Minerva anestesiologica
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Minerva anestesiologica · Feb 2010
Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries.
Local anesthetic toxicity remains one of the most dreaded complications of the intravenous regional anesthesia (IVRA) technique. It results from the sudden release of a large amount of local anesthetic (LA) into the systemic circulation. This release can occur when the tourniquet deflates accidentally during the procedure or when it is deflated intentionally at the end of the procedure to terminate the anesthesia. The forearm tourniquet IVRA technique may offer distinct advantages over the conventional upper arm tourniquet IVRA technique. Use of a forearm tourniquet allows the dosage of local anesthetic to be decreased to almost half of what is required with an upper arm tourniquet, and the incidence of tourniquet pain has been reported to be less with forearm tourniquet. In this study, authors assessed the clinical efficacy of administering IVRA with lidocaine plus ketorolac using either a forearm or upper arm tourniquet. ⋯ In conclusion, forearm IVRA provides effective perioperative anesthesia and analgesia. The technique results in a similar clinical profile as upper arm IVRA while using half the dose of both lidocaine and ketorolac.
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Minerva anestesiologica · Feb 2010
The pharmacodynamic effects of rocuronium during general anesthesia in patients with type 2 diabetes mellitus.
The aim of this prospective study was to investigate whether the neuromuscular response to rocuronium is affected by the presence of type 2 diabetes mellitus. ⋯ The present study has proven that the rocuronium-induced neuromuscular block was not affected in patients with type 2 diabetes mellitus during isoflurane based general anesthesia.
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Minerva anestesiologica · Feb 2010
Case ReportsSuccessful emergent reintubation using the Aintree intubation catheter and a laryngeal mask airway.
Tracheal extubation can be potentially catastrophic, especially in patients with difficult airways. This article describes a case where planned extubation in a patient with a large tongue lesion led to complete airway obstruction and subsequent cardiac arrest. Reintubation was facilitated using a laryngeal mask airway and an Aintree intubation catheter.
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Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. ⋯ In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data.