Minerva anestesiologica
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Minerva anestesiologica · Jul 1999
Randomized Controlled Trial Comparative Study Clinical Trial[Percutaneous or surgical trachetomy. Prospective, randomized comparison of the incidence of early and late complications].
To compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy. ⋯ In experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.
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Sepsis is a condition at high risk for the patients to develop organ(s) or system dysfunction/failure and represent a very limiting process for survival. Researchers and clinicians proposed standardization of terminology for sepsis and related problems to improve communication and to evaluate the efficacy of preventive measures and therapeutic interventions. Interrelationship among systemic inflammatory response syndrome (SIRS), infection and sepsis are surrounded by non infectious satellite events such as trauma, burns, pancreatitis, haemorrhagic shock, immune-mediated organ injury and infectious cause such as fungemia, parasitemia, viremia. ⋯ Multiple sources of sepsis is a phenomenon clearly associated with poor prognosis and all the sepsis trials managed in the last decades have failed on reducing mortality rate in enrolled patients. Development of scoring system routinely used at bedside represent an important method to establish cost-effectiveness in this exiting area of study and clinical management. Controversial results on sepsis need a sort of consensus at different level from researchers to clinician experiencing new strategies for prevention and more appropriately therapeutic approach for the management of this syndrome.
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Minerva anestesiologica · Jul 1999
Case Reports Randomized Controlled Trial Clinical Trial[Use of remifentanil in ambulatory obstetric-gynecologic surgery. A dose-effect study].
Remifentanil, a recently commercialised opioid, is characterised by a predictable and non cumulative effect which vanishes rapidly without determining side effects in the long term. These characteristics make remifentanil an ideal opioid in continuous infusion for the ambulatory surgery setting. Aim of this study was to assess the ideal dose of remifentanil, administered in bolus before propofol, in patients undergoing uterine curettage and assisted by mask ventilation in 100% oxygen. ⋯ The administration in bolus of remifentanil, before the inducing agent, permits short-term surgery in ambulatory surgery settings thanks to the rapid recovery of vital functions. Compared to the other doses, the 1.5 micrograms/kg dose guaranteed a good control over surgical stress without influencing the speed of awakening and without determining uncomfortable side effects.
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Minerva anestesiologica · Jul 1999
Case Reports[Use of the laryngeal mask for airway control in difficult intubations in children].
LMA was introduced in clinical practice by Arthur Brain in 1983 as a valuable substitute of tracheal tube in adult who underwent general anaesthesia; since then its applications have been extensively studied. LMA is a relatively new non-invasive ventilatory device which has allowed a radical change in the management of modern general anaesthesia. ⋯ In all these cases, LMA provided a patient airway and a satisfactory ventilation during both induction and the repeated attempts of inserting the tracheal tube; in one case, since the orotracheal intubation failed, LMA has proved to be as effective as the tracheal tube during the maintenance of general anaesthesia. Therefore, LMA is recommended as an essential ventilatory device in the hands of paediatric anaesthesiologists.