Pressure control ventilation and minitracheotomy in treating severe flail chest trauma.

OBJECTIVE: To evaluate pressure control ventilation (PCV) delivered through a minitracheotomy in treating severe flail chest trauma. DESIGN: Case report. SETTING: Intensive care unit of a trauma center. PATIENT: A 34-year-old woman affected by flail chest trauma and acute respiratory failure, who was initially treated with tracheal intubation to obtain internal pneumatic stabilization. The patient failed extubation and noninvasive mask treatment (pressure support ventilation plus PEEP) due to poor chestwall mechanics. INTERVENTIONS: Minitracheotomy was performed and ventilation was achieved with high levels of inspiratory pressure (PCV or assisted PCV) to overcome the resistance of the cannula (Mini-Trach II, Portex, ID 4 mm). Esophageal and carinal pressures were monitored. Ventilatory treatment was always performed with the full cooperation of the patient; the patient's glottic function was always intact. The patient was successfully treated with pressure control ventilation delivered through the Mini-Trach. After 7 days of PCV, the patient was switched to assisted PCV. On the 20th day after admission, she was weaned from mechanical ventilation. CONCLUSIONS: We conclude that a suitable gas exchange and pneumatic stabilization in a flail chest condition can be achieved using minitracheostomic ventilation. At the same time, this treatment could reduce some side effects of traditional tracheal intubation.

Althesin in high risk patients with heart disease in orthopedic surgery.

Althesin was used in 65 patients with heart diseases undergoing orthopedic surgery, alone or in association with neuroleptanalgesic drugs. Patients were classified according to four types of heart diseases: atrial fibrillation in older patients (41.53%), disorders of cardiac rhythm (23.07%), valvular diseases (9.23%), ischemic heart disease (26.15%) and according to the degree of risk (ASA 3 and 4). All patients were carefully studied before the operation, and adequately treated with cardiac drugs in order to reduce heart rate, to reduce blood pressure and to reduce heart failure, whenever necessary. Anesthesia was induced with Althesin in all patients, and maintained with Althesin/N2O/O2 in 24.61% of the cases, and Althesin/N2O/O2/NLA in 75.39% of the cases. No significant changes in heart rate or in blood pressure were observed either during surgery or in the first 24 hours after the operation. There were five deaths in the days after the operation, one of which was due to surgery. One patient was discharged while still in a coma. All the other patients were discharged from the hospital within approximately four weeks from the day of the operation in good general condition. It was concluded that Althesin is a very reliable anesthetic agent for patients with heart diseases.

[Althesin in geriatric injury anesthesia; an evaluation of 100 patients over 70]. / L'althesin in anestesia geriatrica traumatologica; valutazione in 100 pazienti ultrasettantenni.

The physiopathological characteristics of senescence justify unremitting research into anaesthesiological techniques that increase the anaesthesia safety margin in the elderly. Althesin has been studied in 100 over-70s who underwent traumatological surgery. The drug was used in 10% solution administered by continuous drop by drop venous perfusion, for induction also. All patients were submitted to orotracheal intubation under local anaesthesia or using a small dose of succinylcholine. The condition was maintained by N2O in proportions equal to the oxygen and by small doses of analgesic (prevalently neuroleptoanalgesia drugs). Cardiocirculatory and respiratory parameters total anaesthetic consumption and the quality of arousal were studied. The value of Althesin in the narcosis of the elderly is stressed, with particular reference to the good cardiocirculatory stability, the little effect on pulmonary compliance, the early arousal with post-narcotic depressive phenomena and the high therapeutic index.