Minerva anestesiologica
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Minerva anestesiologica · May 2002
ReviewNew drugs, new techniques, new indications in pediatric regional anesthesia.
The use of regional anesthesia in children represents one of the most effective methods for perioperative analgesia and postoperative pain control. Things have been dramatically changed in the last two decades due to the appearance of new safer drugs and new tools; moreover new techniques were introduced showing their efficacy. In this paper we briefly describe the efficacy of new local anesthetics and adjuvants; we review the use of continuous peripheral blocks and other not very diffused techniques of regional anesthesia.
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Recovery and outcome parameters of children undergoing surgery as outpatient are reported. There are minor differences between different drugs in terms of outcome, speed of recovery and recovery adverse events. ⋯ Most complications (pain, nausea, vomiting, croup) are transient and managed before discharge. The most frequent complications at home are undertreated pain, loss of appetite, and behavioral changes.
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Initial Implementation of Mechanical Ventilation was focused on providing adequate oxygenation and relief of work of breathing. Over the last few decades it has become apparent that stretch-induced lung injury, associated with normocapnia or hypocapnia, is a real phenomenon. Attempts to reduce stretch-induced injury led to development of permissive hypercapnia in the neonatal population, and later to its acceptance as a standard of care in adult patients with ARDS. ⋯ It is now apparent that hypercapnia by itself can be protective. In addition, hypocapnia can be harmful. These observations led to the hypothesis of therapeutic hypercapnia, i.e., deliberate production of high CO2 as a goal in the care of critically ill patients.
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Automatic tube compensation (ATC) is a new option to compensate for the non-linearly flow-dependent pressure drop across an endotracheal or tracheostomy tube (ETT) during inspiration and expiration. ATC is based on a closed-loop working principle. ATC is not a true ventilatory mode but rather a new option which can be combined with all conventional ventilatory modes. ⋯ Moreover, sufficient spontaneous breathing with ATC alone, i.e. without any additional ventilatory assist, might help to predict more accurately readiness for extubation in the last phase of weaning from mechanical ventilation. Furthermore, it has been shown in patients with acute lung injury that ATC unloaded the inspiratory muscles and increased alveolar ventilation without adversely affecting cardiorespiratory function. It is the purpose of this article to describe the working principle of ATC and to give a review of the actual scientific discussion concerning ATC.
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Pulse-oximeter is described as the most important technological proceeding for monitoring the patients' safety during anesthesia, after surgery and in emergency. This opinion was widely confirmed in the 1990s when pulse-oximeter has been definitively introduced in the standard for base monitoring in the OR and has been proposed for routinary use also in the ICU. In this paper we consider the importance, in the cardiovascular, respiratory and brain parameters monitoring, of continuous oximetry of mixed venous blood (SVO2) and blood venous saturation in the internal jugular vein (SjvO2).