Minerva anestesiologica
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Minerva anestesiologica · Nov 2013
Neuraxial anaesthesia in patients with intracranial hypertension or cerebrospinal fluid shunting systems: what the anaesthetist should know?
The management of patients with central nervous system disorders such as brain tumours, hydrocephalus, intracranial hypertension, or subarachnoid haemorrhage has improved in recent years resulting in increased life expectancy. Consequently, the prevalence of patients with increased intracranial pressure or cerebrospinal fluid shunting devices presenting for non-neurological procedures has increased. ⋯ It describes current knowledge, exposes and weighs the real benefits and risks of this technique in this setting. It provides several scenarios and anaesthetic options to help the practitioner with choosing a tailored approach in this specific population.
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Minerva anestesiologica · Nov 2013
Randomized Controlled Trial Comparative StudyComparing Propofol versus Sevoflurane Anesthesia for Epileptogenic Focus Detection during Positron Emission Tomography in Pediatric Patients.
Fluoro-D-deoxyglucose positron emission tomography (FDG-PET) is a standard procedure for interictal assessment and accurate pre-surgical evaluation of presumed epileptogenic zone localization. Profound sedation or general anesthesia is frequently required to reduce movement artefacts in young or cognitively impaired patients during image acquisition. This study compares the impact of propofol and sevoflurane anesthesia on overall quality of PET images, detectability of a hypometabolic lesion and demarcation of the detected lesion in pediatric patients suffering from focal epilepsia. ⋯ For surgical planning in patients with epilepsy, FDG-PET imaging is an indispensable functional imaging technique to detect hypometabolism. We conclude that both, sevoflurane and propofol based anesthetic regimes are suitable to detect hypometabolic cerebral lesions during FDG-PET.
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Minerva anestesiologica · Nov 2013
Observational StudyElevated adipose tissue lactate to pyruvate (L/P) ratio predicts poor outcome in critically ill patients with septic shock: a microdialysis study.
Sepsis is a disease affecting tissue metabolism; in vivo microdialysis (MD) is a bedside technique enabling researchers to monitor tissue metabolic changes. We conducted this study aiming to evaluate the relationship between lactate to pyruvate (L/P) ratio, a sensitive marker of tissue oxygenation and perfusion, and mortality in critically ill septic patients. ⋯ Elevated adipose tissue L/P ratio is associated with poor outcome in critically ill patients with septic shock. Microdialysis deserves to be further studied as a research tool in the multi-modal monitoring of septic critically ill patients.