Minerva anestesiologica
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Minerva anestesiologica · Apr 2006
ReviewInterfacing spontaneous breathing and mechanical ventilation. New insights.
Mechanical ventilation (MV) with positive pressure insufflations of gas into the lung may be required to ensure sufficient oxygenation of blood and elimination of carbon dioxide in acute respiratory failure. Interfacing spontaneous breathing and mechanical ventilation has been used to improve gas exchange and may offer other advantages regarding integrity of lung tissue. Airway pressure release ventilation (APRV), or bilevel positive airway pressure (BiPAP), is a mechanical ventilatory mode with a low respiratory rate upon which spontaneous breaths can be superimposed during any time of the respiratory cycle. ⋯ Since blood flow goes preferentially to the dependent regions, the altered ventilation distribution results in improved matching of ventilation and perfusion, further enhancing or facilitating gas exchange. Moreover, there is less cyclic collapse, i.e. less re-collapse during expiration and reopening during inspiration than with MV alone. Further development of the interfacing technique can be expected, with synchronization and also dosing of the mechanical support and with triggering of the ventilator that is based on neural recordings rather than mechanical signals as pressure and flow.
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Minerva anestesiologica · Apr 2006
Randomized Controlled TrialLevobupivacaine and ropivacaine in the infraclavicular brachial plexus block.
Infraclavicular brachial plexus block were first described by Raj, yet this block remained underutilized despite theoretical advantages. The aim of this prospective, randomized study was to compare equipotent doses of levobupivacaine and ropivacaine. ⋯ The long duration of sensory block associated with the with good analgesia, less toxicity and the pharmacodynamic properties of levobupivacaine include this new local anaesthetic as a valid choice respect other local anaesthetic for infraclavicular plexus block.
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Minerva anestesiologica · Apr 2006
Case ReportsPurpura fulminans during meningococcal sepsis treated with Drotrecogin alpha. A clinical case.
A male patient, 29 years old, was admitted to our unit with purpura fulminans, coagulation deficiency, renal failure and subsequent septic shock accompanied by respiratory insufficiency in the absence of meningeal signs. The serum levels of endogenous protein C, ATIII and calcium were well below the norm. The bacteriological examination revealed the presence of gram-negative diplococci. ⋯ Forty-eight hours after being admitted, the recombinant protein C infusion was started at a dose of 24 microg/kg/h for the duration of 96 h. The skin lesions regressed, starting from the ecchymosis and the edema of the face, trunk and auricular pavilions. A week after the onset of the symptomatology the chest X-ray appeared clear, the renal function had normalised, and the signs of shock had disappeared.
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Postoperative pain management an important clinical issue. The clinicians tool-bag remains incomplete. Improvements in the management of postoperative pain will ultimately translate into the broader, safer application of surgical procedures upon a wider patient population. The application of multimodal therapy that includes non-pharmacologic therapies, preemptive therapies, and new medications for the treatment of postoperative pain is an emerging concept that provides significant immediate as well as potential future advantages.
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Minerva anestesiologica · Mar 2006
ReviewLung protective ventilation in ARDS: the open lung maneuver.
This review addresses the current state of lung protective strategies and their physiological rationale. Lung protective ventilation can reduce mortality in adult respiratory distress syndrome (ARDS) patients. We review the latest knowledge on the progression of lung injury by mechanical ventilation. ⋯ Furthermore, we discuss possible future improvements to mechanical ventilation; especially the open lung maneuver. The rationale behind the open lung maneuver and steps to accomplish an open lung are described, as well as data from animal and human studies. Finally, guidelines for future strategies and/or investigations are presented.