Analgesia and sedation in hemodynamic unstable patient (Views : 2565 times)
Written by:
Višnja Majerić Kogler, Judith Deutsch, Sanja Sakan
Review articles
Abstract
Pain, restlessness, tension and delirium are almost always encountered while treating hemodynamic unstable critical patients in the intensive care units. Usually in critical patients, the evaluation of the nature and pain intensity (VAS scale) are often impossible. During the last 10 years intense nociceptor somatic and visceral post operative pain is believed to be the most crucial factor in the development of endocrine and neurohumoral disorders, within the postoperative period. Chronic post operative pain is appearing often (30%-40%), with great influence on the quality of patients life. The modern principal in treating acute pain is the use of multimodal balanced analgesia approach, which is individually catered with drug and dose for each patient. Modern systemic analgesia is understood to be the continuous use of opiates or opioids, titrated towards pain intensity, with a minimum number of complications even in hemodynamic unstable patients. The combined use of opioids with NSAID and paracetamol reduces the overall dosage of opioids by 20% - 30% and therefore significantly contributes to hemodynamic and respiratory stability. Effective and safe epidural analgesia in hemodynamic unstable patients can be optimized by simultaneous use of various drugs with different mechanisms of action (local anaesthetic, opioid, adrenalin, ketamin). The accepted concept of analgosedation in critical patients is understood to be the use of short acting drugs (fentanyl, sufentanil, remifentanil, midazolam, propofol) in which drug dosage can be quickly adjusted in respect to the present clinical state of the patient.
Key words: acute postoperative pain, multimodal balanced analgesia, analgesia drugs
Anesthetic management in awake craniotomy (Views : 4884 times)
Written by:
Amato de Monte, Francesa Zorzi, Massimiliano Saltarini, Paolo Bonassin, Marco Vecil, Palma de Angelis
Review articles
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
Clinical Applications of Capnography (Views : 3633 times)
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
Extracorporeal membranous oxygenation (ECMO) in neonates and children experiences of a multidisciplinary paediatric intensive care unit (Views : 4371 times)
Written by:
Ivan Vidmar, Janez Primožić, Gorazd Kalan, Štefan Grosek
Review articles
Abstract
Extracorporeal membranous oxygenation ECMO was applied in 18 patients. All children had deep hypoxia and 80% probability of dying. Average duration of ECMO in newborns was 131 hours, and in older patients 253 hours. Seven patients were discharged from the intensive care unit (late survivors), 5 of them are in perfect somatic and mental condition.
Key words: extracorporeal membra-nous oxygenation, neonate, child
Hemodynamic changes in infective endocarditis (Views : 1641 times)
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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