Minerva anestesiologica
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Minerva anestesiologica · Sep 2001
Reduction of operating and recovery room times and overnight hospital stays with interscalene blocks as sole anesthetic technique for rotator cuff surgery.
The effort to decrease hospital stays and to increase operating room efficacy has become an important consideration in the practice of anesthesia. ⋯ This study confirms that the interscalene block as sole anesthesia technique is safe and effective and can contribute to shorten the hospital length of stay of patients undergoing shoulder rotator cuff surgery.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Comparative Study Clinical TrialHypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery.
To evaluate the usefulness of hypertonic saline solutions (HTS) as an alternative to mannitol in neurosurgery. ⋯ HTS can safely be used in humans they obtain a reduction of ICP without reducing CVP, serum osmolality and Na+ serum values. Our data underline the possibility of their use as an alternative to mannitol in the treatment of patients scheduled for intracranial surgery, especially when multiple doses are needed.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Comparative Study Clinical TrialEffects of sevoflurane versus propofol on QT interval.
Prolongation of the QT interval is an alteration of the electrocardiogram (ECG) that may result in a potentially dangerous polymorphic ventricular tachycardia known as torsade de pointes. Michaloudis et al. investigated the effect of isoflurane and halothane on the QT interval in premedicated and non premedicated children, and in premedicated adults. Isoflurane significantly prolonged the QTc interval, in contrast to halothane, which shortened the QTc interval. The aim of the study was to evaluate the effect of sevoflurane on the QT interval in patients undergoing non-cardiac surgery. ⋯ The amount the sevoflurane-associated QT prolongation may possibly be of clinical significance in some patients presenting long QT syndrome, hypokalemia, or in presence of other agents or factors that lengthen QT.
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Ropivacaine is a relatively new long-acting local anesthetic. It is a pure S(-) isomer, with a high pKa and low lipid solubility. Because of its physical and chemical properties, ropivacaine produces a marked differential in sensory and motor blockades, with a toxic potential lower than other long-acting anesthetic solutions. The purpose of this paper was the evaluation of the literature concerning indications and advantages of ropivacaine for different regional anesthesia techniques. ⋯ Ropivacaine is a long-acting local anesthetic with a marked differential blockade between sensory and motor fibres, overall at the low concentrations used for postoperative analgesia. It probably has a slightly lower potency as compared with bupivacaine, but provides similar clinical efficacy in the different fields of regional anesthesia. Ropivacaine is less cardiotoxic and causes less central nervous system toxicity than bupivacaine, and this lower toxic potential has been reported not only with equivalent but also with equipotent concentrations and doses. For this reason, ropivacaine represents a useful alternative to bupivacaine for central and peripheral nerve blocks as well as for the management of postoperative pain relief.
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The rational approach to acute pain management is to use the highest quality evidence available. Acute pain management is more than a collection of interventions. It is a package of care that needs to be examined as a whole as well as in its parts. ⋯ Existing tools can do the job if doctors and nurses are educated, both to dispel the myths and misconceptions and to take responsibility for providing pain control. It is much easier to dispel myths when you have the evidence. In 1846, the first anaesthetic provided pain-free surgery - 150 years later patients should not have to endure unrelieved pain anywhere in the hospital.