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1.
Int Angiol ; 29(3): 278-83, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20502417

ABSTRACT

This study evaluated the feasibility of open infrarenal abdominal aortic aneurysm (AAA) surgery under peridural and spinal anesthesia (vigil patient) alone in high-risk patients with severe chronic obstructive pulmonary disease (COPD) ineligible for endovascular aneurysm repair (EVAR) or open surgery in general anesthesia. Between January 2005 and July 2007, seven patients underwent open AAA surgery with combined spinal and epidural anesthesia ([CSEA] without intubation) alone. Regional abdominal anesthesia was established by spinal anesthesia at L2-3 (levobupivacaine plus fentanyl) associated with peridural anesthesia at T7-8 (levobupivacaine). In this series (6 males and 1 female) the average age was 76.5 years (70-87); the AAA measured 7 cm in diameter on average (range 6-12.2). The survival rate was 100% (7/7 patients) at 6-12 months postoperative; no morbidities occurred during the postoperative phase. Owing to the small size of the series, no statistically significant conclusions can be drawn; even so, repair surgery was found to be effective, without the occurrence of morbidities or mortalities. In high-risk patients (severe COPD), open surgical repair of infrarenal AAA may be done with CSEA alone without intubation when, because of the patient's health, general anesthesia would pose too high a risk or when EVAR is unfeasible. Furthermore, the authors believe that surgical AAA repair under CSEA in vigil patients is a valid treatment option in those subjects with a high operative risk (severe COPD) and untreatable by either open AAA surgery under general anesthesia or EVAR.


Subject(s)
Adjuvants, Anesthesia , Anesthesia, Epidural , Anesthesia, Spinal , Anesthetics, Local , Aortic Aneurysm, Abdominal/surgery , Pulmonary Disease, Chronic Obstructive/complications , Vascular Surgical Procedures , Aged , Aged, 80 and over , Anesthesia, Epidural/adverse effects , Anesthesia, Spinal/adverse effects , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortography/methods , Bupivacaine/analogs & derivatives , Feasibility Studies , Female , Fentanyl , Humans , Italy , Levobupivacaine , Male , Severity of Illness Index , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Vascular Surgical Procedures/adverse effects
2.
Minerva Anestesiol ; 65(9): 675-8, 1999 Sep.
Article in Italian | MEDLINE | ID: mdl-10522140

ABSTRACT

A case of pulmonary edema secondary to dislocation of laryngeal mask during awakening from anesthesia is described. The complication has been ascribed to physiopathological changes of the alveolo-capillary membrane caused by inspiratory efforts secondary to dislocation of laryngeal mask during awakening from anesthesia. Other possible causes of pulmonary edema are discussed, especially the cardiogenic one, and among the non cardiogenic edema, the Mendelson's syndrome. The quick identification and the intensive care of post obstructive pulmonary edema lead to a rapid resolution of the pathology.


Subject(s)
Anesthesia, Inhalation/adverse effects , Laryngeal Masks/adverse effects , Pulmonary Edema/etiology , Acute Disease , Adolescent , Humans , Male
3.
Thorac Cardiovasc Surg ; 34(3): 168-71, 1986 Jun.
Article in English | MEDLINE | ID: mdl-2426830

ABSTRACT

This study was undertaken to evaluate the potential role of a perioperative calcium-channel blocker (Diltiazem) infusion in improving myocardial preservation. Forty consecutive CAD patients were randomly assigned to a control (C; n = 20) and a treated (D; n = 20) group. In patients in the latter group diltiazem was continuously infused at 0.5 to 2.0 mcg/kg/min i.v. from anesthesia induction until the aortic cross-clamping, and from myocardial reperfusion till the 48th postoperative hour. During the preCPB phase hypertension occurred less frequently in group D (3 vs 12 cases, p = 0.0033). In the immediate postischemic period, depression of contractility and the need for inotropic support were observed in 3 cases in group D and in 9 in group C (p = 0.0384). Postoperatively, group D patients had a lower incidence rate of hyperkinetic arrhythmias or conduction disturbances (p = 0.0218), as well as of ECG signs of ischemia (p = 0.0016). Significant CK enzyme level increase was noted in 13 patients in group C versus 4 in group D (p = 0.0040). Two perioperative myocardial infarctions were diagnosed, both in group C. These clinical data show that continuous perioperative infusion of diltiazem can effectively increase myocardial preservation during ischemic arrest, without unfavorable effects on the hemodynamics, electrical activity or mechanical performance of the heart.


Subject(s)
Benzazepines/therapeutic use , Cardiopulmonary Bypass , Diltiazem/therapeutic use , Premedication , Blood Pressure , Electrocardiography , Humans , Intraoperative Period , Male , Middle Aged
6.
Minerva Anestesiol ; 46(2): 199-201, 1980 Feb.
Article in Italian | MEDLINE | ID: mdl-7453985

ABSTRACT

Following mention of problems of cerebral haemodynamics and the action of various anaesthetics on endocranial pressure, a personal anaesthesiological technique based on the use of althesin in drip form is reported and its advantages listed.


Subject(s)
Alfaxalone Alfadolone Mixture , Anesthesia, Intravenous/methods , Neuroradiography/methods , Angiography/methods , Humans
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