. A double-blind evaluation of adding clonidine.
The aim of this prospective, randomized, double-blind study was to evaluate the effects of adding 1 microg/kg clonidine to 20 ml of ropivacaine 0.75% for axillary brachial plexus anesthesia. ⋯ Adding 1 microg/kg clonidine to 20 ml of ropivacaine 0.75% for axillary brachial plexus anesthesia provided a 3 h delay in first analgesic request postoperatively, without clinically relevant effects on the degree of sedation and cardiovascular homeostasis.
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Clinical shock is a common problem of the critically ill patient. Assessment of the circulating volume is important to assure adequate oxygen supply to the tissues, and hypovolaemia must be treated promptly to avoid organ dysfunction. ⋯ Clinical signs are often late indicators and the monitoring of hemodynamic variables through cardiac catheterism can be misleading. The fluid challenge approach provides a useful diagnostic test of hypovolaemia, and a method for titrating the dose of fluid tailored to the individual's requirement.
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Minerva anestesiologica · Apr 2001
Case ReportsExperiences with continuous intra-arterial blood gas monitoring.
Management of critically ill patients requires frequent arterial blood gas analyses for assessing the pulmonary situation and adjusting ventilator settings and circulatory therapeutic measures. Continuous arterial blood gas analysis is a real-time monitoring tool, which reliably detects the onset of adverse pulmonary effects. It gives rapid confirmation of ventilator setting changes and resuscitation and helps to ensure precise adjustment of therapy. ⋯ The Paratrend 7+ sensor proved to be clinical feasible and showed an improved precision in terms of clinical situations with an arterial pO2 smaller than 50 kPa. However, the results are not much different regarding the findings with older systems consisting of hybrid technology combining optodes and electrochemical oxygen measurement. The advantages might be seen if the sensor is used for a period over several days in patients on ICU as demonstrated by the two case reports.
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Quality of recovery after anesthesia and surgery is an important dimension of the patient's experience and may be related to the quality of anesthesia care. Quality of recovery is also related to patient satisfaction. We have developed and validated a quality of recovery (QoR) score. ⋯ Patient satisfaction is associated with higher QoR Scores. The measurement of quality of recovery is an important aspect of a quality anaesthetic practice. The QoR Score can be incorporated into routine practice and this should improve patient care and resultant levels of satisfaction.