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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Anesthetic management in awake craniotomy

Abstract

Resection of brain tumors may cause neurological sequelae, according to the site and size of the brain tissue removed. Awake craniotomy has been proposed as a surgical approach to satisfy criteria of radical surgery while minimizing eloquent brain damage. The most critical aspect of awake craniotomy is to maintain adequate patient comfort, analgesia, immobility and cooperation during a long surgical operation, ensuring in the meanwhile the safety, control and maintenance of vital functions. Apart from pharmacological, surgical, technical knowledge and skillfulness, the ability to maintain close psycho-emotional
contact and support with the patient throughout the operation is a fundamental task that the anesthesiologist has to pursue for the operation to be successfully managed.
This review summarizes the current opinion on anesthetic management of patients undergoing awake craniotomy.

Key words: anesthesia, awake craniotomy, brain mapping, brain tumor, neuro-oncology

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Low flow, minimal flow and closed circuit system inhalational anesthesia in modern clinical practice

Abstract

Low, minimal flow and closed circuit anesthesia has been pursued since the beginning of the history of anesthesia. For many decades this form of anesthesia has been restricted to devoted enthusiasts and those very fond of gas kinetics. For most clinicians, selecting a fresh flow gas higher than 3-5 L/min was widely accepted as a routine anesthesia technique. The introduction onto the market of new volatile agents as well as advanced anesthesia machines accompanied by highly reliable monitoring systems, made minimal flow or closed system anesthesia feasible on a daily basis. Clinical, cultural, environmental, pharmacological, technological and economic reasons, force the modern anesthesiologist to reconsider the role of minimal flow and closed circuit volatile anesthesia, in clinical practice. This paper analyses the main advantages offered by these anesthesia techniques.

Key words: anesthesia, low flow, minimal flow, closed circuit, body temperature, humidification

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Hemodynamic changes in infective endocarditis

Abstract

Hemodynamic disturbances in patients with infective endocarditis (IE) are complex and might be consequences of various pathogenic processes. Congestive heart failure (CHF) is a major contributor of hemodynamic derangements, but since IE is often a septic disease, reversible myocardial dysfunction as well as septic shock might sometimes dominate or represent additional contributing factors of disturbed hemodynamics. The major cause of CHF is malfunction of affected valves. It occurs with an incidence of 32 % and is often severe. This is why CHF is the most important risk factor associated with poor patient outcome. Results of the project ‘International Collaboration on Endocarditis’ related to the characteristics of CHF in patients with IE are presented.

Key words: infective endocarditis, congestive heart failure, sepsis, Staphylococcus aureus

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Insight into pathophysiology of sudden infant death syndrome

Abstract

Physiological studies that have been undertaken in children with apparent life-threatening events point to disturbances of the autonomic nervous system and brain stem abnormalities. These abnormalities are manifested as breathing dysfunctions and sleeping patterns, as well as heart rate variability. The diminished arousal response in infants who are exposed to intermittent hypoxia can be fatal during conditions when oxygen availability is limited. This inference well explains well the success of campaigns for supine sleeping position, which associated with the decrease in the rate of sudden infant
syndrome deaths.

Key words: apparent life-threatening event, sudden infant death syndrome, autonomic nervous system, sleep

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Clinical Applications of Capnography

Abstract

This article gives a short review of the basic definitions of capnography and its use. The introduction gives an overview of the historical development of this procedure. Technical features of the method are presented, followed by several definitions for understanding the basic terms needed to realize the applications of capnography. The last section is a descriptive part that explains the most important clinical applications of capnography, the strengths and limitations of this method. This article distinguishes capnography applications as a single procedure and its benefits as a complimentary procedure.

Key words: capnography, monitoring, ventilation, end-tidal CO2

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