Minerva anestesiologica
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Minerva anestesiologica · Jun 1999
ReviewInterventional neuroradiology. Recent developments and anaesthesiologic aspects.
To summarise recent developments in interventional neuroradiology (INR) and to discuss related anaesthesiologic considerations. ⋯ The role of the anaesthetist in INR consists in providing patient comfort by analgesia and sedation, adequate monitoring, maintenance of vital functions and (if required) the management of systemic heparinisation. The patient's underlying condition, the duration and the kind of intervention have to be considered to decide on the anaesthetic management. Most of the procedures can safely be performed under light sedation, which allows continuous neurological evaluation of the patient. Knowledge of the risks and hazards of the different procedures and close collaboration with the neuroradiologist form the basis for appropriate management in case of a potentially fatal ischaemic or haemorrhagic complication that may occur in 1 to 8% of interventions. For prompt control of airway, respiration and blood pressure in these emergencies experienced anaesthesia staff is required.
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Acute respiratory failure is accompanied by a severe gas exchange impairment that is signified by a large shunt and no or only little of additional ventilation-perfusion mismatch. The shunt is caused by perfusion of collapsed and consolidated lung tissue that is mainly located in the lower, dependent lung region. ⋯ Spontaneous breathing seems to improve gas exchange, and in proportion to its share of total ventilation, when added to mechanical ventilation. A shift from total mechanical ventilation to partial or fully spontaneous breathing may be the road of the future and should be tested further.
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Minerva anestesiologica · Jun 1999
Review[Therapeutic applications of hypothermia in intensive care].
A brief review about the effects of hypothermia is presented, with regards to the difference between accidental hypothermia and controlled mild hypothermia (Core temperature = 33-35 degrees C). Mild hypothermia does not seem to affect the cardiac performance, while recent experimental reports show potential protective effects on the cardiac muscle during acute infarction. Mild hypothermia improve the outcome of brain function after cardiac arrest and head injury, while experimental reports show a potential protective effect of local spinal cord cooling during ischemic injury. ⋯ In this setting a mild induced hypothermia potentially may decrease the side effects of therapeutic hypoventilation (permissive hypercapnia) both on haemodynamics and brain circulation. Preliminary data are presented about five ALI/ARDS patients, enclosed in a randomized trial, who were mechanically ventilated and cooled with an air-sheet: three patients died because of underlying disease and two patients survived with complete recovery. Mild controlled hypothermia seems to provide new interesting clinic uses.
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Regional anaesthesia is useful in day surgery when properly applied. Most commonly used techniques are IVRA, axillary block, local/infiltration plus monitored anaesthesia care. Spinal anaesthesia is also frequently used in DS. ⋯ The use of monitored anaesthesia care as an adjunct to RA increases patient acceptability and satisfaction with different blocks. In most cases there is less pain after operation if RA was used when compared to GA but control of pain is important at the time when the block wears off. Patient information and cooperation as well as timely discharge of patients home is important for successful RA in DS.
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Minerva anestesiologica · Jun 1999
ReviewPresent and future options in continuous renal replacement therapies of sepsis and MOF.
Conventional continuous extracorporeal treatments such as hemofiltration and hemodiafiltration have not achieved significant reduction in cytokine plasma levels, in spite of their increasing popularity mainly related to the unnecessary fluid restriction thereby rendering adequate caloric intake possible (Actualités Nephrologiques, 1994). This is mainly due to reduced filtration, to saturability of the adsorption-related phenomena and to the absence of a convective mass transfer. New approaches have been more recently introduced. ⋯ These modalities that are based on plasma filtration with the use of different sorbents. The preliminary results obtained from ongoing clinical trials will be presented. We will also expand on the technical, biological and clinical aspects that should be addressed in order to establish a new modality as innovative in the treatment of sepsis.