1,721,093 research outputs found
Apparet Life Threatenin Events: esiste un ruolo del monitoraggio domiciliare?
No full textQuando si deve afrontare un caso di ALTE ( Apparent Life Threatening Events) la sfida per il medico consiste nel trattare l'evento acuto, identificarne la causa, spiegare al paziente-genitore cosa fare, decidere se sarà necessario un monitoraggio successiv
SIDS: una rivisitazione
No full textSIDS is still today after the " back to sleep campaigns" the most frequent cause of death in the first year of life in the industrialized word. The Lombardia county has held since 2000 a similar advice campaign. The 3 main suggestions are: sleep supine, avoid overheating , avoid active ant to second-hand smoking
Perioperative management of obstructive sleep apnea: A systematic review
No full textINTRODUCTION: Obstructive sleep apnea (OSA) is the leading sleep disordered breathing condition, with a prevalence rate of moderate to severe OSA of approximately 10-17% in the general population. EVIDENCE ACQUISITION: We performed an Ovid-Medline search of all articles published up to August 2016. We included all articles providing updated evidence on epidemiology, pathophysiologic mechanisms and perioperative interventions. EVIDENCE SYNTHESIS: OSA is associated with a number of comorbidities and increased perioperative risks. Although in-laboratory polysomnography represents the gold-standard for diagnosis of OSA, it is costly and time-consuming. Anesthesiologists may screen patients for OSA through one of the available questionnaires, of which the snoring, tiredness, observed apnea, high blood pressure (STOP)-Body Mass Index, age, neck circumference and gender (Bang), STOP-bang questionnaire is the most externally validated. Although its sensitivity for the identification of mild OSA patients is 83.6%, its specificity is only 56.4%. OSA patients are associated with a higher risk of both difficult ventilation and intubation. However, practice guidelines refer to available guidelines for difficult airway management. Perioperative continuous positive airway pressure use may be of benefit since it has been reported to be associated with a reduction of both respiratory and cardiovascular complications and symptom relief. When feasible, regional anesthesia techniques and a multimodal analgesia approach should be adopted to reduce intraoperative and postoperative exposure to opioids. CONCLUSIONS: Preoperative screening of OSA patients is of relevance given the increased perioperative morbidity of these patients. Further studies are needed to provide conclusive data on which perioperative interventions are most effective at reducing this risk
Correspondence: Type i and II pectoral nerve blocks with serratus plane block for awake video-assisted thoracic surgery
No full text
Obstructive sleep apnea: Screening is the waiting room for preoperative testing, postoperative monitoring, and safety measures
No full textN/
Update on perioperative management of the child with asthma
Full text linkAsthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child
- …
