Minerva medica
-
Case Reports
Cardiorespiratory effects of change in posture after spinal anesthesia with hyperbaric bupivacaine.
Spinal anesthesia is a special regional anesthetic technique that is applied in lower limb orthopedic and other surgical procedures made below the transverse umbilical line, which is able to produce a neuraxial central block. The patient's position, together with the baricity of the drug solution injected, is a variable that can affect the success of anaesthesia. ⋯ We describe a case of cardiovascular and respiratory effects occurred approximately 65 min after spinal anesthesia with 7 mg of 1% hyperbaric bupivacaine in a patient during change in posture from mild anti-Trendelemburg to supine decubitus. These findings show that a change in posture after spinal anaesthesia with hyperbaric bupivacaine can affect the safety of this anesthesia technique, also after a longer period of time than is usually recommended to avoid the spread of anaesthetic drug.
-
Randomized Controlled Trial Comparative Study
Regional versus IV analgesics in labor.
The aim of this study was to compare combined spinal epidural (CSE), epidural (E) and IV pethidine analgesia and their effects on the mother, fetus, newborn and the labor course. ⋯ Regional analgesia especially CSE using bupivacaine or lidocaine is a safe effective method for analgesia in labor with relative better efficacy of bupivacaine.
-
Left main coronary artery disease, present in 5-9% of patients with angina pectoris, is associated with high mortality risk when treated medically. For several decades coronary artery bypass grafting (CABG) has been regarded as the treatment choice for unprotected left main coronary artery (ULMCA) disease patients. ⋯ A number of registry reports, as well as a substudy from a large, randomized trial, have indicated that PCI may be an acceptable alternative to CABG in some patients with ULMCA stenosis. PCI already offers tangible short-term advantages over CABG as it is less invasive, reduces hospitalization duration, avoids the disability of surgical recovery, and allows patients to subsequently have CABG if necessary.
-
In Italy, chronic pain has a prevalence of about 26%, a rate that warrants efforts by specialists and primary care physicians to improve its treatment. From a study of various treatment systems, it is clear that a radical change in the approach to pain pathology is needed. ⋯ A further limitation to current therapeutic practice is to consider pain intensity as the sole reference parameter in its treatment. In light of these considerations, the Advisory Board has drawn up a strategy to improve outcomes of pain therapy: 1) a shared therapeutic pact between physician and patient based on efficacious communication rather than on information alone; 2) identification of defined therapeutic objectives that allow for reaching a balance between reduction of pain and occurrence of adverse effects; 3) adoption of drug therapies that respond at least in part to an approach based on the pathogenic mechanism of pain rather than on pain intensity alone.
-
Hydronephrosis is the most common congenital anomaly observed with prenatal ultrasonography. Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatal hydronephrosis. Spontaneous rupture has been reported in adults with severe hydronephrosis. ⋯ Diuretic renography revealed loss of right renal function completely. Because there was not any complain or any clinical sign, surgery was not thought. Spontaneous follow-up was recommended.