Biomedical subjects

E Cerchierini

Publications and source records attributed to E Cerchierini.

3 recordsLinked to original sources

PubMed2003

Prospective, randomized, controlled evaluation of the preventive effects of positive end-expiratory pressure on patient oxygenation during one-lung ventilation.

BACKGROUND AND OBJECTIVE: This prospective, randomized, controlled study evaluated the effects on oxygenation by applying a selective and patient-specific value of positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation. METHODS: Fifty patients undergoing thoracic surgery under combined epidural/general anaesthesia were randomly allocated to receive zero PEEP (Group ZEEP, n = 22), or the preventive application of PEEP, optimized on the best thoracopulmonary compliance (Group PEEP, n = 28). Patients' lungs were mechanically ventilated with the same setting during two- and one-lung ventilation (FiO2 = 0.5; VT = 9mL kg(-1), inspiratory :expiratory time = 1 : 1, inspiratory pause = 10%). RESULTS: Lung-chest wall compliance decreased in both groups during one-lung ventilation, but patients of Group PEEP had 10% higher values than patients with no end-expiratory pressure (ZEEP) applied--Group ZEEP (P < 0.05). During closed chest one-lung ventilation, the PaO2 : FiO2 ratio was lower in Group PEEP (232 +/- 88) than in Group ZEEP (339 +/- 97) (P < 0.05); but no further differences were reported throughout the study. No differences were reported between the two groups in the need for 100% oxygen ventilation (10 patients of Group ZEEP (45%) and 14 patients of Group PEEP (50%) (P = 0.78)) or re-inflation of the operated lung during surgery (two patients of Group ZEEP (9%) and three patients of Group PEEP (10%) (P = 0.78)). Postanaesthesia care unit discharge required 48 min (25th-75th percentiles: 32-58 min) in Group PEEP and 45 min (30-57 min) in Group ZEEP (P = 0.60). CONCLUSIONS: The selective application of PEEP to the dependent, non-operated lung increases the lung-chest wall compliance during one-lung ventilation, but does not improve patient oxygenation.

Anesthesia, Epidural↗

PubMed2001

Ropivacaine.

BACKGROUND: Ropivacaine is a relatively new long-acting local anesthetic. It is a pure S(-) isomer, with a high pKa and low lipid solubility. Because of its physical and chemical properties, ropivacaine produces a marked differential in sensory and motor blockades, with a toxic potential lower than other long-acting anesthetic solutions. The purpose of this paper was the evaluation of the literature concerning indications and advantages of ropivacaine for different regional anesthesia techniques. METHODS: We have evaluated results of prospective, randomized, controlled trials evaluating clinical use of ropivacaine for epidural anesthesia and analgesia, as well as spinal and peripheral nerve blocks. RESULTS: The literature clearly demonstrates both efficacy and safety of ropivacaine used for epidural anesthesia and analgesia as well as for upper and lower limb peripheral nerve blocks, both single-shot and continuous peripheral blocks. Although ropivacaine has not been registered yet for spinal anesthesia, various studies show its efficacy and safety also in this field. Because of its pharmacodynamic properties, intrathecal ropivacaine seems also interesting for outpatient procedures. CONCLUSIONS: Ropivacaine is a long-acting local anesthetic with a marked differential blockade between sensory and motor fibres, overall at the low concentrations used for postoperative analgesia. It probably has a slightly lower potency as compared with bupivacaine, but provides similar clinical efficacy in the different fields of regional anesthesia. Ropivacaine is less cardiotoxic and causes less central nervous system toxicity than bupivacaine, and this lower toxic potential has been reported not only with equivalent but also with equipotent concentrations and doses. For this reason, ropivacaine represents a useful alternative to bupivacaine for central and peripheral nerve blocks as well as for the management of postoperative pain relief.

Amides↗

PubMed2001

[Levobupivacaine for peripheral blocks of the lower limb: a clinical comparison with bupivacaine and ropivacaine].

BACKGROUND: The aim of this study was the comparison of clinical profile of sciatic nerve block performed with either 0,5% levobupivacaine, 0,5% bupivacaine, or 0,5% ropivacaine. METHODS: With ethical committee approval and written informed consent 45 ASA physical status I-II patients, undergoing elective hallux valgus repair received intravenous premedication with midazolam (0,05 mg/kg) followed by femoral nerve block with 15 ml of 2% mepivacaine. Then patients were randomly allocated to receive a sciatic nerve block with 20 ml of either 0,5% levobupivacaine (n=15), 0,5% bupivacaine (n=15), or 0,5% ropivacaine (n=15). An independent blind observer evaluated the onset time and duration of nerve block and postoperative analgesia. Postoperative analgesia consisted of 100 mg IV ketoprofen every 8 hours with the first administration at request. RESULTS: The onset time of sciatic nerve block was 15 (5-60) min with levobupivacaine, 30 (5-60) min with bupivacaine, and 15 (5-60) min with ropivacaine (P = NS). No differences in the quality of nerve block as well as in the nerve block resolution times were observed among the three groups. The duration of postoperative analgesia was 16 (8-24) hours with levobupivacaine, 14 (8-24) hours with bupivacaine, and 17 (8-24) hours with ropivacaine (P=NS). CONCLUSIONS: Using 0,5% levobupivacaine for sciatic nerve block results in similar clinical effects as those produced by using the same volume and concentration of either bupivacaine or ropivacaine.

Amides↗