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C Melloni

Publications and source records attributed to C Melloni.

At least 19 recordsLinked to original sources
PubMed2006

Cisatracurium versus vecuronium: a comparative, double blind, randomized, multicenter study in adult patients under propofol/fentanyl/N2O anesthesia.

AIM: The aim of this study was to compare the time course characteristics of cisatracurium (C) and vecuronium (V) induced neuromuscular block (NMB) following multiple doses, allowing spontaneous complete recovery (SCRT) and evaluating the influence of age. METHODS: Following institutional approval and signed informed consent, 177 adult ASA 1-2 patients were included in a randomized, double-blind, multicenter study under N20/02/fentanyl/propofol anesthesia. Muscle relaxation was induced with 0.15 mg/kg C or 0.l mg/kg V and was maintained with 0.03 mg/kg of C or 0.02 mg/kg of V injected at T1 25% recovery. Intubating conditions were assessed at 2 min after the initial dose. Time course of NMB was monitored using accelerography (Tofguard) of the adductor pollicis with train-of-four (TOF). Data were analyzed with parametric (Anova) and non parametric statistics (c2, Kruskal Wallis). RESULTS: Both drugs offered good/excellent intubating conditions: duration of action of NMB (mean values +/- SD, minutes) were: dur25 first dose: V 38.20+/-13.2 vs C 51.5+/-11.3 (P<0.02 ); dur25 following repeated boluses (average): V 23.2+/- 8.6 vs C 28.2+/-9.5, ns; dur25 last dose: V 25.1+/-11.5 vs C 31.5+/-11.4, ns: SCRT following last dose: V 50.2+/-23.2 vs C 46.4+/-17.5, ns: t125% to t4/T1 0.80:V 27.1+/-18.7 vs C 18.8+/-10.2, ns. Stratifying for age >or< 65 no differences were noted in the intervals studied following C, while all were longer following V. The duration of block of C was longer than V; the SCRT after the final dose of C was shorter than V albeit not significant. There was a clinically significant increase in duration of block and recovery time in elderly patients for V but not for C. CONCLUSIONS: C and V allow predictable NMB duration and spontaneous recovery even if administered in multiple repeated doses; but in elderly patients duration of block and recovery time is longer following V.

Adolescent↗
PubMed2005

Periodontal health improves systemic inflammatory and haemostatic status in subjects with coronary heart disease.

OBJECTIVES: A relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors has been recently documented in an Italian population. The present study was performed to assess whether intensive dental care may produce a periodontal improvement along with a change in systemic inflammatory and haemostatic factors. MATERIAL AND METHODS: The study population consisted of 18 males aged 40-65 years with proven CHD and elevated values of systemic inflammatory and haemostatic factors. A detailed description of their oral status was given by using two different dental indices (clinical periodontal sum score and clinical and radiographic sum score). Blood samples were taken for measurement of the following systemic markers of inflammation [(C-reactive protein (CRP), leucocytes, fibrinogen)] and haemostatic factors [(von Willebrand factor, fibrin D-dimer and oxidized-low density lipoprotein (Ox-LDL)]. All parameters were determined in each subject at baseline, after 4 months as a control and 3 months after an intensive protocol of scaling and root planing. anova for repeated measures was used for the statistical analysis. RESULTS: No statistical difference was found between values at baseline and at the 4-month-control. All oral indexes showed a significant decrease (p< .01) 3 months after periodontal treatment. All systemic inflammatory indexes decreased but only the decrease in CRP reached statistical significance (p< .05). A significant decrease (p< .01) was also found as regards Ox-LDL among haemostatic factors. CONCLUSIONS: Preliminary results from the present study suggest an association between poor oral status and CHD, and provide evidence that the improvement of periodontal status may influence the systemic inflammatory and haemostatic situation.

Adult↗
PubMed2005

Morbidity and mortality related to anesthesia outside the operating room.

Morbidity and mortality related to sedation or anesthesia outside the operating room has not been investigated so far, but it is assumed to be a relevant problem because the increasing needs for sedation/analgesia in remote locations for a wide range of diagnostic and operative procedures (endoscopy, radiology, magnetic resonance...) and the lack of monitoring, inadequate training of personnel,insufficient staffing. Many complications could occur to patients, like anaphylactic shock,accidental hypothermia,difficult airway maintenance, aspiration,nausea and vomiting, and anesthesiologists, like exposure to pollution, radiation, electromagnetic fields, falls and trauma. Recent guidelines and personal experience are presented and discussed.

Ambulatory Surgical Procedures↗
PubMed2005

Which distal anastomosis should be used in PTFE femoro-tibial bypass?

AIM: The PTFE prosthesis represents an alternative to the autologous saphenous vein in femoro-tibial revascularization for limb salvage in the absence of venous material in the patient. The aim of our study is to confirm the validity of PTFE revascularization and determine the best distal anastomosis in terms of patency using 3 different techniques. We carried out a retrospective analysis, evaluating patients who underwent PTFE femoro-tibial revascularization for critical ischemia. METHODS: Between January 1998 and June 2002 we performed 46 femoro-tibial revascularizations at the Vascular Surgery Division of the Poliambulanza Hospital in Brescia using a PTFE prosthesis, from a total of 192 infrainguinal revascularizations (24%). All patients presented a critical ischemia, with trophic lesions or gangrene in 76% of the cases (35/46) and who were previously treated unsuccessfully with medical therapy. Seventeen cases (36%) were a redo bypass due to previously failed revascularization. In all cases the saphenous vein was not available due to past peripheral or coronary revascularization (45%), saphenectomy (20%) or inadequate diameter (35%). The distal anastomoses were performed on the peroneal artery in 29 cases, on the anterior tibial artery in 14 cases and on the posterior tibial artery in 3 cases. The distal anastomosis was performed by interposing a segment of vein between the prosthesis and the tibial artery in 12 cases; in 22 cases the interposition was performed using a vein patch, and in the remaining 12 cases a PTFE prosthesis provided with a premanufactured expanded anastomosis (Distaflo(c)) was used. RESULTS: Average follow-up was 22.5 months (range: 3-48 months). The primary and secondary patency rate at 48 months, calculated with the Life table method, was 35% and 47%, respectively. Limb salvage in the same time period was 56%. Depending on the anastomosis performed (Distaflo(c), vein patch, distal vein) we obtained a secondary patency rate of 31%, 62%, and 44% respectively after 48 months with a significant difference between distal vein patch and the other two anastomoses (p<0.001). CONCLUSIONS: The PTFE bypass on the tibial artery performed for limb salvage in the absence of a saphenous vein represents a valid alternative to other types of prostheses with a patency percentage that is acceptable in the medium term. Within our study population, anastomosis by vein patch interposition gave better results than other types of tibial anastomosis.

Aged↗
PubMed2004

Poor oral health is associated with coronary heart disease and elevated systemic inflammatory and haemostatic factors.

OBJECTIVES: To assess the relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors in an Italian population. MATERIAL AND METHODS: The study population consisted of 63 males aged 40-65 years with proven CHD and 50 controls matched for age, geographic area, and socioeconomic status. A detailed description of their oral status was given using four different dental indices (total dental index (TDI), panoramic tomography score, clinical periodontal sum score (CPSS), and clinical and radiographic sum score (CRSS)). Blood samples were taken for measurement of the following CHD risk factors: serum total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and glucose; a series of systemic markers of inflammation (C-reactive protein, leucocytes, fibrinogen, homocysteine) and a series of haemostatic factors (von Willebrand factor, fibrin D-dimer, prothrombinic fragment F1.2, plasminogen activator inhibitor type I (PAI-1), and serum antibodies) against oxidized LDL (anti-Ox-LDL). RESULTS: Multiple logistic regression adjusted for all risk factors for CHD showed statistically significant relationships (p<0.01) between all dental indices and CHD. Significant relationships (p always <0.01) were found between CPSS and CRSS and leucocyte count. Significant relationships (p always <0.05) were also found between TDI and the von Willebrand factor, and between CPSS and the von Willebrand factor, anti-Ox-LDL, and PAI-1. CONCLUSIONS: The present study suggests an association between poor oral status and CHD, and provides evidence that inflammatory and haemostatic factors could play an important role in this association.

Adult↗
PubMed2000

Effective doses of cisatracurium. Potentiation by sevoflurane and increasing requirements with age.

BACKGROUND: The aim of the study was to investigate whether or not sevoflurane at different concentrations influenced the ED(effective dose) 50, 90 and 95 of cisatracurium and whether there is any relationship with age. METHODS: Individual dose response curves for cisatracurium were constructed in 80 consecutive patients randomly assigned to four groups: group 1 TIVA with fentanyl and propofol; group 2, 3 and 4 sevoflurane 1, 1.5, 2 MAC respectively, MAC age adjusted and with N2O 65%. Patients were premedicated with diazepam and induction accomplished with fentanyl (1.5-2 micrograms/kg) and propofol (1.5-2 mg/kg); following intubation with succinylcholine (0.4 mg/kg), TIVA or sevoflurane at the desired MAC was maintained until equilibration occurred and then cisatracurium administered in 8-10 micrograms/kg boluses until the attainment of ED95. Neuromuscular monitoring utilized TOF stimulation and ratio evaluation between Ist twitch of the train and basal twitch (T1/Tc) and continuous recording of accelerometry (Tof-guard). Single dose response curves were analyzed with sigmoid equations; the Eds and other parameter means were subjected to analysis of variance for parametric and non parametric data. RESULTS: More boluses were required under TIVA and sevo 1 MAC anesthesia (8.3 and 7.1 vs 4.9 of sevo 1.5 and 2 MAC); maximal depression (94.95%) was reached more frequently with sevo, while under TIVA an average 90% depression only was obtained. Mean ED50 (microgram/kg) where 22 (sevo) vs 34 (TIVA): ED90 averaged 36 (sevo) vs 53 (TIVA); ED95 averaged 39 (sevo) vs 56 (TIVA), with significant differences (p < 0.05) between Eds obtained from TIVA group in comparison with sevoflurane groups, but without differences between averaged EDs obtained with different MAC values among sevoflurane groups. The investigation of the relationship between age and Eds demonstrated a linear regression for all groups considered together (p = 0.000) for all Eds (50, 90, 95). CONCLUSIONS: In conclusion, the presence of MAC multiples of sevoflurane potentiated only slightly the dosages of cisatracurium and EDs linearly increase with age, particularly under sevoflurane anesthesia.

Aging↗
PubMed2000

Superior mesenteric and renal artery embolism during PTA and re-stenting of infrarenal abdominal aorta. Report of a case and review of the literature.

The authors report a case of acute superior mesenteric and right renal artery embolism that occurred during an interventional radiological procedure on the abdominal aorta of a young diabetic woman. The onset of a severe abdominal pain during the procedure evoked the clinical suspicion of intestinal ischemia related to the dislodgement of atheroembolic material into the mesenteric artery; the event was correctly diagnosed, but the surgical therapy was delayed by many hours because of the fact that the patient was in a peripheral hospital of the region and had to be transferred to our institution. Fortunately in spite of the considerable delay, the operation was fully successful, probably because of the favourable location of the embolus, which allowed collateral splanchnic circulation to maintain a good metabolic balance.

Angioplasty, Balloon↗
PubMed2000

[Propofol and remifentanil in day surgery].

BACKGROUND AIM OF THE STUDY: to compare AG versus MAC using propofol & remifentanil in a day surgery setting evaluating intra and postoperative clinical conditions and emergence times. METHODS: Propofol and remifentanil, either for general anesthesia (AG) then conscious sedation (MAC), have been administered to 218 patients undergoing mainly plastic or proctologic surgery as day hospital. AG was induced with propofol 1.5-2 mg/kg followed by a continuous infusion of 10 mg/kg/h and remifentanil infused at 10 micrograms/kg/h; MAC was started with propofol 3 mg/kg/h and remifentanil 4-5 micrograms/kg/h; during the maintenance phase of both AG and MAC, infusion rates of both drugs were adjusted according to clinical needs. Diazepam (0.05-0.06 mg/kg) and/or midazolam (2-3 mg) were given as premedication or coinduction as necessary. All patients received field infiltration with local anesthetics (lidocaine or mepivacaine); patients under GA were artificially ventilated with O2/air through IOT or LMA. Surgical and anesthesiological data were collected on specially designed records, with special attention to time intervals between anesthesia (FA) and surgery (FC) end and eyes opening (EO), orientation (OR), return of spontaneous breathing (SR), extubation (EST), sitting (SED), walking (CAMM), dressing (VEST) and discharge (DIM); data were analyzed with parametric and non parametric analysis of variance. RESULTS: All emergence intervals were longer under AG than under MAC: the earlier in the range of 4-5 vs 0.5-1 min; for the late intervals; FA-SED 24 +/- 18 vs 15 +/- 8, FA-PIED 65 +/- 48 vs 34 +/- 17, FA-VEST 69 +/- 58 vs 33 +/- 17, FA-CAMM 68 +/- 42 vs 39 +/- 19. Discharge times (83 +/- 67 vs 73 +/- 60) were similar between the two groups. Drugs consumption under AG were roughly double than under MAC; total dose infused of propofol (mg/kg/min) 0.118 +/- 0.044 vs 0.06 +/- 0.036; total dose of remifentanil (microgram/kg/min): 0.106 +/- 0.049 vs 0.066 +/- 0.027. AG resulted in a higher % incidence of intraoperative hypotension and bradycardia: hypotension 61.7 vs 25.7 and bradycardia 30.3 vs 12.4. SaO2 decreased more commonly during MAC than AG (20.9% vs 10.1); intraoperative itching was referred in 20% of MAC patients. Conversions rate from MAC to AG was 2.8%. Psychomotor agitation was more frequent following AG (14%) than MAC (2%); nausea (1%), vomiting, shivering (12%), headache (2%), ortostatic hypotension (2%) were similar between the two groups. Diazepam and/or midazolam caused a significant prolongation of recovery intervals, for both AG and MAC with a mean delay of the order of 100-200%. CONCLUSIONS: Propofol- remifentanil gave excellent conditions for a wide variety of day surgery procedures, offering good anesthesia with quick emergence; the addition of bdz, even at low doses, prolongs significantly discharge times.

Adult↗
PubMed1999

[Comparison of manual infusion of propofol and target-controlled infusion: effectiveness, safety and acceptability].

BACKGROUND: Diprifusor TCI is a newly developed target-controlled system for the infusion of propofol. Purpose of this study is to evaluate the acceptability, efficacy and safety of Diprifusor TCI in comparison with the manually controlled technique. METHODS: This multicentre, randomised, parallel group study was carried out in 160 patients undergoing surgical procedures of 10 min to 4 h duration in 8 centres. In each centre 20 male or female patients, aged > or = 18 years, ASA I-III were randomised to treatment with either Diprifusor TCI (TCI group--80 patients) or manually controlled infusion (MI group--80 patients). Assessments included hemodynamics; adverse events, including accidents, actual or possible; recovery times; anesthetist ratings of quality of induction and maintenance, and of ease of control and use of technique. Ratings were summed up in a global quality score (study end-point). RESULTS: Induction doses were significantly lower (median values 1.4 vs 1.9 mg/kg) and maintenance infusion rate significantly higher (median values 10.2 vs 8.8 mg/kg/h) in the TCI group; anesthetists ratings obtained maximum scores in most patients of either group, but more frequently in the TCI group, with significant differences for ease of control (good 91.2% TCI vs 74.7% IM; adequate 8.8 vs 21.5%; poor 0 vs 3.8%), and of use of technique (good 91.2% TCI vs 60.8% IM; adequate 8.8 vs 39.2%); the global quality score showed a significant advantage for the TCI system (median value 12 vs 11). CONCLUSIONS: The TCI technique is effective and safe, and has a better acceptability than the manually controlled infusion technique.

Adolescent↗
PubMed1997

A comparison of 2% and 1% formulations of propofol for the induction and maintenance of anaesthesia in surgery of moderate duration.

This study, conducted in 110 patients undergoing surgery of moderate duration, compared the pharmacodynamic equivalence, efficacy and safety of 1% and 2% formulations of propofol. Anaesthesia was induced with propofol 2 mg.kg-1 given over 40 s and supplementary bolus injections of propofol were given if needed. There were no significant differences between the groups in mean induction times, total induction doses of propofol, frequency and mean duration of apnoea, fentanyl requirements or mean recovery times (times to eyes opening and to orientation). Isolated statistically significant group differences in systolic and diastolic blood pressures and heart rates during induction were not considered clinically significant. Discomfort on injection occurred in 40% and 52% of those given 1% (n = 55) and 2% (n = 55) propofol, respectively; there was no statistically significant group difference in severity. No major adverse effects were reported. This study showed that the 2% formulation has a similar safety and pharmacodynamic profile to the 1% formulation.

Adult↗
PubMed1995

[A new instrument for neuromuscular transmission monitoring: the accelerometer Tofguard. Comparative study of isometric force transduction in the assessment of pipecuronium dose-response relationship].

Pipecuronium effective doses 50,90,95 (ED50, ED90, ED95) have been obtained with the cumulative dosage method studying the influences of two different anesthetic techniques (TIVA vs isoflurane), of the patients age, of two different monitoring techniques, force transduction vs accelerometry, both evaluated by T1/TC ratio, ratio between Ist muscular response following the muscle relaxant and the values obtained before its injection, and TOFR, ratio between 4th and Ist response of every train. 33 patients, 55 years average age, 66 kgs average weight, ASA 1&2, scheduled for elective operations were anesthetized with propofol-fentanyl-N2O; tracheas were intubate under topical analgesia; maintenance of anesthesia included propofol and fentanyl or isoflurane 1 MAC. Neuromuscular monitoring included the simultaneous measurement of force of thumb adduction (FT 10 Grass) and its acceleration (Tofguard); neuromuscular blockade was evaluated by T1/TC and TOFR. Pipecuronium was administered in small decreasing boluses until 95% of T1/TC depression. Under force monitoring, ED50, ED90, ED95 values were 19, 28, 33 micrograms/kg respectively with T1/TC, being slightly lower with TOF stimulation (15, 24, 26 micrograms/kg); ED's were not influenced by anesthesia and were inversely related to age. Under accelerometry, EDs were always lower (16,27 e 27 micrograms/kg) under T1/TC, while with tof their values were similar to those derived from force measurements. ED's values obtained with T1/TC, either with force than accelerometry, while accelerometry was more sensitive than force for all ED's. EDs values, both under T1/TC than TOF, either with force transduction than accelerometry, resulted highly correlated each other, indicating a substantial agreement between the two mechanical methods of monitoring. It is concluded that the new instrument Tofguard offers the same reliability than force transduction, with the advantages of being smaller, portable and able to calculate directly the depth of neuromuscular blockade.

Adult↗
PubMed1995

[Clinical pharmacology of pipecuronium; a comparative study of its duration of action in balanced anesthesia (propofol/fentanyl) vs isoflurane].

Clinical pharmacology of pipecuronium; a comparative study of its duration of action between balanced (propofol/fentanyl) and isoflurane anesthesia. Pipecuronium duration of action has been compared between patients under balanced (propofol/fentanyl) or 0.8-1 Mac isoflurane anesthesia. T1/TC 10-25-50-75-90% (T1/TC, 10, T1/TC, 25, T1/TC, 50 TOF, 75T1/TC 90) and TOF 10-25-50-75% (TOF 10%, TOF 25%, TOF 50%, TOF 75%) ratios were studied; T1/TC 10-75% (T1/TC 10/75) and TOF 10-75% (TOF 10-75%) recovery times were also derived. The muscle relaxant has been utilized in 55 patients divided into groups according to the method of its administration: in group I (33 patients) the drug was injected in small divided doses until ED95% was reached, according to the cumulative dosage method; in group II (8 patients) and III (12) the drug was injected at 0.35 micrograms/kg and 50 micrograms/kg respectively. Neuromuscular function was monitored by isometric force transduction, stimulating the adductor pollicis by tof every 12 sec. Pipecuronium duration of action (min) following single doses was longer than following the cumulative dosage method (TOF 25% vs 61%, TOF 50% 103 vs 76, TOF 75% 136 vs 102). The presence of isoflurane significantly prolonged recovery times (TOF 10%, from 55 to 70, TOF 25% from 61 to 88, TOF 50% from 75 to 120) in group I (cumulative doses) patients. Recovery times were dose related, while age did influence recovery only at the earlier intervals (T1/TC 10 and 25%). Keeping in mind the limited range of age and dosages, advantages and disadvantages of the drug are discussed, comparing the experimental results with those derived from the literature.

Adult↗
PubMed1993

[Myasthenia and muscle relaxants].

Eighteen myasthenic patients have been operated on under general anaesthesia; 14 subjected to thymectomy and 2 to emergency procedures (caesarean section and laparotomy because of intestinal obstruction). Atracurium (0.3 mg/kg) and vecuronium (0.06 mg/kg) exhibited a long duration of action only in the two cases affected by the more severe signs and symptoms of the disease.

Adolescent↗
PubMed1992

[The use of propofol in status epilepticus].

Three cases of status epilepticus not responsive to an aggressive treatment are described. The seizures and EEG activity were rapidly brought under control with a continuous infusion of propofol (3-6 mg/kg/hour), maintained between 21 hours and 7 days. Patient awakening at the end of the infusion period was rapid and without sequelae.

Adult↗