Minerva anestesiologica
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Minerva anestesiologica · Mar 2007
Effects of volume shift on the pressure-volume curve of the respiratory system in ALI/ARDS patients.
The pressure-volume (PV) curve in acute lung injury and acute respiratory distress syndrome (ALI/ARDS) patients has been proposed for estimating the underlying pathology, lung recruitment and setting mechanical ventilation. The supersyringe method may lead to artifacts due to thermodynamics and gas exchange. Another possible confounding factor is the volume shift, primarily blood, out of the chest wall when the intrathoracic pressures rise. We set out to quantify the volume shift and investigate its mechanisms. ⋯ The volume shift, constituted mainly of blood, significantly affects both inspiratory and expiratory PV curve. Caution is needed when interpreting the PV parameters (Minerva Anestesiol 2007;73:1-10).
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Minerva anestesiologica · Mar 2007
Case ReportsColistin, meropenem and rifampin in a combination therapy for multi-drug-resistant Acinetobacter baumannii multifocal infection. A case report.
A 16 year-old girl underwent a multifocal (lungs, skin, soft tissues) infection due to multiresistant Acinetobacter baumannii after a car crash. To treat such a severe disease we used a combination therapy of colistin (2 millions Units twice/day), rifampicin (600 mg/day), meropenem (1 g 3 times a day) after a synergistic activity test was performed (checkerboard method on Mueller-Hinton broth and 5x10(5) cfu/mL inoculum). After 24 days, when a significant clinical improvement was gained, the 3-drugs combination therapy was replaced with i.v. levofloxacin 500 mg twice/day but, after 10 days of quinolones therapy, fever started again and the same multidrug resistant (MDR) A. baumannii was isolated from the skin grafts, central venous catheter tip and bronchial alveolar lavage. ⋯ This therapy was continued for 70 days even if the patient was apyretic because A. baumannii was still present in the skin secretions. After 109 days of hospitalization in our intensive care unit, the patient was transferred to a rehabilitative unit. This case shows how useful is, in selected cases, rediscovering old antibiotic drugs, specially when they are adopted as a combination therapy, and highlights the importance of the clinical microbiological laboratory as it may help clinicians in choosing the best drugs combination.
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Minerva anestesiologica · Jan 2007
Randomized Controlled Trial Comparative StudyComparison between spinal anaesthesia and sciatic-femoral block for arthroscopic knee surgery.
We compared spinal anesthesia and sciatic-femoral block for arthroscopic knee surgery in terms of hemodynamic changes, intraoperative anesthesia, postoperative analgesia, postoperative motor block and bladder function, side effects, and patient satisfaction. ⋯ In conclusion the sciatic-femoral nerve block is a valid alternative to spinal anesthesia for arthroscopic knee surgery, leading to a faster discharging from the hospital.
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Minerva anestesiologica · Jan 2007
Laryngeal mask in prone position: pure exhibitionism or a valid technique.
The laryngeal mask airway (LMA) is used worldwide during general anesthesia with controlled or spontaneous breathing. Normally its use is limited to patients undergoing surgery in the supine but not the prone position. ⋯ To start anesthesia with patients already prone shortens the induction-incision time, reduces the manpower involved in the positioning process and causes fewer hemodynamic changes than the standard technique of induction and intubation in the supine position followed by turning the patient facedown.