33 research outputs found
Mountain Rescue During the COVID-19 Outbreak. Considerations and Practical Implications
No full textThe World Health Organization (WHO) was informed by the Chinese authorities in December 2019 of the presence of a viral outbreak probably originating from a fish and animal market in the city of Wuhan, the
capital of central China’s Hubei province
The cutting edge of thoracic anesthesia during the Coronavirus disease 2019 (COVID-19) outbreak
No full textCoronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread
PER UN’ARCHEOLOGIA FUTURA, PETRICOR X: INTRODUZIONE
No full textprogetto insieme teorico ed utopico di un'ipotetico ritrovamento archeologico in Capo Massullo a Capri. Vari strati archeologici vengono progettati con delle architetture completamente inventate, che però rappresentano una interpretazione in chiave arcaica della stessa casa Malaparte a Capri. Come se l'architettura di Curzio Malaparte e Adalberto Libera fosse fondata su precedenti rovine. Si studiano le possibili giaciture, le geometrie di diversi strati insediativi, dal terreno vergine con fossili preistorici, al primo insediamento umano, ad un sito liturgico con un temenos proteso verso il mare, esattamente come e dove è posizionata la famosa casa
Bilateral ultrasound-guided erector spinae plane block for postoperative pain management in surgical repair of pectus excavatum via Ravitch technique
No full textThe influence of propofol, remifentanil and lidocaine on the tone of human bronchial smooth muscle
No full textBackground: Bronchoscopy is generally a safe procedure, but the induction of anaesthesia can induce bronchospasm. Consequently we investigated the influence of propofol, remifentanil and lidocaine on the tone of the human bronchial smooth muscle. Materials and methods: The influence of propofol, remifentanil and lidocaine on the contractile response of human bronchial smooth muscle to electrical field stimulation (EFS) has been evaluated. The role of capsaicin-sensitive sensory nerves and of inducible nitric oxide synthase has also been assessed. Furthermore, the interaction between these three dugs has been measured by Bliss Independence (BI) theory. Statistical significance (P < 0.05) was assessed by Student's t test or ANOVA. Results: Propofol (1.3 mu g ml(-1)) and lidocaine (1 mg ml(-1)) reduced the baseline tone of bronchial rings (-14.45 +/- 4.53% and -33.40 +/- 1.07%, respectively, P < 0.05), whereas remifentanil had not such effect. Aminoguanidine prevented the relaxant effect of propofol. Propofol did not alter the bronchial contractile response to EFS following 30 min of treatment, whereas remifentanil enhanced the bronchial tension (133.83 +/- 9.38%, control 101.93 +/- 6.82%, P < 0.05 P < 0.05) and lidocaine completely abolished the contractility at 1 mg ml(-1) (P < 0.05). The desensitization of capsaicin-sensitive sensory nerves normalized the hyperresponsiveness induced by remifentanil (-26.77 +/- 1.68%, P < 0.05). Significant BI antagonism (P < 0.001) was detected for propofol and lidocaine on the bronchial hyperresponsiveness induced by remifentanil. Conclusion: Propofol and remifentanil may be used safely for bronchoscopy, although remifentanil should be associated with propofol or lidocaine to prevent the potential opioid-mediated bronchospasm. (C) 2013 Elsevier Ltd. All rights reserved
Bilateral ultrasound-guided erector spinae plane block for pectus excavatum surgery: a retrospective propensity-score study
No full textObjective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique. Design: A retrospective cohort study. Setting: At a university hospital. Participants: All participants were scheduled for surgical repair of PE. Interventions: From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed. Measurement and main results: A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p < 0.005). Conclusions: Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects
A Practical Guide for Using the EZ-Blocker Endobronchial Blocker: Tips and Tricks After 10 Years of Experience
No full textThe EZ-Blocker (EZB) is a "Y-shaped," semirigid endobronchial blocker used for lung isolation and one-lung ventilation during thoracic surgery. Like many medical tools, initial efforts to use this endobronchial blocker may prove challenging for the uninitiated. However, some tips and tricks can be applied fairly rapidly to aid the clinician in properly placing the device, and, furthermore, may help the cli-nician get the most out of this innovative device. This article focuses on some of the technical aspects of its placement that the authors have developed over time. Additionally, other facets and potential pitfalls are discussed that relate to intraprocedural issues that may sometimes arise when using this device. The following aspects of the EZB as a lung-isolation device are discussed: standard positioning techniques, alternative positioning techniques, use in pediatric patients, approaches to achieving exceptional lung isolation, advanced uses, and limitations and potential issues. Although some information was taken from the authors' rather extensive experience with using this endobronchial blocker, some of the relevant literature are also reviewed, with the goal of being to improve the reader's knowledge of the device and improve the likelihood of its successful placement. The underlying design of the EZB remains unique among commer-cially available bronchial blockers in improving positional stability. The Y-shaped conformation, however, can lead to challenges when positioning the device in some patients. Therefore, some very practical tips and tricks are provided to assist the clinician in correctly positioning the device and other hints to improve the quality of lung isolation and surgical conditions.(c) 2023 Elsevier Inc. All rights reserved
Ultrasound-guided erector spinae plane block versus intercostal nerve block for post-minithoracotomy acute pain management: a randomized controlled trial
No full textObjective: Several nerve block procedures are available for post-thoracotomy pain management.Design: In this randomized trial, the authors aimed to determine whether the analgesic effect of preoperative ultrasound-guided erector spinae plane block (ESPB) might be superior to that of intraoperative intercostal nerve block (ICNB) in pain control in patients undergoing minithoracotomy.Setting: University hospital.Participants: Sixty consecutive adult patients scheduled to undergo minithoracotomy for lung resection were enrolled.Interventions: Patients were allocated randomly in a 1:1 ratio to receive either single-shot ESPB or ICNB.Measurements and Main Results: The primary outcome was the intensity of postoperative pain at rest, assessed with the numeric rating scale (NRS). The secondary outcomes were (1) dynamic NRS values (during cough); (2) perioperative analgesic requirements; (3) patient satisfaction, on the basis of a verbal scale (Likert scale); and (4) respiratory muscle strength, considering the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) variation from baseline. The ESPB group showed lower postoperative static and dynamic NRS values than the ICNB group (p < 0.05). Total remifentanil consumption and requirements for additional analgesics were lower in the ESPB group (p < 0.05). Patient satisfaction was higher in the ESPB group (p < 0.001). A significant overall time effect was found in MIP and MEP variation (p < 0.001); ESPB values were higher at all points, reaching a statistically significant level at the first and sixth hours for MIP, and at the first, 12th, 24th, and 48th hours for MEP (p < 0.05).Conclusions: ESPB was demonstrated to provide superior analgesia, lower perioperative analgesic requirements, better patient satisfaction, and less respiratory muscle strength impairment than ICNB in patients undergoing minithoracotomy. (C) 2020 Elsevier Inc. All rights reserved
Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion. a double-blind, randomized, active-controlled trial
No full textBackground. Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/
or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent l-opioid agonist,
reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The
pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In
this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in
patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia.
Methods. Sixty-four patients, undergoing remifentanil infusion during general anaesthesia andmajor lung surgery, were randomly
assigned to receive either buprenorphine i.v. infusion (25lg h1 for 24h) ormorphine (equianalgesic dose) perioperatively. The
presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative
pain scores, opioid consumption and postoperative neuropathic pain assessed one and threemonths postoperatively.
Results. A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control
group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the
buprenorphine-treated group than in the morphine-treated group: 18 vs 9min (P1⁄40.002). At 30min postoperatively, patients
receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine
(P1⁄40.009). At three months, no differences between groups were noted.
Conclusions. Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical
incision but shows no long-term efficacy at three months follow-up
Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection
No full textBackground: One-lung ventilation (OLV) is a ventilation procedure used for pulmonary resection which may results in lung injury. The aim of this study was to evaluate the local inflammatory cytokine response from the dependent lung after OLV and its correlation to VT. The secondary aim was to evaluate the clinical outcome of each patient. Methods: Twenty-eight consecutive patients were enrolled. Ventilation was delivered in volume-controlled mode with a VT based on predicted body weight (PBW). 5 cmH2O positive end-expiratory pressure (PEEP) and FiO20.5 were applied. Bronchoalveolar lavage (BAL) was performed in the dependent lung before and after OLV. The levels of pro-inflammatory interleukins (IL-1α, IL-1β, IL-6, IL-8), tumor necrosis factor alpha (TNFα), vascular endothelial growth factor (VEGF), endothelial growth factor (EGF), monocyte chemoattractant protein-1 (MCP-1) and anti-inflammatory cytokines, such as interleukins (IL-2, IL-4, IL-10) and interferon (IFN-γ), were evaluated. Subgroup analysis: to analyze the VT setting during OLV, all patients were ventilated within a range of 5-10 mL/kg. Thirteen patients, classified as a conventional ventilation (CV) subgroup, received 8-10 mL/kg, while 15 patients, classified as a protective ventilation (PV) subgroup, received 5-7 mL/kg. Results: Cytokine BAL levels after surgery showed no significant increase after OLV, and no significant differences were recorded between the two subgroups. The mean duration of OLV was 64.44±21.68 minutes. No postoperative respiratory complications were recorded. The mean length of stay was for 4.00±1.41 days in the PV subgroup and 4.45±2.07 days in the CV group; no statistically significant differences were recorded between the two subgroups (P=0.511). Conclusions: Localized inflammatory cytokine response after OLV was not influenced by the use of different VT. Potentially, the application of PEEP in both ventilation strategies and the short duration of OLV could prevent postoperative complications
