Minerva anestesiologica
-
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.
-
Minerva anestesiologica · Jan 2014
The effects of intrathecal and systemic adjuvants on subarachnoid block.
Various intrathecal and systemic adjuvants to local anaesthetics have been found to improve the quality and extend the duration of spinal block. Intrathecal opioids are the most frequently used; the lipophilic fentanyl and sufentanil enhance and moderately prolong the sensory block, whereas the hydrophilic morphine significantly prolongs spinal analgesia. Nausea/vomiting, pruritus, urinary retention and respiratory depression are possible side effects. ⋯ Opioids enhance, alpha-2 agonists and ketamine prolong the block, magnesium sulphate reduces postoperative analgesic consumption and nimodipine may delay the regression of sensory block. Nitrous oxide inhalation has also been found to enhance the level of sensory spinal block. Even though opioids are the most popular adjuvants to spinal local anaesthetics, a variety of drugs given intrathecally or systemically, can accelerate, improve and extend the spinal block.
-
Minerva anestesiologica · Jan 2014
Letter Case ReportsThoracic Aortic Mural Thrombus as a cause of multi-organ failure.