Minerva anestesiologica
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Minerva anestesiologica · Apr 2011
Randomized Controlled TrialHigher postoperative pain and increased morphine consumption follow pre- rather than post-incisional single dose epidural morphine.
Neuraxial administration of morphine is an effective way of controlling postoperative pain and reducing analgesic consumption. Some animal models have demonstrated that preemptive administration of neuraxial narcotics reduces pain, while others have revealed the contrary. In addition, there have been no consistent results in clinical settings. This double-blind, randomized study compared the effects of pre- vs. post-incisional administration of neuraxial morphine on postoperative pain perception and analgesic requirements over 48 hours following laparotomy for open colectomy under standardized general anesthesia. ⋯ Pre-incisional epidural morphine in patients undergoing open colonic surgery under general anesthesia was associated with more postoperative pain, a greater need for analgesics, and poorer patient satisfaction compared to post-incisional morphine administration.
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Minerva anestesiologica · Apr 2011
ReviewPositron emission tomography in ARDS: a new look at an old syndrome.
This is a review of some of the main findings obtained by positron emission tomography (PET) concerning the pathophysiology of acute respiratory distress syndrome (ARDS) and acute lung injury. PET (which is nowadays often combined with computed tomography) is a functional imaging technique based on the detection of a labeled molecule administered to a subject. Based on the molecule used, different lung functions can be imaged. ⋯ Administration of [18F]FDG facilitates the imaging of cellular metabolic activity, reflecting an acute neutrophil-sustained inflammatory process. This technique has been used in experimental ARDS and, more recently, in patients. It showed, for example, that inflammatory activity of the lungs is markedly increased even in "normally aerated" regions at levels that are, in some cases, even higher than in the non-aerated regions.
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Minerva anestesiologica · Apr 2011
Tidal volume is a major determinant of cyclic recruitment-derecruitment in acute respiratory distress syndrome.
Overdistension and cyclic recruitment-derecruitment contribute to ventilator-induced lung injury. High tidal volumes are thought to increase mortality mainly by inducing overdistension. However, experimental evidence suggests that tidal volume (VT) may also influence cyclic recruitment-derecruitment. Our main goal was to determine whether high tidal volumes increase cyclic recruitment-derecruitment in acute respiratory distress syndrome (ARDS) patients, as measured by dynamic computed tomography (CT). ⋯ High tidal volume is a major determinant of cyclic recruitment-derecruitment in ARDS patients with diffuse attenuations.
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Minerva anestesiologica · Apr 2011
Bilateral Bispectral Index (BIS)-Vista as a measure of physiologic sleep in sleep-deprived anesthesiologists.
Anesthesiologists who work extended hours exhibit acute and chronic sleep deprivation. The newest bilateral Bispectral Index (BIS)-Vista monitor offers new advantages over earlier models, which include a new algorithm (version 1.4). One possible useful application for BIS monitoring of physiological sleep would be in critically ill patients who almost uniformly suffer from sleep disruption and deprivation because they loose their circadian rhythm due to the harsh noisy environment of critical care units. Previous studies, which used earlier versions of the BIS monitor to depict normal physiologic sleep, produced widely conflicting results. The aim of our study was to assess whether the new BIS-Vista monitor would exhibit a temporal decline that corresponds to natural physiologic sleep stages in healthy sleep-deprived, post-call anesthesiologists. ⋯ We demonstrated that although the BIS-Vista monitor was neither designed nor validated for monitoring normal physiologic sleep, it depicted a temporal decline that corresponds to normal physiologic sleep stages in sleep-deprived anesthesiologists.