Minerva anestesiologica
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Minerva anestesiologica · Jul 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPropofol 1% and propofol 2% are equally effective and well tolerated during anaesthesia of patients undergoing elective craniotomy for neurosurgical procedures.
The 2% formulation of the intravenous anaesthetic agent, propofol (Diprivan), delivers half the amount of lipid compared with the original 1% formulation. This may provide an acceptable alternative for patients who have an impaired ability to metabolise lipids. ⋯ We conclude that propofol 2% is as effective and as well-tolerated as propofol 1% for anaesthesia and is an acceptable alternative to propofol 1% in patients undergoing elective craniotomy in neurosurgery. The lower lipid load suggests it may be of particular benefit to patients with disorders of lipid metabolism.
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Minerva anestesiologica · Jun 2000
Clinical Trial[Post-intubation subglottal stenosis in children: risk factors and prevention in pediatric intensive care].
Endotracheal intubation (EI) may result in significant injury to the larynx and trachea; subglottic stenosis is the most dangerous consequence of this injury in the pediatric age. It is well known that there are potential risk factors for post-intubation subglottic stenosis, and namely the underlying disease requiring EI, the age and body weight at EI, the duration and number of EI, the absence of sedation and the occurrence of infectious, hypotensive or hypoxic events during the period of EI and the traumatic EI. On the basis of our data an attempt is made to understand which factors are more important in the pathogenesis of this complication and whether post-intubation subglottic stenosis is a preventable complication of EI in children. ⋯ Prevention of post-intubation subglottic stenosis is possible through a better management of the EI and of the child with a tracheal tube. Sedation of intubated children and skill in the EI technique and in the tube size selection are very important. Many intubations can be avoided with a better attention to the tube fixation and to extubation criteria. Some children at high risk for this complication can be identified.
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Minerva anestesiologica · Jun 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Laryngeal mask vs tracheal tube in pediatric anesthesia in the presence of upper respiratory tract infection].
The aim of this report is to assess the incidence of postoperative respiratory complications in patients recently suffering from inflammation of the upper respiratory tract in whom a LMA or an uncuffed orotracheal tube have been used. ⋯ The frequency of ARE increases significantly in URI patients with both LMA and the tracheal tube, but with the former is far lower than with the latter. Despite the appearance of only minor and transient complications, it is confirmed that the tracheal intubation is an additional risk factor as a result of the mechanical airway simulation. In recent URI, it would seem appropriate to avoid tracheal intubation, if possible, preferring the LMA.
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The Bispectral Index or "BIS" is a single number, composed from different EEG features, using multivariate statistical methods. It was designed for monitoring the depth of hypnosis during anaesthesia and sedation. ⋯ Unlike univariate measures, such as Spectral Edge Frequency or Median Frequency, the Bispectral Index is drug independent and changes with increasing doses of hypnotics in an almost linear way. Though sophisticated technology, the A-2000 BIS monitor and the BIS sensor are easy to use and also allow non-experts to monitor the depth of hypnosis and sedation on a routine basis.
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Sevoflurane and Desflurane are relatively new halogenated agents which make induction and control of depth of anaesthesia easier, recovery rapid and of good quality and they have less side-effects and toxicity. In children sevoflurane could replace halothane because it provides smooth and rapid induction with less cardiovascular depression and arrhythmias. Desflurane is not used because of its pungent odour. In adults sevoflurane could be preferred to desflurane because it allows rapid induction and laryngeal mask insertion or tracheal intubation without myorelaxants, a similar time of recovery, no clinical evidence for renal and hepatic toxicity, no more costs for anaesthesia for a lower MAC.