Minerva anestesiologica
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Minerva anestesiologica · Apr 2015
Randomized Controlled TrialAntiemetic efficacy of combined aprepitant and dexamethasone in patients at high-risk of postoperative nausea and vomiting from epidural fentanyl analgesia.
Postoperative opioid analgesia increases the incidence of postoperative nausea and vomiting (PONV). We investigated whether a combination of the neurokinin-1 antagonist aprepitant and dexamethasone decreases PONV incidence compared with dexamethasone alone in high-risk patients receiving continuous epidural fentanyl. ⋯ The combination of aprepitant and dexamethasone was more effective in preventing postoperative vomiting compared with dexamethasone alone in patients at high-risk of PONV from continuous epidural fentanyl analgesia.
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Minerva anestesiologica · Apr 2015
Enhanced visual acuity with echogenic needles in ultrasound-guided axillary brachial plexus block : A randomized, comparative, observer-blinded study.
We prospectively evaluated the effect of insertion angle on the visibility of echogenic and nonechogenic needles in phantoms and in axillary nerve blocks in patients. ⋯ Needles with enhanced echogenicity improved physician comfort, image quality, needle visibility, and visualization time of the needle during ultrasound-guided procedures in phantoms and axillary nerve blocks using insertion angles of 30-45° and ≥ 45°.
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Minerva anestesiologica · Apr 2015
Observational StudyUltra-early decompressive hemicraniectomy in aneurysmal intracerebral haemorrhage: a retrospective observational study.
The rupture of an intracranial aneurysm leading to subarachnoid hemorrhage (SAH) is frequently complicated by an extensive intracerebral hematoma (ICH). ICH represents a factor that worsens clinical outcome either due to early or delayed critical increase of intracranial pressure (ICP). Data on the management of aneurysmal ICH are lacking. Besides the securing of the ruptured aneurysm, there is the option of decompressive surgery to prevent secondary damage. The aim of this study was to analyze feasibility of decompressive hemicraniectomy (DHC) and the impact of timing in patients suffering from aneurysmal SAH with extensive ICH. ⋯ Our data demonstrate that DHC is feasible in aneurysmal ICH. Timing appears to be a crucial factor concerning early and long-term control of ICP and outcome. We are therefore in favor of ultra-early DHC to treat especially poor grade patients with intracerebral mass lesion in aneurysmal hemorrhage to facilitate the ICP management as well as care within the ICU.
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Minerva anestesiologica · Apr 2015
Risk of perioperative seizures in patients undergoing craniotomy with intraoperative brain mapping.
The identification of risk factors associated with perioperative seizures would be of great benefit to the anesthesiologist in managing brain tumor patients undergoing craniotomy with intraoperative brain mapping. ⋯ Clinical seizures are common intraoperative and postoperative complications of supratentorial craniotomies with intraoperative brain mapping. The identification of those patients at higher risk of seizures may guide intraoperative and postoperative medical management.
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Determining the venous-to-arterial PCO2 difference (PCO2gap) during resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a ScvO2>70% associated with hyperlacticemia. Because hyperlacticemia is not a discriminatory factor in defining the cause of that stress, a PCO2gap>6 mmHg could be used to identify global tissue hypoperfusion. Monitoring the "Gap" could be a useful complementary tool after optimization of O2-derived parameters was achieved to evaluate the adequacy of blood flow to global metabolic demand. In this regard it can help to titrate inotropes in order to adapt O2 delivery to CO2 production, or to choose between haemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO2 related to metabolic demand.