Minerva anestesiologica
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Traditionally, anaesthetists evaluate the effect of neuromuscular blocking agents clinically. We observe the fasciculations following injection of succinylcholine, the movements of the reservoir bag, the spontaneous movements of the patient, headlift etc. However, with the advent of new fast acting neuromuscular blocking agents and the increasing awareness of the problems of postoperative residual neuromuscular block there is an mounting understanding of the importance of a more objective assessment of the neuromuscular function during anaesthesia. ⋯ In this lecture I shall give my personal bias on whether or not routine monitoring of neuromuscular function during anaesthesia is essential. Also, I shall try to answer the question "why, how and when should we monitor neuromuscular function during clinical anaesthesia?"
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The paper includes a short review on paediatric anaesthesia in day surgery. It discussed on why day surgery in children is so popular since the beginning of the century; the Italian laws on this item and the guidelines of the Italian Society of Anaesthesiology on "day surgery" and "preoperatives of children".
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Post-thoracotomy pain is the most severe form of pain after surgery and is continuously exacerbated by ventilatory function. Due to the multiplicity of nociceptive inputs from the chest wall, thoracic viscera, diaphragm and postoperative chest tubes, postoperative pain may be difficult to control with single modalities. The aim is excellent analgesia with function i.e. normal ventilation and rapid mobilisation. ⋯ The most popular and probably most effective technique at the present time is thoracic epidural analgesia using a combination of different local anesthetic agents and opioids. There are few data indicating any influence on outcome of different postthoracotomy analgesic techniques. Improvement in outcome requires a co-ordinated approach from all caregivers using the best possible analgesic techniques.