Panminerva medica
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Case Reports
Pulmonary edema and acute hypercapnic respiratory failure treated with bi-level nasal-CPAP: case report.
Noninvasive mechanical ventilation has been suggested for the treatment of patients with respiratory failure. We describe the case of a patient affected by bilateral cystic bronchiectasis and acute hypercapnic respiratory failure, due to a cardiogenic pulmonary edema, successfully treated with bi-level nasal-CPAP. This report suggests that in some cases noninvasive ventilatory support may mean avoiding tracheal intubation, even with critically ill patients.
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The results obtained from 355 patients of both sexes subjected to general and orthopaedic surgery with super-selective subarachnoid anesthesia (SSA) by means of small (26-27 gauge) needles with a modified Whitacre needle with ogival point are described. The use of thin spinal needles with "pencil-point" type ends together with microdoses of local anesthetics has meant a reduction in the complications typical of this technique such as hypotension, post-dural puncture, headache (PDPH) and urinary retention. Super-selective subarachnoid anesthesia realised through an infusion of 0.8-1 ml of hyperbaric bupivacaine is a safe effective technique with a low percentage of side-effects.