Minerva anestesiologica
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Minerva anestesiologica · Jul 2005
Editorial Biography Historical ArticleJohn J. Bonica. A biography.
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The magnetic resonance imaging suite is a challenging environment for the anaesthesiologists, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner and patient-related factors. ⋯ A well-equipped anesthesia machine, standard monitoring (electrocardiogram, oxygen saturation and non-invasive blood pressure), trained personnel and adequate planning should be standard for all out of the operating room procedures. Finally, rigorous discharge criteria are recommended to detect residual sedation.
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Minerva anestesiologica · Jun 2005
ReviewNeurologic deficit after peripheral nerve block: what to do?
Regional nerve injury is a recognized complication of plexus anesthesia. Nerve damage after regional anesthesia is the most frightening complication for the patient, the anesthetist and the surgeon too. ⋯ The principles to avoid anesthetic-related nerve damage during regional anesthesia are given. Finally treatment and surveillance, after nerve damage has occurred, are explained.
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Minerva anestesiologica · Jun 2005
ReviewThrombolytics in CPR. Current advantages in cardiopulmonary resuscitation.
Cardiac arrest carries a very poor prognosis. More than 70% of cardiac arrests are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis during CPR has two major effects: first, it causally treats the condition that caused cardiac arrest and second, it has been shown to have beneficial effects on the microcirculatory cerebral reperfusion after cardiac arrest. ⋯ In addition, the neurological condition of surviving patients may be markedly improved by thrombolysis. Although thrombolytic therapy is associated with a risk of bleeding complications, currently available data do not suggest an increase of bleeding complications if thrombolysis is administered during CPR. Recently, a large randomized multicentre study has started to assess the efficacy and safety of thrombolysis during prehospital CPR.
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Regional anesthesia has become a routine practice in paediatric anesthesia and local anaesthetics are now widely used in infants and children. Although local anaesthetics are generally quite safe and effective, they may produce systemic toxic reactions affecting the heart and brain. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anaesthetic, is the most commonly used local anaesthetic for paediatric regional anesthesia. ⋯ Efforts to minimize the risk of complications during caudal anesthesia must be directed towards measures that reduce accidental intravenous and intraosseous injections, reduce the total amount of local anaesthetic used and use drugs with lower toxic potential. In patients under general anesthesia, when using a large amount of local anaesthetic, in case of accidental intravenous infusion, patients receiving levobupivacaine may tolerate larger doses before manifestation of toxicity compared with those receiving bupivacaine. There are clinical situations including prolonged local anaesthetic infusions, use in neonates or small babies, and caudal block, where replacement of bupivacaine with levobupivacaine appears to be safer.