1,720,976 research outputs found
Tossicità sistemica degli anestetici locali. Trattamento con emulsione lipidica
Full text linkBackground: Lipid emulsion infusion reverses cardiovascular compromise due to local anesthetic overdose in laboratory and clinical settings.
The author compared the efficacy of resuscitation from bupivacaine-induced asystole using lipid emulsion infusion versus epinephrine, vasopressin, combination of epinephrine and vasopressin, and saline control in a prospective randomized animal study.
Methods: Bupivacaine was infused in male Spregue-Dawley rats anesthetized with isoflurane, producing asystole in all subjects. Rats were ventilated with 100% oxygen, given chest compression, and randomized to receive 30% lipid emulsion, vasopressin, epinephrine alone or combined with vasopressin, and saline.
Treatment boluses were repeated at 2.5 and 5 minutes for a native rate-pressure product less than 20% baseline. Electrocardiogram and arterial blood pressure were monitored continuously and at 10 min arterial blood gas, central venous oxygen saturation and blood lactate were measured.
Results: Lipid infusion resulted in higher rate-pressure product, pH and central venous oxygen saturation than in vasopressors groups and in control group at 10
min. Metrics indicated better tissue perfusion in lipid group than in the others group. Epinephrine treatment caused persistent ventricular ectopy in all subjects. Vasopressin and epinephrine were associated with developing of pulmonary edema.
Conclusion: Lipid emulsion in this rat model provide superior hemodynamic and metabolic recovery from bupivacaine-induced cardiac arrest than do vasopressors. Vasopressin and epinephrine were associated with adverse outcomes. Systolic pressure was not an useful metric in the vasopressors group. Further studies are required to optimize the clinical management of systemic local anesthetic toxicity.E’ stato precedentemente dimostrato il recupero di attività cardiaca spontanea dopo l’infusione di una emulsione lipidica (30% soy oil emulsion) in seguito ad arresto cardiaco bupivacaina-indotto sia in vivo sia in modelli sperimentali di cuore isolato.
Numerosi case reports sono stati pubblicati sull’utilizzo clinico dell’emulsione lipidica nella rianimazione di pazienti in arresto cardiaco in seguito ad overdose di anestetico locale.
Le linee guida 2005 dell’American Heart Association (AHA/ACLS resucitation protocol) prevedono l’utilizzo di una dose di 40 U di vasopressina, al posto della prima o seconda dose di epinefrina, come farmaco di prima linea nel trattamento dell’arresto cardiaco.
Abbiamo studiato l’efficacia dell’emulsione lipidica versus i farmaci suggeriti dai protocolli ACLS in un modello sperimentale di arresto cardiaco bupivacaina-indotto in ratti. Sono stati analizzati parametri emodinamici, metabolici ed elettrocardiografici. L’emulsione lipidica è risultata superiore, in termini di sopravvivenza, parametri
emodinamici e metabolici, all’adrenalina, alla vasopressina e alla loro associazione nel trattamento dell’arresto cardiaco indotto da un’overdose di bupivacaina. Ulteriori studi sono necessari per confermare queste osservazioni e soprattutto per determinare eventuali implicazioni sul piano clinico
Successful Treatment of a Recurrent Wide Tracheoesophageal Fistula With a Bioabsorbable Patch
No full textAcquired nonmalignant tracheoesophageal fistula (TEF) is a rare condition that requires proper treatment. We present the case of a 55-year-old woman with a 4.5-cm recurrent TEF, which had developed after an attempted surgical repair. After closure of the esophageal defect in two layers, a tracheoplasty technique was used to repair the tracheal membranous wall with a synthetic bioabsorbable patch (Gore Bio-A tissue reinforcement) covered with an intercostal muscle flap. The use of Gore Bio-A tissue reinforcement is an innovative and effective method to close a wide tracheal defect while achieving a scaffold for epithelial colonization
Successful Treatment of a Recurrent Wide Tracheoesophageal Fistula With a Bioabsorbable Patch
No full textAcquired nonmalignant tracheoesophageal fistula (TEF) is a rare condition that requires proper treatment. We present the case of a 55-year-old woman with a 4.5-cm recurrent TEF, which had developed after an attempted surgical repair. After closure of the esophageal defect in two layers, a tracheoplasty technique was used to repair the tracheal membranous wall with a synthetic bioabsorbable patch (Gore Bio-A tissue reinforcement) covered with an intercostal muscle flap. The use of Gore Bio-A tissue reinforcement is an innovative and effective method to close a wide tracheal defect while achieving a scaffold for epithelial colonization
A review of local anesthetic systemic toxicity cases since publication of the American society of regional anesthesia recommendations: To whom it may concern
No full textThrombotic risk following video-assisted thoracoscopic surgery versus open thoracotomy: a systematic review and meta-analysis
No full textThere is no consensus on the risk of thrombotic events following video-assisted thoracoscopic surgery (VATS) versus open thoracotomy (OT), despite multiple studies. In fact, the estimates for the overall thrombotic risk for VATS versus OT are inconclusive. In this systematic review and meta-analysis, we endeavoured to ascertain the best estimate of thrombotic risk in VATS versus OT
Feasibility and Utility of Chest-X ray on Portable Normothermic Perfusion System
Full text linkEx Vivo Lung Perfusion (EVLP) represents a unique platform for donor lung assessment and reconditioning.
Graft assessment during EVLP is a complex process based on different parameters. In addition to standard parameters, radiologic evaluation is acquiring great importance in its ability to identify small unrecognized inflammatory/infectious processes that can complicate the postoperative outcome
Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study
No full textGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Post-operative hypercoagulable whole blood profiles in patients undergoing open thoracotomy vs video-assisted thoracoscopic surgery
No full textBACKGROUND: Patients undergoing video-assisted thoracoscopic surgery (VATS) have a lower risk of thrombosis compared to those undergoing open thoracotomy (OT) which may be due to several post-operative factors such as early mobilisation, shorter hospital stays, lower transfusion rates and lower risk of infections. Whether the higher thrombotic risk after OT is also linked to a peri-operative hypercoagulable state is a matter of debate. We therefore conducted a case-control study to compare peri-operative coagulation profiles in patients with primary lung cancer undergoing VATS vs OT.MATERIAL AND METHODS: All consecutive patients undergoing VATS or OT for primary lung cancer at the Department of Thoracic Surgery of Padua University Hospital, Italy, between February and June 2018 were enrolled. Each patient provided a venous blood sample at least 30 min prior to surgical incision (T0) and 4±1 days after surgery (T1). Peri-operative coagulation profiles were assessed via traditional, viscoelastic whole blood (ROTEM [Instrumentation Laboratory-Werfen]) and impedance aggregometry (Multiplate Analyser [Roche Diagnostics]) tests.RESULTS: We enrolled 65 patients (males 43, females 22; mean age 65±13 years) of whom 35 (54%) underwent VATS and 30 (46%) underwent OT. Compared to healthy controls, the surgical group (VATS and OT patients) had a significantly shorter clot formation time and higher alpha angle and maximum clot firmness values, as well as increased mean platelet function. In the post-operative period, patients who underwent OT had a significantly shorter clot formation time, higher alpha angle and maximum clot firmness values and higher mean platelet function vs VATS patients.DISCUSSION: Whole blood ROTEM profiles and Multiplate aggregometry identified a more hypercoagulable post-operative state in patients who underwent OT than in those who underwent VATS. Larger studies are warranted to confirm our results and ascertain whether the observed hypercoagulability might promote post-operative thrombosis
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