Minerva anestesiologica
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Minerva anestesiologica · Mar 1994
Comparative Study Clinical Trial Controlled Clinical Trial[Respiratory exchange during laparoscopic and laparotomic cholecystectomy].
The utility of laparoscopic cholecystectomy in reducing postoperative pain and patient's hospital discharge is already known. Nevertheless peritoneal gas insufflation required by surgical procedure can modify respiratory homeostasis during general anesthesia. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy on pulmonary dead spaces and alveolar gas exchange during inhalation anesthesia compared with traditional laparotomic cholecystectomy. ⋯ VDphy/VT, VDalv/VT, P(a-Et)CO2 and A-aDO2 increased significantly in the CL-S compared to the CL-T group (p < 0.05). No differences were found in the VDan/VT. These results can be explained by analteration of the ventilation to perfusion ratio (VA/Q) with an increase of high VA/Q regions due to the antitrendelenburg positioning with a redistribution of blood flow towards basal zones.(ABSTRACT TRUNCATED AT 250 WORDS)
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Minerva anestesiologica · Mar 1994
Case ReportsDouble simultaneous hemodialysis during prolonged cardio-pulmonary resuscitation for hyperkalemic cardiac arrest. Case report.
A 57-year old male uremic patient developed a sudden cardiac arrest due to severe hyperkalemia. The cardiac arrest lasted 135 minutes and was initially unresponsive to conventional therapy. It was successfully treated by prolonged external cardiac massage, assisted ventilation and double simultaneous arteriovenous hemodialysis to rapidly decrease the high potassium level.
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Minerva anestesiologica · Mar 1994
[Sciatic and femoral nerve block with electro-neural stimulator (ENS) in surgery of the knee in day-care surgery].
This study was designed to evaluate locoregional anesthesia (double block of sciatic and femoral nerves with ENS) for ambulatory knee arthroscopic surgery. A statistical evaluation was performed in 50 adult outpatients (41 males, 9 females, ASA class 1 or 2) undergoing ambulatory knee arthroscopic procedures. Basal and intraoperative BP, HR SaO2 were recorded and the intensity of analgesia was also assessed according to the patient's subjective evaluation. ⋯ The effectiveness of the anaesthetic block was classified as very good in 84% of patients, good in 2%, sufficient in 6% and inadequate in 8%. All patients were discharged in four hours after surgery. Our study shows that in ambulatory arthroscopic surgery, sciatic and femoral block with ENS is a valuable alternative to general anaesthesia.
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Minerva anestesiologica · Mar 1994
[Monitoring of cuff pressure in double-lumen endotracheal tubes during anesthesia for thoracic surgery].
It is well known that cuff overinflation in endotracheal tubes may cause serious damage to the tracheal mucosa. Cuff overinflation is also related to the diffusion of nitrous oxide across the cuff membrane, thus giving way to a progressive volume/pressure increase up to overcoming, critical capillaric perfusion pressure. The kinetics of hi-lo cuff-pressure in single-lumen endotracheal tubes during general anesthesia using nitrous oxide has been well documented. ⋯ In ten of these case, special equipment was used in order to keep the cuff-pressures steady and at the lowest sealing level. The pressure shows the same trend in both cuffs but, depending on the medium calibre of the main left bronchus and the volume/pressure relations of the endobronchial cuffs, the pressure in the latter increases faster. The investigation was performed using an original equipment developed by the authors; such equipment is able not only to monitor the cuff-pressures, but also to maintain them at steady controlled levels (below 20 cm water seal), by means of counterregulating all the volume variations due either to anesthetic requirements, or to the diffusion of nitrous oxide.(ABSTRACT TRUNCATED AT 250 WORDS)
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Minerva anestesiologica · Mar 1994
Randomized Controlled Trial Comparative Study Clinical Trial[Trazodone versus flunitrazepam in premedication in day-care surgery].
A prospective single-blind study was conducted to compare flunitrazepam vs trazodone in the premedication of patients undergoing day-case surgery for termination of pregnancy, with particular regard to the degree of preoperative sedation, intraoperative analgesia and postoperative recovery. 86 patients were randomly allocated to receive orally 45 minutes before the surgical procedure either flunitrazepam 2 mg (group F) or trazodone 50 mg (group T). In both groups anaesthesia was achieved by i.v. fentanyl 2.5 micrograms/kg and ketamina 250 micrograms/kg. Patients in group F showed a deeper degree of preoperative sedation. ⋯ In the postoperative period, the incidences of emetic symptoms and dizziness were similar in both groups; the incidence of drowsiness was significantly higher in group F at 120 minutes but not at 180 minutes of observation. Psychomotor performance was assessed preoperatively two days before the surgical procedure and 60, 120 and 180 minutes after surgery, using the Toulouse-Pieron test and the reaction time to a luminous stimulus with the aid of a computerized analogic tachystoscope (Neurometer). Trazodone allowed a more rapid recovery of psychomotor performance and it can represent a valid alternative to the use of benzodiazepines in the premedication of day-case surgical patients.