Minerva anestesiologica
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Minerva anestesiologica · May 2003
ReviewMechanical and infectious complications of central venous catheters.
Central venous catheters (CVC) are an important tool in the operation room and intensive care unit. The application of CVC is associated with both mechanical and infectious complications. Knowledge and recognition of risk factors and implementation of strict guidelines will help to reduce the number and severity of complications. Catheter-related factors, patient-related factors, selection of the site of puncture and catheter use and care related factors, all play a contributive role in the risk on complications.
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The aim of the paper is to review the literature concerning 4 unanswered or debatable questions concerning the practice of regional anesthesia in pediatric patients. The published material concerning the 4 selected topics is reviewed, namely importance of ropivacaine, preoperative coagulation screening tests, hemodynamic stability following neuraxial blocks and prevention/treatment of post-dural puncture headache. Of the 4 questions considered in this article, 3 can be reasonably answered in a consensual way. ⋯ Preoperative coagulation screening tests are not necessary, even not useful in children when clinical history is not suggestive of coagulation disorders, with the notable exception of neonates and prematurely born infants less than 45 weeks of post-conceptual age. The long established hemodynamic stability following neuraxial blocks results from well equilibrated compensatory mechanisms which may not be functional in children with preoperative hemodynamic instability or anomalies of the regional blood flow distribution. Finally, even though the post-dural puncture headache is not frequent in children, its management still remains difficult and no definitive recommendation can be currently made in case of inadvertent dural puncture during an attempted epidural anesthesia in children.
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Minerva anestesiologica · May 2003
Review[Prevention of cardiovascular accidents during locoregional anesthesia].
Cardiovascular complications can be divided into 2 big categories involving the cardiovascular system in locoregional anaesthesia: those of local anaesthetics with direct effect on sympathetic fibres, which regulate the cardiovascular activity and those who derives from alteration of the normal cardiac function due to the toxic effect of the drugs. While the first are referred to the extension of a central block, the second considers the overdose caused by accidental intravenous injection. This is more frequent in peripheral blocks then in central blocks. ⋯ The prevention of those complications should foresee through an accurate anamnesis the subjective conditions of risk: so we have to choose the best individual technique and dose of anaesthetics; the use of qualitative correct material, the ENS as a support to identify nerve structures and the application of more recent and safe drugs represented by the compound of S(-) enantiomers, Ropivacaine and Levobupivacaine. Which are described to be less cardiotoxic but with the same characteristics as Bupivacaine. Finally don't forget respect the classical rules of security during locoregional anaesthesia.