Minerva anestesiologica
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Minerva anestesiologica · Jun 2013
Randomized Controlled Trial Comparative StudyA prospective, randomized controlled trial comparing the left lateral, modified lateral and sitting positions for spinal block characteristics for Cesarean delivery.
Maternal position affects spinal block characteristics. We investigated the effect of lateral, modified lateral and sitting position for spinal anesthesia with 2 mL hyperbaric bupivacaine 0.5% on spinal block characteristics in this prospective, randomized study. ⋯ Onset time (mean ± SD) for sensory block to T5 dermatome for the lateral, modified lateral and sitting groups was 6.8 ± 2.7, 13.6 ± 6.2 and 9.7 ± 5.5 min, respectively; P<0.001. The median (interquartile range) maximum dermatomal level was significantly lower in the modified lateral group (T5[T3-T5]) compared with the lateral (T3[T2-T4]) and sitting (T3[T3-T4]) groups, respectively; P=0.022 and P=0.030, respectively. Three women in the modified lateral group required general anesthesia compared with none in the other groups; P= 0.044. Apgar scores and cord blood pH, PO2 and PCO2 were similar between groups. Conclusion: The modified lateral position with 10 mg of hyperbaric bupivacaine was associated with a slower onset and a lower maximum sensory block necessitating higher requirement for conversion to general anesthesia. It did not offer any advantage over lateral and sitting positions for induction of spinal anesthesia for elective Cesarean delivery and cannot be recommended.
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Minerva anestesiologica · Jun 2013
Improved ventilation-perfusion matching by abdominal insufflation (pneumoperitoneum) with CO2 but not with air.
Pneumoperitoneum (PP) by CO2-insufflation causes atelectasis however with maintained or even improved oxygenation. We studied the effect of abdominal insufflation by carbon dioxide (CO2) and air on gas exchange during PP. ⋯ CO2-PP enhanced the shift of blood flow towards better ventilated areas of the lung compared to Air-PP and SNP blunted the effects seen with CO2-PP. SNP may thus have blunted and CO2 potentiated vasoconstriction, by hypoxic pulmonary vasoconstriction or another mechanism.
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Minerva anestesiologica · Jun 2013
Editorial CommentOxygen instead of Blood - Not in too sick or too low.
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Minerva anestesiologica · Jun 2013
Randomized Controlled Trial Comparative StudyAcupuncture versus valproic acid in the prophylaxis of migraine without aura: a prospective controlled study.
The pharmacologic treatment of migraine still remains below the expectations. The aim of this study is to compare the effectiveness of traditional acupuncture and valproic acid in migraine prophylaxis. ⋯ Our data show a lower pain intensity and lower Rizatriptan intake at six-months follow-up with no adverse events in acupuncture patients compared to those treated with valproic acid.