Minerva anestesiologica
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Minerva anestesiologica · Feb 2010
The pharmacodynamic effects of rocuronium during general anesthesia in patients with type 2 diabetes mellitus.
The aim of this prospective study was to investigate whether the neuromuscular response to rocuronium is affected by the presence of type 2 diabetes mellitus. ⋯ The present study has proven that the rocuronium-induced neuromuscular block was not affected in patients with type 2 diabetes mellitus during isoflurane based general anesthesia.
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Minerva anestesiologica · Feb 2010
Case ReportsSuccessful emergent reintubation using the Aintree intubation catheter and a laryngeal mask airway.
Tracheal extubation can be potentially catastrophic, especially in patients with difficult airways. This article describes a case where planned extubation in a patient with a large tongue lesion led to complete airway obstruction and subsequent cardiac arrest. Reintubation was facilitated using a laryngeal mask airway and an Aintree intubation catheter.
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Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. ⋯ In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data.
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Minerva anestesiologica · Feb 2010
Transcatheter implantation of an aortic valve: anesthesiological management.
Transcatheter aortic valve implantation (TAVI) is an emergent alternative technique to surgery in high-risk patients with aortic stenosis. Here, we describe the anesthesiological management of patients undergoing TAVI at our institution over an 18-month period. ⋯ TAVI is feasible in high-risk patients who would not be able to undergo surgical valve replacement. Hemodynamic management is the main concern of intraoperative anesthesiological management. General or local anesthesia plus sedation are both valid alternative techniques that can be titrated according to patient characteristics. Close postoperative monitoring in the ICU is required.
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Some may consider anesthesia a risky endeavor. However, anesthesia is safer now than ever before, and compared to other disciplines, anesthesiology is still among the leading disciplines with regard to patient safety. ⋯ Given the facts that errors and adverse events associated with patient harm and deaths continue to occur and that the complexity of our health care system will steadily increase, it is clear that more needs to be done in order to make anesthesia safer. With its proposals for training on patient safety, the European Society of Anesthesiology (ESA) makes an important contribution thereto, which merits expeditious and efficient implementation both in academia and everyday practice.