1,721,171 research outputs found
A novel approach to reversal of neuromuscular blockade
No full textPostoperative residual curarization is still a problem of the modern anesthesia. Neostigmine is not the safest drug that allows a safe decurarization, especially when neuromuscular transmission monitoring is not used. Sugammadex is a Á- cyclodextrin designed to encapsulate rocuronium bromide, providing a rapid reversal of neuromuscular blockade. It has not cardiovascular, respiratory and cholinergic effects. It has been used in renally impaired patients with no neu- romuscular blockade recurrence. Sugammadex reverses either a shallow or a deep neuromuscular block. Volatile agents such as sevoflurane seems not to influence the sugammadex ability to reverse the rocuronium neuromuscular block- ade. There is no difference in the sugammadex pharmacokinetic in children and adults. Sugammadex would be able to have a role in the future in reversing a non depolarizing steroidal neuromuscular block
The postoperative airway: unique challenges?
No full textPurpose of review
The review is focused on the challenge of managing airway and ventilation in the intraoperative and postoperative period.
Recent findings
In past years, a lot of attention was focused on tracheal intubation in difficult airway, whereas only in recent years extubation time of difficult airway is also covering an important role. Protective ventilation strategies have been studied in acute respiratory distress syndrome and then in general anesthesia, either for thoracic or bariatric surgery, whereas in general abdominal surgery, in healthy lung, few studies are present demonstrating the effective protective role of low tidal volume, lung recruitment maneuvers (LRM) and positive end-expiratory pressure (PEEP). In the early postoperative period, the role of noninvasive ventilation is growing as it reduces postoperative pulmonary complications, postoperative length of stay and costs.
Summary
The combination of planning extubation of predicted and unpredicted difficult airway, both intraoperative low tidal volume and low FiO2 with LRM and PEEP at different points of surgery and postoperative noninvasive ventilation should be considered in patients undergoing surgery to decrease the rate of postoperative pulmonary complications and major fatal complications such as brain damage and death
Goal-directed therapy in anesthesia: any clinical impact or just a fashion?
No full textGoal-directed therapy (GDT) describes the protocolized use of cardiac output and related parameters as end-points for fluid and/or inotropic therapy administration. Identifying the patient who will benefit from it has implications throughout perioperative management. The fundamental principle behind GDT is optimizing tissue perfusion by manipulating heart rate, stroke volume, hemoglobin and arterial oxygen saturation to improve oxygen delivery by using fluids, inotropes, red blood cells and supplementary oxygen. Although cardiac output and SvO2 were previ- ously measured using the pulmonary artery catheter, a number of less invasive methods are now available. For in- traoperative GDT, the esophageal Doppler-derived Flow Time correct (FTc) is the parameter used most frequently, although other parameters such as stroke volume obtained from Vigileo, PICCO and/or LiDCO, mixed and/or central venous oxygen saturation (SvO2/ScvO2), oxygen delivery and global end diastolic volume (PiCCO system) may be applied in daily clinical practice. The correct target to be followed during the intraoperative period must be clearly established. Most parameters depend primarily on O2 consumption and are not reliable or useful during an- esthesia. To date, the quantity and the type of fluids to administer during major elective surgery remain an object of continuing debate. In conclusion, in terms of evidence-based medicine, GDT during anesthesia has a clinical impact when performed using an FTc-based fluids algorithm protocol. In contrast, GDT can be considered unreliable if confusing targets such as SvO2 or ScvO2 higher than 70% during anesthesia are followed
Renewable sources urban cells microgrid. A case study
Full text linkNowadays, microgrid technologies play a relevant role in the research field as well as in the commercial market. The opportunity to provide electricity in wide areas without using centralized electrical infrastructure networks is a reliable key for achieving the European Union sustainability goals. In this regard, the proposed research aims at describing an electric microgrid configuration powered by a photovoltaic system, supplying three school buildings located in the center of Italy. Additionally, the resilience theme is deeply investigated, analyzing the use of an emergency generator system (EGS) in case of electric grid blackouts. MATLAB/Simulink was chosen to simulate the users’ energy demand as well as to calculate the microgrid performance. Results show that almost the total consumption of the microgrid is covered by the photovoltaic system, and the use of an EGS allows energy resilience and moderate economic savings for the communit
Environmental parameters assessment of a new diffuser for air cooling/heating system: Measurements and numerical validation
No full textAir distribution of HVAC systems is the most popular type used in the building sector, having a relevant impact on indoor air quality and occupant wellness. Many types of research developed optimal solutions for the HVAC system’s design, focusing on specific components of the distribution system, on the airflow and geometry of ducts, on the size of ducts, on the shape and position of air diffusers. However, few works in literature proposed a globally experimental and simulation analysis of an air distribution system with a variable mass flaw rate. Along this line, the presented research investigates the potentialities of a new ceiling diffuser, installed in an exhibition room. This system provides a variable mass flow rate thanks to its configuration, providing adequate thermal comfort. A warm wall is chosen as the heating system. Several tests are carried out, six for cooling and two for heating with different volumetric air rates and supply air temperature of the diffusers. The combination of two methods, the measurement campaigns and the computational fluid dynamics (CFD) technique represent a suitable approach to examine the thermal indoor environment. In general, results show a strong capability of this diffuser to provide a uniform temperature and velocity field inside the room. Moreover, experimental and numerical data are significantly comparable with an average deviation of 1% for the velocity and lower 1% for the temperature, guaranteeing an optimal distribution of the understudy environmental parameters on the vertical and horizontal planes
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