Minerva anestesiologica
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In the light of the most recent acquisitions published in the international literature, this review analyzes the pharmacologic features and modes of use of tramadol, one of the most widely used, on a worldwide scale, analgesic agents in acute and chronic pain of moderate to severe intensity. The action of the 2 enantiomers of tramadol--which exert different pharmacologic effects--and of metabolite M1, is differentiated. The global activity of tramadol results from the sum of their specific actions. ⋯ Moreover, tramadol maintains a good tolerability profile in the elderly subjects and a good analgesic efficacy in the long-term treatments with reduced pharmacological interactions and a low incidence of constipation. These global features assured its inclusion into the most recent guidelines on the management of chronic pain. Furthermore, data from literature showed that tramadol is devoid of immunosuppressive activity, has a poor tendency to tolerance and a minimum risk of addiction and abuse.
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Minerva anestesiologica · Sep 2005
ReviewMonitored anesthesia care and loco-regional anesthesia. Vascular surgery use.
Association of locoregional techniques such as deep and superficial cervical block, lumbar epidural and/or peripheral blocks, and conscious sedation with hypnotic drugs (propofol 1-3 mg/kg/h or midazolam 2-4 mg/h) and/or opiates drugs (sufentanil 5-10 mcg or remifentanil 0.05-0.1 mcg/kg/min) is actually, the gold standard for vascular surgery. Our personal experience is based on 328 patients submitted to carotid endarterectomy, aneurysm repair and peripheral surgery.
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Postoperative pain treatment is the challenge of the new century; we know that even starting from the 24(th) week of gestational age, the fetus can feel pain and that memory of uncontrolled pain can change the pain threshold in children. We have now new drugs and new tools for an optimal pain control also in children and this review is an update on the new therapies and devices which can help us in the daily clinical practice.
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Minerva anestesiologica · Sep 2005
ReviewCentral venous catheters. Observations on the implantation technique and its complications.
The growing utilization of central venous catheterism is linked to the necessity of treating with an always larger number of hospitalized and nonhospitalized patients. The technological development provided us with different devices and materials for specific indications. In the majority of cases the central venous catheter is positioned through direct puncture of a central vein using Seldinger method. ⋯ The most frequent immediate complications for catheterism are the arterial puncture, pneumothorax, arrhythmias and the wrong positioning. Among the late complications there are the catheter infections correlated, catheter and vessel thrombosis. The use of a proper technique, completed by the operator's experience and the right management of the device, lead to a decrease of the risk level related to the central venous catheterism.