Minerva anestesiologica
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Comparative StudySupplemental single shot femoral nerve block for total hip arthroplasty - Impact on early postoperative care, pain management and lung function.
Peripheral regional anesthesia is beneficial in the management of postoperative pain in hip surgery, and can also reduce post-operative care unit (PACU) stay. Its opioid-sparing actions may also be beneficial for respiratory mechanics and pulmonary function. The aim of our pilot study was to evaluate the effect of a supplemental single shot femoral block for elective total hip arthroplasty on early respiratory function and postoperative management within the first 24 postoperative hours. ⋯ Supplemental single shot femoral nerve block for total hip arthroplasty resulted in earlier PACU discharge capability, improved lung function during the first six hours and better pain control within the first 24 postoperative hours.
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Minerva anestesiologica · Jan 2014
Case ReportsDecompressive craniectomy may cause diagnostic challenges to asses brain death by computed tomography angiography.
According to Italian legislation to diagnose brain death (BD) after the initial documentation of the clinical signs, repetition of clinical testing and confirmation of the loss of bioelectrical activity of the brain (EEG) is required. However, when EEG is unreliable it is necessary to demonstrate cerebral circulatory arrest (CCA). Accepted imaging techniques to demonstrate CCA include: cerebral angiography, cerebral scintigraphy, transcranial Doppler (TCD) and computed tomography angiography (CTA). ⋯ Nevertheless its diagnostic reliability is affected by some limitations in patients with decompressive craniectomy. Here we report two cases of brain injury with clinical signs of BD and at the same time, opacification of intracranial arteries on CTA and a pattern consistent with flow arrest on the corresponding insonable arteries on TCD. The discrepancy between CTA and TCD results points out a methodology limitation that could be overcome by updating Italian legislation according to other European Countries legislation.
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Minerva anestesiologica · Jan 2014
Determination of respiratory system mechanics during inspiration and expiration by FLow-controlled EXpiration (FLEX): A pilot study in anesthetized pigs.
Differences between inspiratory and expiratory lung mechanics result in the hysteresis of the pressure volume-loop. While hysteresis area is a global parameter describing the difference between inspiration and expiration in mechanics under quasi-static conditions, a detailed analysis of this difference under the dynamic conditions of mechanical ventilation is feasible once inspiratory and expiratory compliance (Cin/Cex) are determined separately. This requires uncoupling of expiratory flow rate and volume (V). ⋯ The relation between inspiratory and expiratory compliance profiles is associated with the hysteresis area and behaves PEEP dependent. Analysing the Cin-Cex-relation might therefore potentially offer a new approach to titrate PEEP and tidal volume.