Minerva anestesiologica
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Minerva anestesiologica · May 2002
ReviewAntithrombin III. Key factor in extracorporeal circulation.
Antithrombin III plays many different roles during cardiac operations with cardiopulmonary bypass. Basically, it acts as the natural inhibitor of thrombin, which, in presence of heparin, blocks the thrombin action and avoids gross thrombus formation inside the extracorporeal circulation circuit. ⋯ Moreover, patients pre-treated with heparin reach the operating theater with reduced levels of circulating antithrombin III; this may lead to the heparin resistance phenomenon and may further increase the risk for postoperative thrombotic complications. Finally, the anti-inflammatory properties of antithrombin III in the setting of the "whole body inflammatory reaction" induced by the cardiopulmonary bypass represents a new and unexplored field of research.
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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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40% to 60% of children undergoing surgery under general anaesthesia develop anxiety in the preoperative period. Multiple factors contribute to the genesis of this disorder. Preoperative anxiety may complicate the induction of anaesthesia and can cause behavioural modifications in children even long after surgical procedures have been completed. ⋯ A preparation program, premedication and parental presence during induction of anaesthesia are valid tools for achieving this goal. We are herewith presenting a play preparation program carried out by play specialists and offered to all children prior to surgery. This approach proved effective in reducing preoperative anxiety in children and their mothers.
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In appropriately selected patients, NPPV decreases intubation rate, improves survival, and is cost-effective. Pressure support ventilation is commonly used successfully for NPPV. ⋯ A concern with portable pressure ventilators is the potential for rebreathing of carbon dioxide. Despite these issues, pressure support ventilation has been used successfully for noninvasive ventilation in thousands of patients with acute respiratory failure.
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The scanty availability of intensive care beds in our hospital, compared with the needings of the area, led us to employ surgical department beds as post-intensive beds. The possibility of delivering non invasive ventilation by head helmet allowed, also in such settings, the ventilation of patients. This paper analyses the main capacities and problems that are faced by the nurse in the management of head helmet delivered CPAP. Main systems for gas delivery that can be used in the departments, PEEP application modalities and psychologic management of the patient are detailed.