Minerva anestesiologica
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Minerva anestesiologica · May 2009
ReviewPropofol infusion syndrome: update of clinical manifestation and pathophysiology.
Propofol infusion syndrome (PRIS) is defined as acute bradycardia progressing to asystole combined with lipemic plasma, fatty liver enlargement, metabolic acidosis with negative base excess >10 mmol l(-1), rhabdomyolysis or myoglobinuria associated with propofol infusion. The purpose of this review was to provide a new update of reported case reports and to describe recent retrospective studies and animal research relevant for the pathophysiology and clinical presentation of PRIS. New case reports of PRIS have confirmed previously identified risk factors, and have also further revealed the incidence of PRIS in patients previously not estimated to be at risk for this syndrome. ⋯ PRIS has to be kept in mind if propofol is used for anesthesia or sedation. Recommendations for the limitation of propofol use have to be adhered to. Early warning signs must prompt immediate cessation of propofol infusion and adequate treatment.
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Minerva anestesiologica · May 2009
Case ReportsProbable case of vascular air embolism during endonasal CO2 laser surgery.
Laser surgery in narrow luminal cavities can lead to venous air embolism (VAE) due to high pressure or high flow clearing/cooling systems. We report the first case of initially misdiagnosed VAE during endonasal CO(2) laser surgery. A 56-year-old patient underwent uvulopalatopharyngoplasty and septoplasty with bilateral CO(2) laser turbinoplasty for turbinate hypertrophy and uvula deviation. ⋯ The literature reports cases of VAE during laser surgery in narrow luminal cavities. When operating in narrow luminal cavities, using a liquid instead of a gas as a clearing/cooling system for the distal end of the probe in laser instruments and avoiding direct contact with tissues is advisable. Anesthesiologists, surgeons and the nursing staff practicing endoscopic laser surgery should have wide knowledge of the risks linked to this technique in order to minimize risk to the patient and to manage VAE should it eventually occur.
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Minerva anestesiologica · May 2009
Focused echocardiography entry level: new concept of a 1-day training course.
We describe a training programme for non-specialists in focused echocardiography in the periresuscitation setting which represents an entry level in echocardiography training (FEEL) for emergency and critical care medicine physicians. ⋯ Periresuscitation echocardiography, performed safely, within the competence of practitioners in an ALS-compliant manner is a potentially valuable skill to be acquired by physicians caring for the critically ill, regardless of the environment in which they work, or their level of seniority. This newly-developed blended learning periresuscitation echocardiography programme (FEEL) may serve as entry level in peri-resuscitation echocardiography for both emergency physicians and critical care practitioners.
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Minerva anestesiologica · May 2009
Review Comparative StudyDopamine versus norepinephrine: is one better?
Dopamine and norepinephrine are widely used as first line agents to correct hypotension in patients with acute circulatory failure. There has been considerable debate in recent years as to whether one is better than the other. ⋯ However, dopamine has potentially detrimental effects on the release of pituitary hormones and especially prolactin, although the clinical relevance of these effects is unclear. Observational studies have provided conflicting results regarding the effects of these two drugs on outcomes, and results from a recently completed randomized controlled trial are eagerly waited.