Minerva anestesiologica
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Minerva anestesiologica · Jun 2006
ReviewUsing the nerve stimulator for peripheral or plexus nerve blocks.
Conventional methodology for nerve location utilizes anatomical landmarks followed by invasive exploration with a needle to a suitable endpoint. An appropriate endpoint can be either anatomical in nature (e.g. transaterial technique) or functional (paresthesia or motor response to electrical stimulation). Ability to electrically stimulate a peripheral nerve or plexus depends upon many variables, including; 1) conductive area at the electrode, 2) electrical impedance, 3) electrode-to-nerve distance, 4) current flow (amperage), and 5) pulse duration. ⋯ The above parameters can be varied optimally to enhance successful nerve location and subsequent blockade. Unlike imaging modalities such as ultrasonography, electrical nerve stimulation depends upon nerve conduction. Similarly, percutaneous electrode guidance (PEG) makes use of the above variables to allow prelocation of the nerve by transcutaneous stimulation.
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Minerva anestesiologica · Jun 2006
ReviewPreoperative parental information and parents' presence at induction of anaesthesia.
Preoperative preparation of paediatric patients and their environment in order to prevent anxiety is an important issue in paediatric anaesthesia. Anxiety in paediatric patients may lead to immediate negative postoperative responses. When a child undergoes surgery, information about the child's anaesthesia must be provided to parents who are responsible for making informed choices about healthcare on their child's behalf. ⋯ The issue of parental presence during induction of anaesthesia has been a controversial topic for many years. Potential benefits from parental presence at induction include reducing or avoiding the fear and anxiety that might occur in both the child and its parents, reducing the need for preoperative sedatives, and improving the child's compliance even if other studies showed no effects on the anxiety and satisfaction level. The presence of other figures such as clowns in the operating room, together with one of the child's parents, is an effective intervention for managing child and parent anxiety during the preoperative period.
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Minerva anestesiologica · Jun 2006
ReviewAcquired weakness in the ICU: critical illness myopathy and polyneuropathy.
Illnesses commonly encountered in the ICU, such as sepsis, have frequently been associated with neuromuscular weakness and may play a role in the development of CIM and CIP, whose incidence in the critically ill is greater than initially reported. Although difficult to diagnose from history and clinical/laboratory findings alone, the use of electromyographic and nerve conduction testing is helpful in establishing these diagnoses. ⋯ Acquired neuromuscular weakness in the ICU affects a significant number of patients and may continue to affect their quality of life long after discharge. Although diagnostic techniques are readily available, additional research is necessary to obtain adequate prognostic information and therapeutic options for these patients.
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Minerva anestesiologica · Jun 2006
ReviewMicrocirculatory recruitment maneuvers correct tissue CO2 abnormalities in sepsis.
The rises in tissue partial pressure of carbon dioxide have been observed in critically ill patients with shock and sepsis for a long time and have been proposed to be an earlier and more reliable marker of tissue hypoxia than traditional markers. However, the mechanisms leading to those increases, especially in sepsis and endotoxemia, are not well understood. Recent studies provided further data, supporting the idea that the origin of those increases in partial pressure of CO2 in sepsis as being caused by microcirculatory perfusion deficit resulting in mitochondrial depression by time. ⋯ Recent findings support the idea that the progression from early to severe sepsis is accompanied or possibly even caused by microcirculatory dysfunction, which leads to mitochondrial dysfunction by time. Therefore early identification of microcirculatory dysfunction and correction with microcirculatory recruitment maneuvers are needed to ensure adequate microcirculatory perfusion and tissue oxygenation. Microcirculatory imaging, such as SDF imaging technique, appears to be a very useful tool for this task and its combination together with other systemic and regional tissue oxygenation measurements may provide more information regarding the tissue oxygenation and will be a very promising tool for microcirculatory researchers and the management of critically ill patients at the bedside.
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Metabolically critical illness can be divided in two phases, acute and prolonged. Whereas the acute or hypermetabolic phase is characterized by elevated circulating concentration of catabolic hormones and substrate utilization to provide energy to vital organs, the prolonged or catabolic phase of critical illness is marked by reduced endocrine stimulation and severe loss of body cell mass. The most common analgesic and sedative agents used in the intensive care unit, if used in small or moderate doses, do not interfere significantly with the metabolic milieu; however, prolonged infusions, and in high doses, without adequate monitoring of level of sedation and quality of analgesia, can precipitate morbid events. Further research is needed in the metabolic aspects of analgesia and sedation in the intensive care unit, particularly if a multimodal pharmacologic strategy is used whereby multiple interventions aim at minimizing the risk of overdosing and contributing to attenuation of the stress response associated with critical illness.