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
ReviewNoninvasive ventilation in acute respiratory failure with altered consciousness syndrome: a bargain or an hazard?
Non-invasive ventilation (NIV) is contraindicated or at least not recommended in patients with altered consciousness syndrome (ACS) given to the poor compliance of confused/agitated patients, difficult management of accumulated secretion in depressed cough reflex, and risk of aspirative pneumonia in absence of airways protection. Conventional mechanical ventilation (CMV) via endotracheal intubation (ETI) has been usually considered as the "golden standard" ventilator treatment in ACS. However, the possibility of avoiding ETI-related life-threatening complications by means of NIV, especially in fragile, older patients with multiple comorbidities, is an appealing option. ⋯ In this clinical scenario, an initial cautious NIV trial may be attempted as long as there are no other contraindications and the technique is provided by experienced caregivers in a closely monitored setting where ETI is always readily available. The concomitant use of techniques for removing secretion and/or controlled analgo-sedation performed by expert teams may be considered in highly selected cases. The purpose of this paper was to review rationale, clinical feasibility, advantages and risks correlated with the use of NIV in ACS.
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Minerva anestesiologica · Nov 2013
Randomized Controlled TrialInfluence of acute normovolemic hemodilution on the pharmacokinetics of Cisatracurium Besylate.
Acute normovolemic hemodilution (ANH) is an efficacious blood conservation strategy for avoiding or reducing allogeneic blood transfusion. In a previous publication, on a different cohort of patients, we demonstrated that cisatracurium's potency and duration of action were not influenced by ANH, but we could not establish which role, if any, pharmacokinetics played. ⋯ ANH altered some pharmacokinetic parameters such as significantly larger volumes of distribution. Other parameters such as elimination half-life were considerably longer albeit not statistically significant.
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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.