Minerva anestesiologica
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Acute respiratory failure is accompanied by a severe gas exchange impairment that is signified by a large shunt and no or only little of additional ventilation-perfusion mismatch. The shunt is caused by perfusion of collapsed and consolidated lung tissue that is mainly located in the lower, dependent lung region. ⋯ Spontaneous breathing seems to improve gas exchange, and in proportion to its share of total ventilation, when added to mechanical ventilation. A shift from total mechanical ventilation to partial or fully spontaneous breathing may be the road of the future and should be tested further.
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Minerva anestesiologica · Jun 1999
ReviewInterventional neuroradiology. Recent developments and anaesthesiologic aspects.
To summarise recent developments in interventional neuroradiology (INR) and to discuss related anaesthesiologic considerations. ⋯ The role of the anaesthetist in INR consists in providing patient comfort by analgesia and sedation, adequate monitoring, maintenance of vital functions and (if required) the management of systemic heparinisation. The patient's underlying condition, the duration and the kind of intervention have to be considered to decide on the anaesthetic management. Most of the procedures can safely be performed under light sedation, which allows continuous neurological evaluation of the patient. Knowledge of the risks and hazards of the different procedures and close collaboration with the neuroradiologist form the basis for appropriate management in case of a potentially fatal ischaemic or haemorrhagic complication that may occur in 1 to 8% of interventions. For prompt control of airway, respiration and blood pressure in these emergencies experienced anaesthesia staff is required.
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Minerva anestesiologica · May 1999
ReviewOne lung ventilation: prospective from an interested observer.
The improvements in video endoscopic surgical equipment and a growing enthusiasm for minimally invasive surgical approaches, brought video assisted thoracoscopy (VAT) to the practice of surgery for diagnostic and therapeutic procedures. Most of these procedure required a well collapse lung and should be included in the absolute indication for one lung ventilation (OLV) category. The univent tube, is a novel means of achieving bronchial blockade. ⋯ Finally, one of the most interesting future concept to keep adequate oxygenation during OLV, is the ability to modulate the lung circulation. In fact inhaled nitric oxide (NO) and intravenous Almitrine have been combined with additive effects on gas exchange. In case of OLV using that combination will maximize the HPV of the non-dependent lung while dilate the dependent lung to practically eliminate the transpulmonary shunt.
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Monitoring cerebral oxygenation has been one of the main fields of interest in neurointensive care during the past few years. In fact it is strongly believed that restoring adequate cerebral oxygenation is the premise to maintaining the viability and restoring the function of the damaged CNS. ⋯ Local measurement of brain oxygen tension (ptiO2) is possible through a Clark electrode implanted into the cerebral parenchyma. The paper describes the physical basis of the monitoring, the pathophysiology of ptiO2 and its clinical use.
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Minerva anestesiologica · May 1999
Review[What will jugular bulb oxygen saturation monitoring tell?].
Global cerebral oxygenation can be measured by means of a catheter introduced in the internal jugular vein and placed retrograde in the jugular bulb. The measure of oxygen saturation sampled from the jugular vein (SjvO2) depends on cerebral metabolism and blood flow. This parameter describes the relative balance between oxygen delivery to the brain and oxygen consumption by the brain. ⋯ Besides this, elevated SjvO2 should not be universally interpreted as hyperaemia. Instead, the presence of an elevated SjvO2 is a heterogeneous condition. Increased SjvO2 may be alarming prognostic indicators that carry important implications for comatose patients management.