Minerva anestesiologica
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The response to muscle relaxants and the dose required change during growth from birth to adolescence. Some physiological factors such as development of neuromuscular junction, the different distribution of the muscle fibres, and the extracellular fluid compartment affect the non depolarizing muscle relaxant (NDMR) ED 95, onset time and recovery time. Infants under 1 year of age are more sensitive to the NDMR and need less drug; children aging more than 1 year are more resistant and need a larger amount of drug; the reversal of the neuromuscular blockade before extubation, is extremely important especially in infants with long-acting agents.
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We carried out a perspective study in order to assess the ease of insertion, the type and the incidence of perioperative complications connected with the use of the Laryngeal Mask Airway (LMA). We examined 300 consecutive patients, M/F 261/39, average age 4.2 yrs. (range 0.1-16), ASA I-II, who underwent surgical operations of short or average length not involving the pleural, the oropharyngeal or the peritoneum cavity. The choice about anesthesia was left to the discretion of the anesthesiologist. ⋯ No connections were found between the size of LMA and total complications. Nevertheless, cough or movement during positioning and laryngeal spasm on awakening were significantly more frequent with LMA n. 3. In our experience, the LMA proved to be effectual and safe in the control of the airway during elective operations in pediatric surgery.
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Minerva anestesiologica · Mar 1996
Review[Experience of an intermediate respiratory intensive therapy in the treatment of prolonged weaning from mechanical ventilation].
109 patients who suffered from an episode of acute respiratory failure, necessitated mechanical ventilation (MV) in a general Intensive Care Unit (ICU) and admitted to our Respiratory Intermediate Intensive Unit (RIIU), were retrospectively evaluated for outcome and weaning success. The patients, 69 +/- 9 years old, presented the following diseases: COLD (70%), cardiovascular (15%) and neuromuscular (15%). A relapse of underlying disease (62%), pneumonia (20%), thoraco-muscular pump failure (15%) and pulmonary embolism (3%) were the relapsing causes needing the ICU admission. ⋯ Maximal inspiratory pressure (31 +/- 7 cmH2O) and respiratory rate/tidal volume (83 +/- 34) were measured within 48 hours after RIIU admission. 82 subjects (75%) were weaned after 6 +/- 4 days of MV using in 87% of patients pressure support technique with spontaneous breathing cycles with oxygen supplementation. 8 patients on 109 (7%) died; 20 patients on 109 (18%) were discharged after 40 +/- 9 days of stay in RIIU necessitating home MV more than 18 hours/day by means of a tracheostomy. All patients stay in RIIU for 17 +/- 7 days with a mean cost per die of 750 thousands lire. Our data suggest that a RIIU institution for prolonged weaning in chronic diseases may be a useful solution to decrease superfluous stays in ICU decreasing costs without ba worsening in quality of care.
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Minerva anestesiologica · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Spinal anesthesia in cesarean section: 1% versus 0.5% hyperbaric bupivacaine].
To compare the quality of anesthesia produced by the intrathecal administration of equivalent doses of 0.5% and 1% hyperbaric bupivacaine in patients undergoing cesarian section. ⋯ No important difference was observed in the quality of the anesthesia obtained using the intrathecal administration of equivalent doses of 1% and 0.5% solutions of hyperbaric bupivacaine in patients undergoing cesarian section. In view of the possible relationship between the neurotoxicity of local anesthetics and the concentration of the solution used for spinal anesthesia, it is to be hoped that less concentrated solutions of hyperbaric bupivacaine will be introduced in Italy compared to the 1% solution currently available.