Minerva anestesiologica
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Minerva anestesiologica · Sep 1993
Comparative Study Clinical Trial Controlled Clinical Trial[Propofol-midazolam in continuous infusion for sedation in intensive care].
Two groups of 11 ICU respiratory patients ventilated with PSV have been sedated with propofol (group I) or with midazolam (group II). After the endovenous administration of the induction dose (propofol 1.5 mg/kg; midazolam 0.15 mg/kg) sedation was obtained with continuous infusion of the drugs (propofol 2 mg/kg/h; midazolam 0.24 mg/kg/h). ⋯ At induction midazolam caused a reduction of tidal volume for some minutes and a greatest sedation in comparison with propofol, while propofol caused reduction of MAP (p < 0.01) and transitory apnoea. Even if during the infusion of propofol the level of sedation decreased with time (p < 0.05; y = -0.0357 x + 3.07) it was more stable in comparison with that registered during continuous infusion of midazolam (p < 0.01; y = -0.2018 x + 5.19.
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Minerva anestesiologica · Sep 1993
Case Reports[Unilateral pulmonary edema caused by heart failure. Report of 2 clinical cases].
The authors present two case reports of cardiogenic unilateral pulmonary edema. The information provided by hemodynamic monitoring have not been essential for diagnosis which was bases on clinical, radiological and echocardiographic findings and confirmed by the clinical response to a specific treatment. The authors briefly review the mechanisms which may cause the atypical distribution of the cardiogenic pulmonary edema.
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Minerva anestesiologica · Jun 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Combined anesthesia (epidural-general) in thoracic surgery: the cardiocirculatory response to induction. Propofol vs midazolam plus alfentanil].
Thoracic epidural block may unpredictably blunt the physiological sympathetic response to anaesthetic agents and profound hypotension could result at induction time. The authors evaluate two different induction regimens in 16 patients scheduled for major thoracic surgery in order to assess which of them would produce less hemodynamic changes. After the institution of high thoracic epidural block (6 ml lidocaine-CO2 2% + epinephrine 1/200,000 level: th.2-3), patients were randomly allocated in two induction groups: P and M. ⋯ In P group the fall in blood pressure is more pronounced than M group (p < 0.05). Noteworthy in both groups cardiac frequency do not increase and in M group significantly lowers. In the authors view the midazolam plus alfentanil induction technique compare well with propofol alone and would recommend its use in poor risk patients.
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Minerva anestesiologica · Jun 1993
Randomized Controlled Trial Comparative Study Clinical Trial[The treatment of postoperative shivering with nefopam hydrochloride].
After having considered the physiopathological mechanism of shivering, the authors have estimated in a randomised study the effects of the resolution of shivering by nefopam hydrochloride. This drug a dose of 0.20 mg/kg resolved the symptoms in 100% of cases and the placebo hasn't resolved a case so that case it also obtained the same effects. The authors have proved the efficacy of the nefopam hydrochloride in the control of postoperative shivering in the recommended dose.
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Minerva anestesiologica · Jun 1993
Comparative Study[The thermodilution determination of right ventricular volumes and ejection fraction in the critical patient. Volumetric vs pressure measurement assessment].
The widespread use of hemodynamic investigation techniques, allowed a better understanding of the right ventricle (RV) pathophysiology and led to progressive reevaluation of its role. A modification of the classical Swan-Ganz catheter, made possible the measurement of the ejection fraction (EF) and of the end-systolic and end-diastolic volumes of RV just by the simple application of the thermodilution technique. In this paper, we first refreshed the basic theoretical principles of the technique and then presented our preliminary results of one-year experience in ICU. ⋯ We conclude that the use of the thermodilution technique to measure the volumes of RV, allows a real evaluation of the preload. At the same time it avoids all the problems associated with the measurement of transmural pressure and with the changes produced by shifting of intrapleural pressure. Finally the end systolic volume may be combined with the pressure data to estimate the contractile status and, in our experience, this parameter has proved more sensitive than EF in order to detect changes of contractility of the right ventricle.