Minerva anestesiologica
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Minerva anestesiologica · Jun 2000
Clinical Trial[Post-intubation subglottal stenosis in children: risk factors and prevention in pediatric intensive care].
Endotracheal intubation (EI) may result in significant injury to the larynx and trachea; subglottic stenosis is the most dangerous consequence of this injury in the pediatric age. It is well known that there are potential risk factors for post-intubation subglottic stenosis, and namely the underlying disease requiring EI, the age and body weight at EI, the duration and number of EI, the absence of sedation and the occurrence of infectious, hypotensive or hypoxic events during the period of EI and the traumatic EI. On the basis of our data an attempt is made to understand which factors are more important in the pathogenesis of this complication and whether post-intubation subglottic stenosis is a preventable complication of EI in children. ⋯ Prevention of post-intubation subglottic stenosis is possible through a better management of the EI and of the child with a tracheal tube. Sedation of intubated children and skill in the EI technique and in the tube size selection are very important. Many intubations can be avoided with a better attention to the tube fixation and to extubation criteria. Some children at high risk for this complication can be identified.
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Minerva anestesiologica · May 2000
ReviewThe measurement of the pressure-volume curves with computerized methods.
The authors analyze the physiological basis, technical aspects and clinical usefulness of several methods for pressure-volume curves determinations in mechanically ventilatory, acute respiratory failure patients.
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Due to pharmacokinetic and pharmacodynamic reasons, the elderly are at particular risk of incurring unwanted side effects of drugs commonly used in anaesthesia. The bispectral index (BIS) is an EEG-derived value that measures the sedative component of the anaesthetic state. The BIS could be useful in guiding titration of anaesthetic drugs in the elderly. ⋯ The BIS is a useful guidance for titration of anaesthetic drugs in the elderly. The presence of senile dementia may be a confounding factor in the interpretation of the BIS values during anaesthesia.
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Minerva anestesiologica · May 2000
ReviewMeasurement of pressure-volume curves in patients on mechanical ventilation. Methods and significance.
In critically ill patients measurements of pressure volume curves has been suggested as a method for assessing the severity of lung injury and for monitoring the evolution of the lung disease; it can also guide the ventilatory adjustments to optimize the mechanical ventilation. The static pressure-volume curves are impaired in acute respiratory distress syndrome (ARDS). ⋯ The combined application of positive end expiratory pressure (PEEP) to the level of alveolar recruitment and low tidal volume (< 6 ml/kg) ameliorates the lung function and decrease mortality in ARDS patients. Routine monitoring with continuous technique is easy and develops good therapeutic practice.
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Minerva anestesiologica · May 2000
ReviewTime to reconsider the pre-oxygenation during induction of anaesthesia.
Atelectasis is a frequent finding in paralysed and mechanically ventilated patients. Atelectasis, causing shunt, impairs oxygenation and could contribute to postoperative pulmonary complications. Pre-oxygenation used during anaesthesia induction causes atelectasis. A lowering of oxygen fraction from 100% to 80% does not shorten the safety time of apnoea period, particularly useful for a difficult intubation, but it reduces drastically the atelectasis incidence.