Minerva anestesiologica
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Minerva anestesiologica · May 2012
Survey on controversies in airway management among anaesthesiologists in the UK, Austria and Switzerland.
While surveys about anaesthesia practice appear regularly in the anaesthesia literature, they are usually bound to one country. We compared the approach to specific airway management issues among anaesthesiologists from three different European countries. METHODS A questionnaire was distributed during the main session of three anaesthesia meetings in Austria(A), the UK, and Switzerland(CH). ⋯ CONCLUSION Answers from anaesthesiologists in the UK differed significantly from those in A and CH. Anaesthesiologists in the UK check mask ventilation after induction less frequently, but they check more often when risk factors of difficult mask ventilation are present. Cricoid pressure seems to remain an important part of the rapid sequence induction technique in the UK, whereas anaesthesiologists in Austria and Switzerland rely less on this technique.
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Minerva anestesiologica · May 2012
Clinical TrialReversal of profound and "deep" residual rocuronium-induced neuromuscular blockade by sugammadex: a neurophysiological study.
Sugammadex is the first of a new class of selective relaxant binding drugs developed for the rapid and complete reversal of neuromuscular blockade (NMB) induced by the aminosteroid neuromuscular blocking drugs rocuronium and vecuronium. Neuromuscular blocking drugs block the transmission from the peripheral nerve to the muscle units, with reduction and disappearance of the evoked electromyographic activity. Usually, neuromuscular monitoring for the investigational reversal drug is performed by calibrated acceleromyography. The efficacy of sugammadex in reversing profound and "deep" residual rocuronium-induced NMB using myogenic motor evoked potentials (mMEPs) monitoring was evaluated. ⋯ Neurophysiological monitoring using mMEPs confirmed that sugammadex provided a complete recovery from profound and "deep" residual rocuronium-induced neuromuscular blockade.
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Minerva anestesiologica · May 2012
ReviewAnesthetic concerns for robotic-assisted laparoscopic radical prostatectomy.
The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, respiratory and hemodynamic homeostasis. ⋯ Close coordination between the anesthesia and surgical teams is required for a successful surgery. This review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP.
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Minerva anestesiologica · May 2012
Case ReportsSuccessful pre-emptive emergency management of a compromised airway with a Proseal™ Laryngeal Mask Airway followed by tracheostomy.
Following hemi-glossectomy and right neck dissection a 63-year-old female patient presented as an emergency with a large neck hematoma. There were significant concerns over difficulty in intubation and mask ventilation leading to deterioration into a cannot intubate cannot ventilate (CICV) situation. After careful discussion and planning with the surgical team, who planned a tracheostomy, the situation was salvaged using a ProSealTM Laryngeal Mask Airway (PLMA). The PLMA enabled rapid establishment of a clear airway early in anesthetic induction, controlled ventilation and safe airway maintenance during a difficult tracheostomy.
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Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. ⋯ This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.