Minerva anestesiologica
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Minerva anestesiologica · May 1998
Review Randomized Controlled Trial Clinical Trial[Indications for steroid and tirilazad treatment in patients with subarachnoid hemorrhage].
Tirilazad mesylate, a nonglucocorticoid 21-aminosteroid, has been used in two randomized, double-blind, vehicle-controlled trials in Europe, Australia, New Zealand, and in North America in patients with aneurysmal subarachnoid hemorrhage. The first trial has been concluded, enrolled 1023 patients, and demonstrated a dramatic reduction in mortality from 27% to 3% (p = 0.01) in males receiving 6 mg/kg/day tirilazad for 10 days, when compared to vehicle-treated patients. ⋯ This clinical trial suggest that tirilazad mesylate, at a dosage of 6 mg/kg/day, improves overall outcome in aneurysmal subarachnoid hemorrhage patients. Further data from the North America trial and the trial in women receiving higher doses of tirilazad are still pending.
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Hyponatremia is a common feature after subarachnoid hemorrhage. Hyponatremia is complex in its origin because different neuroendocrine disturbances are involved: elements of inappropriate secretion of ADH, cerebral salt wasting, and blunted response of the reninangiotensin-aldosterone system may occur simultaneously. ⋯ Fluid restriction is therefore contraindicated in hyponatremia following subarachnoid hemorrhage because of the negative impact on intravascular volume. On the contrary, replacement of both volume and sodium should be vigorously accomplished.
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Minerva anestesiologica · Apr 1998
Review[Reasons in favor of lumbar puncture diagnosis (or lavage)].
In patients with strong suspicion of SAH, CT is the initial diagnostic procedure of choice. A lumbar puncture (LP) should be done if a CT is not available. If the patient has no focal deficit or papilloedema there is a little risk in LP. ⋯ The accuracy of CT in documenting SAH diminishes after 24 hours: thereafter, diagnosis is often dependent on LP. In some cases LP can be useful because the procedure may alleviate headache and remove some blood. LP can also quantify cerebro-spinal fluid (CSF) pressure, provide a baseline for future CSF determination, and allow the study of some parameters like arachidonate metabolites, lactic acid, fibrinogen degradation products (FDP) and thrombin-antithrombin complex (TAT).
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Minerva anestesiologica · Apr 1998
[Physiopathology of non-traumatic subarachnoid hemorrhage: loss of consciousness].
The mechanisms underlying the loss of consciousness following the SAH can be only hypothesized at present time. The more convincing hypothesis appears to be the role of a cerebral circulatory insufficiency. ⋯ Different cerebral regions can be affected by the ischemia according to the prevalent location of the SAH, as for instance brain stem or telencephalon; consequently, different pathophysiological modalities can be responsible for the consciousness impairment. The entity of the SAH and of the consequent events responsible for the cerebral ischemia, influence the severity and reversibility of the loss of consciousness.
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Minerva anestesiologica · Mar 1998
Comparative Study Clinical Trial Controlled Clinical Trial[Postoperative analgesia with PCA in 300 patients. A comparison of four therapeutic regimes].
The results of patient-controlled analgesia (PCA) in 300 patients undergoing major operations in general surgery, urology, ENT and obstetrics-gynaecology are presented. ⋯ On the basis of personal experience, patient controlled analgesia has been demonstrated to be an effective, reliable and flexible procedure for the control of postoperative pain.