Minerva anestesiologica
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Minerva anestesiologica · Oct 2007
Case ReportsMyotonia congenita and regional anaesthesia with peripheral nerve stimulation: a case report.
Myotonia congenita is a rare disorder caused by a defect in the skeletal muscle chloride channel function, which may cause sustained membrane depolarisation. We report a case regarding a 52-year-old man affected by this muscular pathology and scheduled for shoulder surgery that was performed under sedation and peripheral nerve block. The international literature does not elucidate clear preference toward a particular anaesthesia technique, but we believe that in this setting, regional anaesthesia and complete monitoring should be preferentially utilized when possible. In any case, the anaesthesia plan should be prudent and avoid exposure to known dangerous anaesthetics.
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Minerva anestesiologica · Sep 2007
Case ReportsPostraumatic ARDS: how to place patients who may offer technical problems in a prone position.
Ventilation in the prone position is a valid choice in the treatment of trauma patients with acute respiratory distress syndrome (ARDS). Two cases of trauma patients with ARDS treated in the prone position are described. The technique was very easy to use and safe. The prone position technique proved very useful in the treatment of post-traumatic ARDS in these 2 cases.
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Minerva anestesiologica · Sep 2007
Intra-abdominal hypertension is not reliable as an early predictor of mortality in the intensive care unit.
The aim of this study was to assess the prevalence of intra-abdominal hypertension and its prognostic value in critical patients. ⋯ Intra-abdominal pressure does not have prognostic value at ICU admission, but may predict bad outcomes later during the ICU stay. Intra-abdominal hypertension is a frequent and rarely recognized event in the ICU which can be monitored by the bladder pressure method throughout the period of hospitalization.
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Minerva anestesiologica · Sep 2007
ReviewMethodologies for the treatment of acute and chronic nononcologic pain in children.
Pain represents the most feared symptom of illness but for many years it has been underestimated in children. Only recently has analgesic treatment become an integral part in the assistance of ill children with acute pain, such as postoperative pain, and with chronic pain. Postoperative pain is a complication of surgery: postoperative pain prevention should replace the current theory and practice of postoperative treatment through the creation of ''pain services'' and adequate pain prevention planning. ⋯ Nonmedical interventions such as distraction, muscular relaxation, and guided imagination for pain control are psychological techniques showing very good results in those children who must undergo various procedures. The medical treatment must guarantee both sedation and effective analgesia. Our medical approach includes local anaesthesia, conscious sedation, deep sedation, and general anaesthesia.
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Minerva anestesiologica · Sep 2007
Case ReportsAnesthesia and myotonic dystrophy (Steinert's syndrome). The role of total intravenous anesthesia with propofol, cisatracurium and remifentanyl. Case report.
Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. ⋯ A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.