Minerva anestesiologica
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Minerva anestesiologica · Sep 2017
ReviewThrombolysis for non-traumatic intra-ventricular hemorrhage in adults: a critical reappraisal.
Intra-ventricular hemorrhage (IVH) is a critical condition with high rate of morbidity and mortality due to acute hydrocephalus and secondary brain injury. Mechanisms underlying the clinical deterioration are not only related to the appearance of an acute hydrocephalus but also to blood-clot mass effect and the inflammatory effects of blood break-down products which impede local blood flow and exert a direct toxic effect on the peri-ventricular structures leading to chronic hydrocephalus. An effective treatment strategy should aim at IVH fast removal and reduction of blood-clot mass effect. ⋯ Protocol-based use of alteplase with extra-ventricular drain seemed safe, therefore such approach may be a potential option in individual cases. Currently no consensus has been reached and extrapolation of data from the literature does not permit to identify a uniform therapeutic approach but merely to outline some rational procedural modalities. Further research and studies are needed to compare the efficacy of the different fibrinolytic agents and protocols on functional outcome.
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Minerva anestesiologica · Sep 2017
Randomized Controlled TrialOpioid-sparing effect of nefopam in combination with paracetamol after major abdominal surgery: a randomized double-blind study.
Because nefopam's morphine-sparing is debated when combined with paracetamol, this study aimed to assess pain relief by IV nefopam in combination with paracetamol after major abdominal surgery. ⋯ This prospective randomized study suggested that nefopam in combination with paracetamol has no benefit after open abdominal surgery.
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Minerva anestesiologica · Sep 2017
Randomized Controlled Trial Comparative StudyTime-to-intubation in obese patients. A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anaesthetists.
Airway management may be difficult in obese patients. Moreover, during prolonged intubation, oxygen desaturation develops rapidly. Videolaryngoscopy improves the view of the larynx, and the Storz® C-MAC™ has been shown to be superior to other videolaryngoscopes in terms of intubation time in obese patients. However, no effort has been made to compare the Storz® C-MAC™ with direct laryngoscopy. The aim of the study was to evaluate if the use of Storz® C-MAC™ may reduce intubation time when compared to direct laryngoscopy (classic Macintosh® blade). ⋯ In obese patients the airway may be secured equally fast using direct laryngoscopy (Macintosh®) and with videolaryngoscopy using the Stortz® C-MAC™. The risk for failed intubation, however, appears to be greater with direct laryngoscopy, especially in male obese patients.
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Minerva anestesiologica · Sep 2017
Randomized Controlled TrialIntraspinal administration of morphine hydrochloride combined with low doses of bupivacaine in hemorrhoidectomy: a clinical randomised trial.
Intrathecal local anesthetics, associated or not to opioids, is commonplace in anorectal surgery, but it is unknown which is the option with the best risk-benefit ratio. The main aim was to assess whether the combination of morphine (50 mcg) with low-dose bupivacaine (3 mg) in an intradural solution has a better analgesic short-term effect than bupivacaine alone at standard doses (5 mg) in hemorrhoidectomy. ⋯ The addition of intradural morphine allows a reduction in the dosage of local anesthetic improves short-term postoperative analgesia and is associated with less motor blockade.
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Minerva anestesiologica · Sep 2017
Practice GuidelineItalian COnsensus in Neuroradiological Anaesthesia (ICONA): managing anaesthesia during endovascular procedures.
Anesthetic management of patients undergoing endovascular procedures for treating intracranial aneurysms or cerebrovascular malformations must consider a number of specific challenges, in addition to those associated with anesthesia for other specialties. In addition to maintenance of physiological stability, manipulation of systemic and cerebral hemodynamic parameters may be required to treat any sudden unexpected catastrophic neurological events. A multidisciplinary group including neuro- and pediatric anesthesiologists, interventional neuroradiologists, neurosurgeons, and a clinical methodologist contributed to this document. ⋯ Groups drafted literature summaries and provisional responses in the form of candidate consensus statements based on evidence, when possible, and clinical experience, when this was lacking. Final wording was agreed at a meeting in April 2016 and where possible evidence was graded using United States Preventive Services Task Force criteria. Consensus (defined as >90% agreement) was based on evidence, clinical experience, clinician preference, feasibility in the Italian healthcare system, and cost/benefit considerations.