218 research outputs found
Local anesthetics with additives for single shot nerve block: What are the benefits and risks?
No full text
Open questions in the treatment of cancer pain: time for a strong evidence-based approach?
No full textPain affects patients with cancer at any stage of their disease. Yet, it is not adequately treated in a significant percentage of cases. In 1986, the WHO proposed a three-step approach for the treatment of pain in cancer patients (from nonopioids to weak opioids to strong opioids, according to pain intensity) following the recommendations of an international group of experts. The application of the WHO strategy demonstrated that a clear and simple approach is of educational value and ensured worldwide dissemination. However, there is little evidence that the WHO approach is the best, and there are still several points to debate on the treatment of cancer pain
TIVA (Total intravenous anaesthesia) per interventi ORL in regime di day-surgery
No full textSono stati sottoposti a microlaringoscopia e a settoplastica in regime di day-surgery 150 pazienti ASA I-II. In tutti i pazienti è stata realizzata un'anestesia totalmeente endovenosa (TIVA) secondo il seguente schema: Propofol in modalità TCI con target plasmatico di 4-6 mcg/ml, remifentanil in infusione per un minuto alla dose di 0,4 mcg/kg/ min, seguito da infusionee continua di 0,25 mcg/kg/min. La miorisoluzione è garantita dalla somministrazione di Vecuronio 0,06 mg/kg oppure Atracurio 0,4 mg/kg. Dopo l'intubazione il target plasmatico del Propofol è ridotto a 3 mcg/ml, la VMC è realizzata con O2 e aria (2 l/min), mantenendo la normocapnia (EtCO2=30 mmHg). L'infusione del Propofolo viene interrotta secondo i tempi di interruzione del farmaco (tempo di risveglio previsto). Il Remifentanil viene sospeso al termine dell'intervento. L'anestesia totalemnte endovenosa ha garantito in tutti i casi una buona stabilità dei parametri emodinamici, con campo operator io sufficientemente esangue, una buona qualità del risveglio, brevi tempi di estubazione, assenza di nausea o vomito post-operatori, dolore postoperatorio (VAS) 0-2 per le microlaringoscopie, 1-3 per le settoplastiche. La TIVA in modalità TCI si conferma una tecnica anestesiologica particolarmente idonea ai requisiti della chirurgia ORL in day-surgery. Infatti permette di ottomizzare in consumo di Propofol modulando il livello di anestesia in relazione alle esigenze chirurgiche, con risveglio pronto e completo, dimissibilità del paziente lo stesso giorno dell'intervento, con conseguente riduzione dei cost
Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis?
No full textEpidural hematoma after thoracic epidural catheter removal in the absence of risk factors
No full textBackground and Objectives: The purpose of this report is to enhance awareness that an epidural hematoma can occur even in patients devoid of risk factors. Case Report: A 69-year-old, 55-kg male was scheduled for video-assisted thoracoscopic resection of bilateral pulmonary metastases and received combined thoracic epidural and general anesthesia. The epidural catheter insertion was unremarkable. All laboratory values were within normal values. No anticoagulation or antiplatelet drugs were administered. The epidural catheter was removed on postoperative day 2. The patient developed signs of an epidural hematoma a few hours later and was treated by decompressive laminectomy. Full neurologic recovery was observed after a 6-month period. Conclusion: Catheter removal is a critical period for epidural hematoma formation even if no risk factors are identified. Early recognition and treatment are essential features for good neurologic recovery after an epidural hematoma
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