Minerva anestesiologica
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Minerva anestesiologica · Jun 2013
Randomized Controlled TrialEffect of propofol and sevoflurane on acid-base balance during pediatric heart catheterization.
Propofol is routinely used for anesthesia during pediatric heart catheterization. Propofol infusion syndrome (PRIS) is a rare, but often fatal complication mainly defined as bradycardia with progress to asystolia during propofol infusion. Metabolic acidosis is regarded as an early warning sign of PRIS. In this study the effect of propofol and sevoflurane on serum base excess, pH and lactate have been examined during pediatric heart catheterization. ⋯ Propofol but not sevoflurane had an effect on base excess and pH during pediatric heart catheterization.
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Given the low physical solubility of oxygen (O2) in plasma, little value is attached to hyperoxic ventilation (FiO2 1.0) as a modality for improving O2 transport and tissue oxygen supply when hypoxemia (i.e., O2 partial pressure (paO2) <60 mmHg) is absent. Because recent experimental and clinical data conflict with this notion, we used mathematical modeling to reevaluate efficacy of hyperoxic ventilation in improving tissue oxygenation in the absence of hypoxemia by specifying its theoretical efficacy in terms of hemoglobin (Hb) equivalents. ⋯ Hyperoxic ventilation establishes a highly available source of O2 that can be utilized effectively for tissue oxygenation. Although further experimental studies are required to quantify this theoretically calculated amount of utilizable O2, these results suggest that the tissue oxygenation efficacy of hyperoxic ventilation, even in absence of hypoxemia, is grossly underestimated in daily clinical practice.
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Minerva anestesiologica · Jun 2013
Review Meta AnalysisNon-invasive ventilation during upper endoscopies in adult patients. A systematic review.
Upper endoscopies (UE) are widely performed. Non-invasive ventilation (NIV) during UE has been used to avoid respiratory complications, mainly in high-risk or sedated patients. We performed a systematic review on this topic. ⋯ This is the first systematic review addressing the use of NIV during upper endoscopies. Its use seems feasible, and based on the limited data available NIV appears safe and likely effective. The patients who would benefit the most are: high-risk and patients undergoing sedation.
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Minerva anestesiologica · Jun 2013
Randomized Controlled Trial Comparative StudyA prospective, randomized controlled trial comparing the left lateral, modified lateral and sitting positions for spinal block characteristics for Cesarean delivery.
Maternal position affects spinal block characteristics. We investigated the effect of lateral, modified lateral and sitting position for spinal anesthesia with 2 mL hyperbaric bupivacaine 0.5% on spinal block characteristics in this prospective, randomized study. ⋯ Onset time (mean ± SD) for sensory block to T5 dermatome for the lateral, modified lateral and sitting groups was 6.8 ± 2.7, 13.6 ± 6.2 and 9.7 ± 5.5 min, respectively; P<0.001. The median (interquartile range) maximum dermatomal level was significantly lower in the modified lateral group (T5[T3-T5]) compared with the lateral (T3[T2-T4]) and sitting (T3[T3-T4]) groups, respectively; P=0.022 and P=0.030, respectively. Three women in the modified lateral group required general anesthesia compared with none in the other groups; P= 0.044. Apgar scores and cord blood pH, PO2 and PCO2 were similar between groups. Conclusion: The modified lateral position with 10 mg of hyperbaric bupivacaine was associated with a slower onset and a lower maximum sensory block necessitating higher requirement for conversion to general anesthesia. It did not offer any advantage over lateral and sitting positions for induction of spinal anesthesia for elective Cesarean delivery and cannot be recommended.