Minerva anestesiologica
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The selection of opioid drugs for anesthesia is often based on empirical judgment such as the selection of opioids with rapid elimination half-life for short surgical procedures (e.g. alfentanil), while opioids with longer elimination half-life (e.g. fentanyl, sufentanil) are used for longer procedures. A better insight in the pharmacokinetic and pharmacodynamic differences between opioids allows a more rational selection of the drug and its dosing scheme, and will contribute to rapid recovery after anesthesia. As opioids are adjuncts to other anesthetic drugs, drug interaction principles should be considered when titrating the opioid administration.
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It is well established that general anesthesia, with or without paralysis, causes profound changes in respiratory function. From a clinical point of view, the more important consequence of this impairment is a decreased efficiency of gas exchange, with a decreased blood oxygenation. The main reason of this respiratory embarrassment is the intraoperative occurrence of atelectasis, mainly in the dependent lung regions. ⋯ As the anesthesia-induced atelectasis are also present in the postoperative period, this ventilatory approach may also be used to prevent this condition. In obese patients PEEP seems to have a major effectiveness than in normal subjects, with an improvement of lung volumes, respiratory mechanics, gas exchange and an occurrence of recruitment. However, further studies are necessary to define optimal value of PEEP and tidal volume for different types of patients.
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Minerva anestesiologica · Apr 2000
Randomized Controlled Trial Clinical Trial[Brachial plexus block. Effect of low interscalenic approach on phrenic nerve paresis].
The aim of the paper was to determine the influence of the brachial plexus block on phrenic nerves paralysis in distal side of interscalenic space (between 1/3 medium and 1/3 inferior), with little volume of local anesthetic drug. Comparative, prospective, randomized study. ⋯ Brachial plexus anesthesia by low interscalenic tract, even using little local anesthetic drug volumes, like other supraclavear block techniques determines ipsilateral diaphragm paralysis.
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Minerva anestesiologica · Apr 2000
[Anesthesia in single and bilateral sequential lung transplantation. Lung Transplantation Group].
Anesthesia for lung transplantation: intraoperative complications and long term results. ⋯ With a strong drug support with pulmonary vasodilators, positive inotropic and systemic vasoconstrictor drugs, in most patients we transplanted C-P bypass can be avoided. Intraoperative deaths were not observed. Two years actuarial survival is 65% for DLT and 60% for SLT.
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Minerva anestesiologica · Mar 2000
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of the effects of morphine and tramadol in the treatment of postoperative pain].
To compare morphine and tramadol in the treatment of postoperative pain (POP), using a system of Patient Controlled Analgesia (PCA). ⋯ Tramadol determines pain relief similar to morphine, with the advantage that it does not lead to abuse, tolerance or addiction.