75 research outputs found
Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians
No full textBACKGROUND:
The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA) insertion in expert users.
AIMS:
The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT) in anaesthetised non-paralysed patients.
METHODS:
In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years), undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m(2), laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron's criteria ≥2) and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group) or SC (SC-group).
STATISTICAL ANALYSIS:
Chi-square test with Yates' correction, Mann-Whitney U-test or Student's t-test were carried-out as appropriate.
RESULTS:
The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% (n = 109) versus 74.4% (n = 99) respectively (P = 0.002). Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; (P = 0.001). There were no differences in insertion time, post-operative airway morbidity and complications.
CONCLUSION:
The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians
Assessment and evaluation of narratives in Guided Imagery and Music (GIM) (Perilli)
No full textThis is a review of the book "Assessment and evaluation of narratives in Guided Imagery and Music (GIM)" authored by Gabriella Giordanella Perilli.
Title: Assessment and evaluation of narratives in Guided Imagery and Music (GIM) Author: Gabriella Giordanella Perilli Publication year: 2017 Publisher: Barcelona Publishers Pages: 94 ISBN: 978194541114
Efficacy and Safety of Prothrombin Complex Concentrates in Liver Transplantation: Evidence from Observational Studies
No full textThe risk/benefit ratio of using prothrombin complex concentrates (PCCs) to correct coagulation defects in patients with end-stage liver disease is still unclear. The primary aim of this review was to assess the clinical effectiveness of PCCs in reducing transfusion requirements in patients undergoing liver transplantation (LT). This systematic review of non-randomized clinical trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was previously registered (PROSPERO:CRD42022357627). The primary outcome was the mean number of transfused units for each blood product, including red blood cells (RBCs), fresh frozen plasma, platelets, and cryoprecipitate. Secondary outcomes included the incidence of arterial thrombosis, acute kidney injury, and haemodialysis, and hospital and intensive care unit length of stay. There were 638 patients from 4 studies considered for meta-analysis. PCC use did not affect blood product transfusions. Sensitivity analysis, including only four-factor PCC, showed a significant reduction of RBC effect size (MD: 2.06; 95%CI: 1.27–2.84) with no true heterogeneity. No significant differences in secondary outcomes were detected. Preliminary evidence indicated a lack of PCC efficacy in reducing blood product transfusions during LT, but further investigation is needed. In particular, future studies should be tailored to establish if LT patients will likely benefit from four-factor PCC therapy
Carbon dioxide elimination pattern in morbidly obese patients undergoing laparoscopic surgery
No full textBackground: Hypercapnia can result from carbon dioxide pneumoperitoneum and adversely affect the postoperative period, particularly in morbidly obese patients. The purpose of the present study was to examine carbon dioxide homeostasis using a metabolic monitor in morbidly obese and normal weight patients during laparoscopic surgical procedures. The setting was a university hospital in Italy. Methods: The data from 25 patients with a body mass index of 47.7 ± 5.5 kg/m2undergoing laparoscopic gastric mini-bypass were compared with the data from 25 normal weight patients undergoing laparoscopic cholecystectomy. The minute ventilation was adjusted to maintain a normal arterial partial pressure of carbon dioxide and normal end-tidal partial pressure of carbon dioxide throughout surgical procedures. The arterial partial pressure of carbon dioxide, end-tidal partial pressure of carbon dioxide, total exhaled carbon dioxide per minute, and arterial blood gas analysis were obtained at 10-minute intervals, along with other cardiorespiratory parameters. Results: The total exhaled carbon dioxide per minute increased by the same percentage in both groups (around 20%). In the laparoscopic cholecystectomy patients, a definite plateau in the total exhaled carbon dioxide per minute was observed within 20 minutes from the start of pneumoperitoneum but not in the morbidly obese patients. After desufflation, the total exhaled carbon dioxide per minute returned more rapidly to the baseline values in the laparoscopic cholecystectomy group than in the morbidly obese group (17.4 ± 6.2 and 24.1 ± 8.3 min, respectively). Conclusion: The results of our study have shown that the load of carbon dioxide insufflated is well tolerated in morbidly obese patients, as well as in normal patients, with proper intraoperative ventilation adjustments. However, after pneumoperitoneum, the return to a normal total exhaled carbon dioxide per minute required a longer period in the morbidly obese group. Prolonged mechanical ventilation is therefore advisable in morbidly obese patients. © 2012 American Society for Metabolic and Bariatric Surgery
Anestesia sequenziale con isoflurane e Propofol in pazienti obesi sottoposti ad intervento di diversione biliopancreatica
No full textN/
Determinants of hemodynamic compensation during veno-venous bypass in liver transplantation
No full textAirway management in obese patients
No full textThe well-known difficulties in airway management in obese patients are caused by obesity-related airways and respiratory changes. Anesthesiologists confront a number of troubles, including rapid oxygen desaturation, difficulty with laryngoscopy/intubation and mask ventilation, and increased susceptibility to the respiratory depressant effects of anesthetic drugs. Preoperative assessment of the airways in the obese should include examination of specific predictors of difficult mask ventilation other than those for difficult intubation.
Difficulties in airway management are decreased after providing optimal preoxygenation and positioning ("ramped"). Other strategies may include
availability of alternative airway management devices, including new video
laryngoscopes that significantly improve the visualization of the larynx and
thereby facilitate intubation. If awake intubation is mandatory, it may be
performed with fibrobronchoscope after providing an adequate topical anesthesia
and sedation with short-acting drugs, such as remifentanil. Succinylcholine for rapid sequence induction might be replaced by rocuronium where sugammadex is available for reversal. A complete reversal of neuromuscular block, measured by train-of-four monitoring, should be obtained before extubation, which requires a fully awake patient in the same position with airway equipment used for intubation
Carbon dioxide absorption during retroperitoneoscopic adrenalectomy: comparison between monolateral and synchronous bilateral approaches
No full textSynchronous posterior retroperitoneoscopic bilateral adrenalectomy (PR-BilA) is a novel technique proposed for the definitive cure of hypercortisolism when a surgical approach is indicated. The aim of the present prospective cohort study was to compare the carbon dioxide (CO2) absorption in patients undergoing PR-BilA with those undergoing single posterior retroperitoneoscopic adrenalectomy (PRA). Twenty-nine patients undergoing PR-BilA or PRA were consecutively enrolled. Anaesthesia was standardised. In both groups, CO2 elimination (VCO2), CO2 dissolved in arterial blood (PaCO2), end-tidal CO2 (EtCO2), and volume per minute (VM) were measured at the following time points: after anaesthesia induction and before CO2 insufflation (T1), 5 min after CO2 insufflation (T2), at the time of maximum VCO2 (T3), and at desufflation (T4). VCO2 was continuously measured using a metabolic monitor. ANOVA for repeated measures was used for statistical analysis. With respect to VCO2, a significant group × time interaction was found (p = 0.03). Post hoc analysis revealed that VCO2 was significantly increased at T4 compared with T1 in both groups (p = 0.02 and p = 0.0001 in the PRA and PR-BilA groups, respectively). Regarding PaCO2, ANOVA analysis showed a significant group effect (p = 0.01), with higher values in the PR-BilA group. EtCO2 and VM did not differ between the two groups. We found that the CO2 absorption was increased in both groups at the end of surgery, in the presence of a higher trend in PaCO2 values during PR-BilA. Therefore, PR-BilA may be considered a safe surgical approach with respect to CO2 absorption, when a mild degree of hypercapnia may be accepted
Factors affecting acute pain perception and analgesics consumption in patients undergoing bariatric surgery
No full textBackground: Previous studies performed in non-obese patients undergoing elective surgery have revealed that psychological factors may affect postoperative analgesic requirements. The aim of this observational prospective study was to investigate the extent to which psychopathological dimensions, including anxiety, depression and alexithymia, may influence postoperative pain intensity and analgesics consumption using patient-controlled analgesia (PCA) in patients undergoing bariatric surgery. Methods: 120 patients, aged 18-60 years, with an ASA physical status I-II, undergoing gastric bypass were enrolled. Anxiety and depression Hamilton scales, and Toronto Alexithymia scale, were administered to patients on the day before surgery. General anesthesia was standardized. After awakening, a PCA pump with intravenous tramadol was immediately made available for a 36-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi), and effective PCA requests number were postoperatively recorded. Pearson's correlations, Anova analyses and multiple linear regression were used for statistical purpose. Results: Positive correlations were found between anxiety, depression, alexithymia and all pain indicators (p < 0.01). Analyses of variance showed that anxious (p < 0.001), depressed (p < 0.001) and alexithymic (p < 0.05) patients had high pain indicators. VASr and VASi were predicted by anxiety and depression (p < 0.05), but not by alexithymia; effective PCA requests number was predicted by anxiety, depression and alexithymia (p < 0.001). Conclusions: Obese patients with high depression, anxiety and alexithymia levels rated their pain as more intense and required a larger amount of tramadol. Pain perception intensity was predicted by anxiety and depression but not by alexithymia, whereas analgesics consumption was predicted by all the investigated psychopathological dimensions
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