Minerva anestesiologica
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Minerva anestesiologica · Oct 1998
ReviewExperimental and clinical studies about the preemptive analgesia with local anesthetics. Possible reasons of the failure.
Though we fully agree with the truthfulness of the physiopathological sequences proving the phenomena of the hyperalgesia onset and therefore a prolongation of the postoperative pain, we do not believe, as stated by some authors that the studies carried out up to now, both experimental and clinical, are sufficient, the first ones to confirm the preemptive analgesia, while the second ones to be defined as contrasting and totally inadequate to confirm the preemptive analgesia effect. The lack of positive clinical data is why some authors have suggested a "revision" and a "reduction" of the word preemptive analgesia. On the contrary, we believe that differences which seem to originate from the clinical works can also be found in the experimental ones if we examine them with the same methodological principle. ⋯ However, an important characteristic that seems to come out from these works is connected to two elements strictly linked each other: the intensity and the duration of the nociceptive impulse produced and the level and the type of the induced block. In our opinion, the failure of many of these works can be attributed to the inadequacy of the analgesic levels (intensity of the block) reached and maintained in the pre-and intraoperative period. Therefore we believe that before thinking of a "review" and "reduction" of the word preemptive analgesia is necessary to take a step backward and to face again the methodological problems of the preemptive analgesia.
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Minerva anestesiologica · May 1998
Review[Hydrocephalus and rebleeding in subarachnoid hemorrhage].
The main features of rebleeding and post-haemorrhagic hydrocephalus in case of subarachnoid haemorrhage following the rupture of an intracranial aneurysm are presented. In both cases frequency, causes, clinical events, prevention and therapy are discussed.
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Minerva anestesiologica · May 1998
Review Randomized Controlled Trial Clinical Trial[Indications for steroid and tirilazad treatment in patients with subarachnoid hemorrhage].
Tirilazad mesylate, a nonglucocorticoid 21-aminosteroid, has been used in two randomized, double-blind, vehicle-controlled trials in Europe, Australia, New Zealand, and in North America in patients with aneurysmal subarachnoid hemorrhage. The first trial has been concluded, enrolled 1023 patients, and demonstrated a dramatic reduction in mortality from 27% to 3% (p = 0.01) in males receiving 6 mg/kg/day tirilazad for 10 days, when compared to vehicle-treated patients. ⋯ This clinical trial suggest that tirilazad mesylate, at a dosage of 6 mg/kg/day, improves overall outcome in aneurysmal subarachnoid hemorrhage patients. Further data from the North America trial and the trial in women receiving higher doses of tirilazad are still pending.
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Minerva anestesiologica · May 1998
Review[Strategy for intensive care in patients with subarachnoid hemorrhage].
Severe medical complications account for 20-30% of all deaths in patients with subarachnoid hemorrhage. High quality of intensive care is needed to prevent and correct pulmonary complications and electrolyte disturbances. ⋯ Extensive monitoring is necessary to achieve adequate observation in the perioperative period and safe treatment of vasospasm. A multidisciplinary approach in a critical area with intensive and sub-intensive beds, based on the cooperative role of neurosurgeons and anesthetists/intensivists, could improve the medical care, reducing complications, ICU stay and costs.
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Hyponatremia is a common feature after subarachnoid hemorrhage. Hyponatremia is complex in its origin because different neuroendocrine disturbances are involved: elements of inappropriate secretion of ADH, cerebral salt wasting, and blunted response of the reninangiotensin-aldosterone system may occur simultaneously. ⋯ Fluid restriction is therefore contraindicated in hyponatremia following subarachnoid hemorrhage because of the negative impact on intravascular volume. On the contrary, replacement of both volume and sodium should be vigorously accomplished.