1,720,975 research outputs found
Prophylactic C-Pap versus Oxygen Support with Venturi Mask in COPD Patients Undergoing Lung Lobectomy: A Pilot StudyElisabetta Gualtieri, Md1; Adducci, Enrica; Md, ; Primieri, Paolo; Md, ; Galla, Amerigo; Md, ; Chiappetta, Marco; Md, ; Granone, Perluigi; 1Università Cattolica del Sacro Cuore, Md1.; Roma, ; Italy, ; 2ieo, ; Milano
No full textObjective: Evaluating the feasibility and the efficacy of prophylactic post-operative Continuous Positive Air Pressure (C-PAP) administration in a thoracic surgery unit, compared to oxygen support with Venturi mask in term of Oxygen Partial Pressure/Oxygen concentration in breathed air (PaO2/FiO2) in COPD patients undergoing lung lobectomy. Materials and Methods: Respiratory morbidity after lung resection may occur in 15-20% of the patients, and C-PAP is an effective therapy. It is usually administered in Intensive Care Unit (ICU), while its prophylactic use is not well investigated and it isn't reported in a thoracic ward. We enrolled 19 patients with stage II COPD according GOLD score underwent lung lobectomy in a prospective randomized trial. Group A (10 patients) received in post-operative (PO) a FiO2 percentage to obtain a saturation > 95% with a Venturi mask, while group B (9 patients) received in PO a prophylactic C-PAP to obtain a saturation > 95% with a facial mask and 7,5 mmHg valve for two hours after surgery and then 2 hours every 8 hours for the first and the second post-operative day. PaO2 evaluation was made during the treatment 2 hours after surgery (T1) and in the first PO day (T2) and in FiO2 21% in the second PO day(T3). The two groups received the same treatment in terms of surgical access and resection (lateral thoracotomy and lobectomy), general anesthesia , PO physiotherapy and analgesic therapy. Results: No differences in terms of general characteristics, comorbidities, respiratory function (FEV1, FVC, DLCO, PaO2/FiO2), heart rate, blood pressure, and surgery time were noted between the two groups. PaO2/FiO2 was 379,5 ± 26,7 vs 415,3 ± 102,2 at T1 (p= 0,6), 357 ± 105 vs 310 ± 127 at T2 (p=0,4) and 323,5 ± 62,9 vs 315,2 ± 33,1 at T3 (p=0,4). We documented respiratory complications in 4 patients in the group A and in 3 patients in the group B. In group A one patients had acute pulmonary oedema needed orotracheal intubation and ICU transfer in first PO day, while the other three patients showed desaturation < 70 % during the first PO day. Three patients in group B had the x-ray chest showed microatelectasis in first post-operative day with resolution the next day. In particular PaO2/FiO2 in complicated patients in group A and in group B was 195 ± 38,5 vs 435,2 ± 129,8 (p=0,019) at T1; 166,3 ± 33 vs 371,3 ± 166,9 at T2 (p=0,022) and 253 ± 33,4 vs 313,6 ± 33,6 at T3 (p= 0,07) respectively. Finally, there were not differences between the two groups in term of prolonged air leak (0 patients in group A and B both), hospital stay and satisfaction about the treatment. Conclusion: Our initial findings show the feasibility of a C-PAP prophylactic program in a thoracic surgery unit and suggest the C-PAP prophylactic role to avoid desaturation and pulmonary oedema and the C-PAP curative role in atelectasis after lung lobectomy in COPD patients, as is notable in a significantly better PaO2/FiO2 in group B complicated patients than in group A complicated patients.
We studied 19 patients with stage II COPD according GOLD score undergoing lung lobectomy. Our initial findings show the C-PAP prophylactic role to avoid desaturation and pulmonary oedema and the C-PAP curative role in atelectasis after lung lobectomy in COPD patients a significantly better PaO2/FiO2 in group B complicated patients than in group A complicated patient
Use of stellate ganglion blockadein two patients with severe pain
No full textUse of stellate ganglion blockade in two patients with severe pain
Libro degli atti 69° Congresso nazionale SIAARTI (Bologna, 14-17 ottobre 2015)
No full textVALIDITÀ DEL BLOCCO PARAVERTEBRALE NELLA CHIRURGIA TORACICA. REVISIONE CRITICA DELLA
NOSTRA CASISTICA
E. Adducci, E. Picconi, E. Gualtieri, A. Mascia, P. Primieri
Anestesiologia e Rianimazione - Università Cattolica S. Cuore, Roma, Italy
Introduzione. Il controllo del dolore nella chirurgia toracica oltre a fornire un comfort adeguato al paziente riduce
lo sviluppo di comorbidità perioperatorie e la possibilità di sviluppo di sindromi dolorose croniche. Lʼefficacia
analgesica di una tecnica deve andare di pari passo con la sicurezza della stessa, pertanto, scopo di questo
studio è stato di valutare lʼefficacia del blocco paravertebrale toracico e lʼincidenza di complicanze.
Materiali e Metodi. In questo studio retrospettivo sono stati esaminati tutti i pazienti sottoposti ad interventi di
chirurgia toracica per via toracotomica nei quali è stato eseguito, dalla nostra equipe, un blocco paravertebrale
antalgico. I pazienti arruolati nello studio hanno ricevuto unʼanestesia generale standard. Il blocco paravertebrale
è stato eseguito dopo lʼinduzione in decubito laterale con la tecnica del mandrino liquido, mediante ago di Thuoy
18G, somministrando a T5-T6-T7, 5 ml di Ropivacaina 0.5% e 5mcg di sufentanil. A livello di T7 è stato
posizionato, inoltre, un cateterino paravertebrale ed è stata infusa Ropivacaina 0,2% + sufentanil 1 mcg/ml
mediante pompa elastomerica alla velocità di 5 ml/h, per la durata di 48 ore. Sono state esaminate le difficoltà
tecniche, le complicanze legate alla tecnica e lʼefficacia analgesica valutata mediante punteggio sulla scala VAS
dellʼintensità del dolore percepito.
Risultati. Sono stati esaminati 247 pazienti (M/F 177/70), di età media 62±19 aa, classe ASAI=10%, ASAII=55%,
ASAIII=33% ASAIV=2%, affetti da neoplasia nel 96% e patologia benigna nel 4% dei casi; sottoposti a
lobectomia (60%), a resezione atipiche (34%),a pneumonectomie (6%). Il tempo medio di esecuzione del blocco
è stato pari a 16.6±12 min. Lʼandamento del VAS è riportato in Fig.1. Nel 7% dei casi si è registrata difficoltà nel
posizionamento del cateterino. Nel 17% dei casi il cateterino era intratoracico ed è stato quindi riposizionato dal
chirurgo. Nel 12% dei casi si è registrata insufficiente analgesia (VAS superiore a 5). In 4 casi si è dovuto
rimuovere il cateterino per presenza di sangue. In 6 casi per il prurito è stato tolto lʻoppioide in associazione. É
stato registrato un caso di marcata ipotensione tale da far sospettare un effetto tossico da anestetico locale
risolto con trattamento subintensivo.
Discussione. Il blocco paravertebrale risulta una tecnica analgesica valida anche se alcuni aspetti vanno
sottolineati per minimizzare gli effetti collaterali: bolo frazionato su più livelli, infusione continua inferiore a 0,1
ml/kg/h, non effettuare il blocco in presenza di precedenti interventi nella regione paravertebrale, pleura parietale
integra (1). Stiamo valutando anche la possibilità di evitare lʼassociazione oppioide+anestetico locale per evitare
gli effetti collaterali legati allo stupefacente. La relativa rapidità di esecuzione e le ridotte complicanze sembrano
essere a favore di questa tecnica che può essere proposta anche a pazienti compromessi clinicamente. Con lo
scopo di ridurre il rischio, sempre presente, di sovradosaggio dovrebbe essere indagato con una casistica più
ampia la minima concentrazione efficace e/o il volume più adeguato.
Bibliografia:
1) Fibla JJ, Molins L, et al. A randomized prospective study of analgesic quality after thoracotomy:
paravertebralblock with bolus versus continuous infusion with an elastomeric pump. Eur J Cardiothorac Surg.
2015 Apr;47(4):631-5.
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Anesthetic management of two patient with Melas syndrome
No full textAnesthetic management of two patient with Melas syndrom
Unusual airways management during one‐lung ventilation in thoracic surgery
No full textAirways management in thoracic surgery is usually more difficult than in other surgery. We reported a case of a patient
who underwent surgery of evacuation of empyema where after a correct insertion of a left double‐lumen tube 37 Fr (DLT),
one‐lung ventilation was not permitted by the high airways pressure. In fact, the hole of bronchial tip was just against the left
bronchial wall retracted probably from inflammatory process. We introduced blindly an Arndt blocker 9 Fr inside the tracheal
lumen of DLT until the orifice of the right upper lobe bronchus, the distance was checked before. After the positioning of the
blocker, the DLT was pulled up to above the carina, and the single‐lung ventilation was permitted. Sometimes, an unusual
use of different devices permits to manage complications. In fact, in this case, the Arndt bronchial blocker helps us to solve
an important ventilatory problem
Gas exchange during one lung ventilation
No full textIntraoperative hypoxemia is possible in thoracic surgery during one lung ventilation also at high oxigen concentration (O2 100%). Aim of this study was to evaluate in forty patients correlations between preoperative pulmonary function tests and PaO2 in front of intraoperative PaO2 during double lung and one lung ventilation
Radioterapia itraoperatoria: problemi anestesiologici durante il trasporto del paziente
No full textProblemi anestesiologici durante il trasporto del paziente sottoposto a raditerapia intraoperatoria
Dolore postoperatorio : confronto di tre metodiche
No full textDolore postoperatorio : confronto di tre metodich
Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia
No full textOBJECTIVES:
Postoperative pain is characterized by a wide variability of patients' pain perception and analgesic requirement. The study investigated the extent to which demographic and psychologic variables may influence postoperative pain intensity and tramadol consumption using patient-controlled analgesia (PCA) after cholecystectomy.
METHODS:
Eighty patients, aged 18 to 70 years, with an American Society of Anesthesiologists physical status I or II and a body mass index between 18.5 and 24.9, undergoing laparoscopic cholecystectomy were enrolled. Self-rating anxiety scale (SAS) and self-rating questionnaire for depression (SRQ-D) were used--1 day before surgery--to assess patients' psychologic status. General anesthesia was standardized. PCA pump with intravenous tramadol was used for a 24-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi) and tramadol consumption were registered. Pearson's and point biserial correlations, analysis of variance, and step-wise regression were used for statistical analysis.
RESULTS:
Pearson r showed positive correlations between anxiety, depression, and pain indicators (P<0.05). Moreover, female patients had higher pain indicators (P<0.05). Analysis of variance showed that anxious (P<0.05) and depressed (P<0.001) patients had higher pain indicators, which significantly decreased during the postoperative 24 hours (P<0.00001). Regression analysis revealed that tramadol consumption was predicted by preoperative depression (P<0.001). VASr was predicted by sex and SRQ-D (P<0.05). VASi was predicted by sex and SAS (P<0.05).
DISCUSSION:
Pain perception intensity was primarily predicted by sex with an additional role of depression and anxiety in determining VASr and VASi, respectively. Patients with high depression levels required a larger amount of tramadol
Aspetti anestesiologici in chirurgia pancreatica
No full textAspetti anestesiologici in chirurgia pancreatic
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