Minerva anestesiologica
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Minerva anestesiologica · Jun 1993
Randomized Controlled Trial Comparative Study Clinical Trial[The treatment of postoperative shivering with nefopam hydrochloride].
After having considered the physiopathological mechanism of shivering, the authors have estimated in a randomised study the effects of the resolution of shivering by nefopam hydrochloride. This drug a dose of 0.20 mg/kg resolved the symptoms in 100% of cases and the placebo hasn't resolved a case so that case it also obtained the same effects. The authors have proved the efficacy of the nefopam hydrochloride in the control of postoperative shivering in the recommended dose.
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Minerva anestesiologica · Jun 1993
Comparative Study[The thermodilution determination of right ventricular volumes and ejection fraction in the critical patient. Volumetric vs pressure measurement assessment].
The widespread use of hemodynamic investigation techniques, allowed a better understanding of the right ventricle (RV) pathophysiology and led to progressive reevaluation of its role. A modification of the classical Swan-Ganz catheter, made possible the measurement of the ejection fraction (EF) and of the end-systolic and end-diastolic volumes of RV just by the simple application of the thermodilution technique. In this paper, we first refreshed the basic theoretical principles of the technique and then presented our preliminary results of one-year experience in ICU. ⋯ We conclude that the use of the thermodilution technique to measure the volumes of RV, allows a real evaluation of the preload. At the same time it avoids all the problems associated with the measurement of transmural pressure and with the changes produced by shifting of intrapleural pressure. Finally the end systolic volume may be combined with the pressure data to estimate the contractile status and, in our experience, this parameter has proved more sensitive than EF in order to detect changes of contractility of the right ventricle.
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Minerva anestesiologica · May 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of clonidine vs trinitroglycerin on myocardial oxygen balance and on pulmonary gas exchange after myocardial revascularization].
The authors examined the effects of clonidine, a preferential alpha-adrenergic agonist, upon myocardial oxygen balance and pulmonary function during the perioperative period in patients undergoing CABG surgery. Anesthesia was provided by fentanyl infusion reaching the final dose of 100 micrograms.kg.min-1 in 10 minutes before skin incision. Ten patients received clonidine 0.125 mg intravenously after induction of anesthesia; a group of 10 patients was managed identically except for nitroglycerin infusion during the pre-CPB period, in order to keep the aortic pressure in the normal range. ⋯ Results are suggestive (in the clonidine group) for ameliorating myocardial oxygen balance by reducing oxygen consumption indexes (systolic aortic pressure, cardiac index, rate pressure product) and increasing coronary blood flow [coronary perfusion pressure (p < 0.01)] at the end of the surgery and intensive care. Global oxygen consumption reduction, recorded in the clonidine group patients, the oxygen available being unchanged, ameliorated the total oxygen balance mainly after sternotomy (p < 0.05) and at the end of bypass (p < 0.05). Cardiac index was greater during the awakening and rewarming period in intensive care and the ventilatory/perfusion ratio was improved, allowing a minor minute ventilation required in clonidine group patients, specially during admission to intensive care.
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The inclusion of charcoal filters in anaesthetic low-flow systems contributes to the acceleration of the kinetics of isoflurane (Forane). In twenty subjects, scheduled for extra- and intracranial surgery, ventilated with a low-flow system (Ohmeda Excel OAV7750 with rebreathing cassette) with a mean total flow of 0.7 l/min, awakening was complete within 5 minutes from stopping isoflurane and including charcoal in the circuit. At the awakening, the expiratory concentration of isoflurane was 0.23% (95% confidence intervals: 0.19-0.27%): these values are similar to those of MACawake of isoflurane after fast alveolar washout. The use of charcoal during low-flow anaesthesia makes low-flow systems more flexible in their use; the anaesthetic level is more easily controllable and accidental overdosing of volatile anaesthetics can be immediately removed.
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Minerva anestesiologica · May 1993
Comparative Study[The Mallampati's scale: a study of reliability in clinical practice].
The need to predict the rank of difficulty of tracheal intubation is of paramount importance in anaesthesia as has been well documented in numerous studies. We assessed the use of the Mallampati scale as possible predictive indicator of difficult tracheal intubation in a study conducted on 700 patients. The rank of difficulty determined during the pre-anaesthesiological examination by the Mallampati scale, was compared to the Cormack scale as assessed by the laryngeal direct examination at the beginning of anaesthesia. ⋯ The evaluation by the scale of Mallampati showed a good sensibility and a low specificity with incorrect overestimation only for the difficult intubation. In our study orotracheal intubation was rated difficult in 10.4% of the patients by the Mallampati scale and in 11% of the patients score by the Cormack scale. The chin to jugulum distance, also studied as a possible predictive parameter, did not correlate with the Cormack scale.