ABSTRACT
The incidence of latex allergy has increased in the last decade in particular for medical and health care staff. The "L. Sacco" Hospital in Milan has developed an organisational model for dealing with clinical problems of patients allergic to latex who need to be admitted in hospital. Guidelines have been drawn up to handle the problem of latex allergy in hospital. An Interdisciplinary Working Group has systematically re-examined the epidemiological, etiopathogenetic, clinical diagnostic and therapeutic aspects of this important medical problem. This last topic has been particularly developed to facilitate doctors with emergency drugs. Nevertheless the most efficient method against the sensitisation is the elimination and reduction in hospital of the allergens causing the disease.
Subject(s)
Latex Hypersensitivity/etiology , Occupational Diseases/etiology , Health Personnel , Humans , Latex Hypersensitivity/diagnosis , Latex Hypersensitivity/epidemiology , Latex Hypersensitivity/therapy , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Occupational Diseases/therapy , Risk FactorsABSTRACT
The Authors report two cases of central nervous system complications after retrobulbar block. These complications have a 0.044% incidence in 4500 subsequent cases of retrobulbar blockade studied from 1981 to 1990. The Authors attribute the respiratory arrest and coma to direct access of the anesthetic to the central nervous system along the subdural space in the optic nerve sheath.
Subject(s)
Brain Stem/drug effects , Coma/chemically induced , Nerve Block/adverse effects , Respiratory Insufficiency/chemically induced , Cataract Extraction , Female , Humans , Male , Middle AgedABSTRACT
The course of respiratory exchange through arterial blood gas analysis after coronary bypass-grafting and valvular replacement has been investigated in a cohort of 62 patients. Arterial blood gases were measured at baseline (the day before surgery), and then 1, 2, 3 and 9 days after surgery; in a subset of 18 patients, randomly selected from the same population, pulmonary function tests were also performed at baseline and repeated on day 9. Arterial blood gases showed a remarkable prevalence of hypoxaemia (as defined as arterial PaO2 less than 60 mmHg): 31% on the first, 50% on the second, and 40% on the third post-operative day; anemia and desaturated mixed venous blood were also prominent findings during the first two days. Arterial PO2 resulted higher afterward, although its mean value then was significantly lower than baseline (81.5 +/- 8.8 vs 93.1 +/- 9 mmHg, p less than 0.005). Pulmonary function tests evidenced widespread restrictive changes, with alterated thoraco-pulmonary mechanics (loss of more than 40% of vital capacity and one second forced expiratory flow) and parenchimal lung damage (residual volume and CO diffusion capacity decrease). Some differences in PaO2 course between coronary patients and valvular patients have been releaved; the mean basal PaO2 value of valvular was significantly lower then the other one (86.7 +/- 10.8 vs 94.7 +/- 10.9, p less than 0.05).
Subject(s)
Coronary Artery Bypass/adverse effects , Hypoxia/etiology , Female , Humans , Hypoxia/physiopathology , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Respiratory MechanicsABSTRACT
Eighty patients were submitted to orotracheal intubation with adult bullard laryngoscope blade. Use and advantages are described, especially in difficult intubation.
Subject(s)
Laryngoscopes , Equipment Design , HumansABSTRACT
Patients, especially males, do not easily stand endoscopic urological diagnostic examinations. So flunitrazepam (0.01 mg/kg IV) has been used to insure a suitable sedation. At the end of such examination flumazenil, a selective benzodiazepine antagonist has been injected. The levels of sedation and orientation so obtained and the cardiorespiratory parameters have been collected during a one hour follow-up from the intravenous injection of the antagonist. This method presents minimal side effects (a marginal, but statistically significative, systolic arterial pressure reduction), a completely normal coordination of movements and awareness of space and time relationship at the end of the observation period. Therefore it is a very good solution for short time examinations giving the chance to safely and shortly dismiss the patient.
Subject(s)
Conscious Sedation , Cystoscopy , Flumazenil/therapeutic use , Flunitrazepam/therapeutic use , Hypnotics and Sedatives/therapeutic use , Adult , Aged , Blood Pressure/drug effects , Consciousness/drug effects , Female , Flumazenil/pharmacology , Flunitrazepam/antagonists & inhibitors , Humans , Hypnotics and Sedatives/antagonists & inhibitors , Male , Middle Aged , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/surgerySubject(s)
Acquired Immunodeficiency Syndrome , Catheterization, Central Venous , Catheters, Indwelling , Adult , Female , Humans , Male , SkinABSTRACT
The present study was designed to compare the rapidity of onset of neuromuscular blockade after administration of 5 different neuromuscular relaxants (succinylcholine, d-tubocurarine, pancuronium, atracurium and vecuronium) in 75 patients, randomly allocated in 5 treatment groups. The facilitation for endotracheal intubation was evaluated using a clinical score. The for onset relaxation was shorter when using succinylcholine. Among non-depolarizing relaxants an adequate facilitation for endotracheal intubation was observed, two minutes after administration of atracurium and vecuronium, while endotracheal intubation was difficult when using d-tubocuranine and pancuronium.
Subject(s)
Intubation, Intratracheal , Neuromuscular Nondepolarizing Agents , Adult , Aged , Atracurium , Electromyography , Female , Humans , Male , Middle Aged , Pancuronium , Tubocurarine , Vecuronium BromideABSTRACT
Nitrogen metabolism was studied in ten injured/septic patients by means of a two compartment model, differentiating muscle from non muscle (central) tissue. During fasting muscle tissue loses a consistent amount of aminoacids which is retained in part by central tissue, giving rise to a positive nitrogen balance, whilst three methyl histidine and body nitrogen output are elevated. Total parenteral nutrition (glucose 15 kcal kg-1 day-1, nitrogen 0.30 g kg-1 die-1) improved body nitrogen balance and three methyl histidine excretion, but did not affect significantly either muscle or central nitrogen balance. Increasing caloric support to 30 kcal kg-1 day-1 did not showed any further effect on body nitrogen balance and three methyl histidine, while it improved significantly vs basal muscle nitrogen balance, but did not affect central nitrogen balance.
