One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial.

OBJECTIVES: The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established. DESIGN: Multicenter, randomized, single-blind, controlled trial. SETTING: Sixteen Italian hospitals. PARTICIPANTS: A total of 880 patients undergoing elective major lung resection. INTERVENTIONS: Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay. MEASUREMENTS AND MAIN RESULTS: ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups. CONCLUSIONS: In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.

[Ropivacaina 0.5% vs Levobupivacaina 0.5 endoscopic urological surgery]. / Ropivacaina 0.5% vs Levobupivacaina 0.5% intratecali in chirurgia endoscopica urologica.

AIM: Subarachnoid anaesthesia has been demonstrated to be safe and effective in elderly patients. Isobaric Ropivacaine 0.5% has been recently introduced for subarachnoid anaesthesia: aim of our trial is to compare this drug with 0.5 Levobupivacaine in elderly patients scheduled for endoscopic urological surgery. METHODS: Premedication: Atropine 0.5 mg + Fenotiazine 50 mg im. Lumbar intrathecal anaesthesia, Group L (n=25) receiving Levobupivacaine 15 mg, Group R (n=25) receiving Ropivacaine 18.05 mg (relative motor blocking potency ratio Ropivacaine / Levobupivacaine = 0.83). Statistical analisys: Bonferroni test and variance analisys. RESULTS: No statistically relevant differences between the 2 groups in terms of antropometric characteristics, onset time and duration of sensitive and motor block, perioperative complications, postoperative analgesic consumption and customer satisfaction. Large presence of comorbidities in the studied population. DISCUSSION: The presence of cases of subtotal anaesthetic coverage (with necessity to recur to general anaesthesia), and others with good anaesthetic coverage, but difficultly treatable hypotensions show that the best dosage of these local anaesthetics is to be found yet. The indications to use a standard dosage for every patient have to be re-evalutated. As positive point, very important the postoperative fast recovery from under limb motor block. A longer recovery time (typical with hyperbaric local anaesthetics) was frequently cause of cognitive alterations in a population of elderly patients.

Exploring soft matter: liposomal vesicles and their tethers.

The malleability of soft matter such as vesicular systems, allows their mechanical manipulation into various interesting structures. Their inherent elastic membrane properties can be utilized in fabricating micro-scaled transport machineries. In this paper, we have described several features of research carried out in our laboratory. This includes the self-healing ability of multilamellar liposome on removal of their inner core. The formation of tethers from their outer bilayers into complex networks has been demonstrated. Photo enhancement of images has revealed the apparent existence of narrow channels inside such tethers. The tethers channels were subsequently used as transport conduits to carry solid polystyrene microspheres as well as large liposomes larger than the tether diameter under controllable speeds of up to 2 microm s(- 1). The possibility of producing multi-compartment liposomal systems connected to each other directly by fusion or indirectly via tether networks has provided us with a system capable of transporting components from one vesicle entity to another.