Minerva anestesiologica
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Minerva anestesiologica · Jun 2011
Age-related differences in mechanism, cause, and location of trauma deaths.
Trauma death has traditionally been described as primarily occurring in young men exposed to penetrating trauma or road traffic accidents. The epidemiology of trauma fatalities in Europe may change as a result of the increasing proportion of elderly patients. The goal of this study was to describe age-related differences in trauma type, mechanism, cause and location of death in a well-defined European region. ⋯ Increasing age was associated with higher mortality, an increased proportion of falls and fatal head or spine injuries.
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Minerva anestesiologica · Jun 2011
Propofol, remifentanil and mivacurium: fast track surgery with poor intubating conditions.
Mivacurium is widespread used because it is the non-depolarizing muscle relaxant with the shortest duration time. Therefore, it seems to be ideal for fast track or ambulatory surgery. However, especially in combination with propofol and remifentanil onset time remains unclear and incidence of poor intubating conditions seems to be higher than in other regimes of anesthesia. ⋯ In combination with propofol and remifentanil the muscle relaxant agent mivacurium led to uncertain muscle relaxation and to poor intubating conditions. Therefore the study was aborted after 35 patients. Probably mivacurium is not a useful muscle relaxant agent if fast and deep muscle relaxation is needed. The advantage of a short duration time is foiled by intubation complications due to insufficient muscle relaxation.
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Apneic oxygenation (AO) is applied during surgery and in intensive care units. Even with AO, apnea is associated with progressive hypoxemia, limiting the tolerable amount of time in AO. This experimental study evaluates the effects of a recruitment maneuver (RM) on oxygenation, CO2 retention, and survival times during prolonged apnea, supported or not supported with intratracheal apneic oxygenation. ⋯ RM prior to AO prolongs tolerance to apnea, probably by increasing the time before intolerable hypoxemia occurs, without a significant difference in PaCO2 levels.