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Biomedical subjects

E Gravino

Publications and source records attributed to E Gravino.

15 recordsLinked to original sources
PubMed2005

Comparison of two protocols of conscious analgosedation in video-assisted talc pleurodesis.

AIM: Video-assisted thoracoscopy surgery (VATS) is classically performed using general anesthesia with a double-lumen endotracheal tube to allow collapse of the operated lung. However, according to our opinion, the risks of general anesthesia with one-lung ventilation could be accepted when major thoracic operation is planned, but it should be avoided or kept at minimum when performing less invasive procedures such as video-assisted talc pleurodesis. In this paper, 2 different protocols are described in order to demonstrate the effectiveness and safety of Monitored Anesthesia Care (MAC) for performing VATS talc pleurodesis. METHODS: We studied 65 neoplastic patients ASA III-IV who underwent video-assisted pleurodesis with talc nebulization. They were randomized into 2 homogenous groups: Group 1, received midazolam (0.015-0.030 mg/kg) and sufentanil (0.15-0.20 microg/kg); Group 2, received midazolam (0.15-0.2 mg/kg) and continuous remifentanil infusion 0.5-1 microg/kg/min in the first minute, followed by 0.05 microg/kg/min. Local anesthesia with 0.2% ropivacaine was employed before the thoracoscopic trocar was inserted in both groups. Intraoperative standard monitoring required ECG, heart rate, non-invasive blood pressure, transcutaneous carbon dioxide and oxygen saturation. Consciousness status has been evaluated by Ramsey scale, while pain intensity by VAS scale. RESULTS: No statistically significant fluctuations were observed for mean arterial pressure, heart rate, SpO(2), tCO(2), VAS and Ramsey score. No postoperative complications and hospital mortality occurred. CONCLUSIONS: Both the protocols offer an efficient control of analgosedation with a minimum incidence of intraoperative and postoperative side effects. Anyway, the titration of the drug is very important.

Adult↗
PubMed2005

Monitored anesthesia care and loco-regional anesthesia. Vascular surgery use.

Association of locoregional techniques such as deep and superficial cervical block, lumbar epidural and/or peripheral blocks, and conscious sedation with hypnotic drugs (propofol 1-3 mg/kg/h or midazolam 2-4 mg/h) and/or opiates drugs (sufentanil 5-10 mcg or remifentanil 0.05-0.1 mcg/kg/min) is actually, the gold standard for vascular surgery. Our personal experience is based on 328 patients submitted to carotid endarterectomy, aneurysm repair and peripheral surgery.

Analgesia↗
PubMed2005

The treatment by V.A.T.S. and M.A.C. of secondary neoplastic pleural effusion in the old patient (> 70 years).

A secondary malignant pleural effusion is a common event in the evolution of some tumours. It is frequent in advanced phase, above all the breast cancer in the woman and the cancer of the lung in the man, but such pathology can interest also extra-thoracic cancers (ovary, colon, prostate, etc.) and the malignant lymphoma. In the majority of cases in order to obtain a good control of the effusion entity with reduction of the respiratory symptoms and improvement of the quality of life, palliative local therapy is indispensable. Numerous methods and substances have been proposed in the time for the treatment of the N.P.E. The talc pleurodesis executed in the old patients (> 70 years) by means of the V.A.T.S. "one trough" and "Monitored Anaesthesia Care" (MAC) has shown valid procedure for the control of the secondary neoplastic pleural effusion, with little uneasiness for the patients, reduced complications and a sure effectiveness.

Aged↗
PubMed2001

Sufentanil: an overview of its use for acute pain management.

UNLABELLED: The knowledge of pharmacodynamics and pharmacokinetics of new opioid drugs is necessary so that anaesthesiologists can choose which one to use, considering the patient's pathophysiology, the surgical procedure, and the dose required to obtain the desired effect. Aim of this review was to evaluate relevant trials on perioperative sufentanil in order to design an optimal strategy for administration. METHODS: Randomised controlled trials on perioperative sufentanil analgesia were identified by Medline research, Embase, Biosis, Scisearch and references mentioned in relevant reviews were hand searched from 1988 to June 2001. RESULTS: Twenty-four trials were considered eligible; they were divided according to the use of sufentanil in abdominal surgery, paediatric surgery and other types of surgery (orthopaedic, maxillo-facial, thoracotomy, lithotripsy, etc.). It was possible to compare the use of iv and epidural sufentanil, in iv PCA and PCEA, in continuous infusion, alone or in combination with local anaesthetics (various concentrations of ropivacaine, bupivacaine), with clonidine, adrenaline and ketamine. CONCLUSIONS: Efficacy of sufentanil in perioperative epidural or intravenous analgesia resulted the same or better than other drugs used commonly despite context-sensible half-life advantages. Its association with local anaesthetics or adjuvant drugs prolongs its action and sometimes decreases the side effects. From the examined trials results that sufentanil can be used at very low doses and its association with local anaesthetics, clonidine, ketamine, and adrenaline by epidural, intravenous or intrathecal route for perioperative analgesia (intra and postoperative) and by various types of administration (PCA, PCEA, fixed intervals doses, continuous infusion, etc.).

Acute Disease↗
PubMed1997

Urinary endothelin excretion in patients with acute lung injury.

Increase in circulating levels of endothelin (ET), a potent vasoconstrictive and mitogenic endothelium-derived peptide, has been proposed as a marker of endothelium dysfunction in acute lung injury (ALI). In the present study, we have measured levels of immunoreactive ET (irET) by radioimmunoassay, in arterial (irETart), venous (irETven) and urine (irETur) samples obtained from 10 patients with ALI and 10 healthy volunteers. Arterovenous ratio, 24 h urine excretion and renal clearance of the peptide were calculated, to obtain indices of endogenous ET metabolism. The arterovenous ratio of irET was significantly higher in patients with ALI than in healthy volunteers (1.20 +/- 0.20 and 0.85 +/- 0.06, respectively; p < 0.05)). Twenty four hour urinary excretion of the peptide was increased in patients with ALI as compared to healthy volunteers (134.10 +/- 21.0 and 71.70 +/- 9.30 ng.24 h-1, respectively; p < 0.001). Renal clearance of irET was similar in patients with ALI and healthy volunteers, indicating that the increase in excretion as well as in arterovenous gradient observed in patients with ALI was related mainly to pulmonary abnormalities of peptide handling. Urinary excretion of endothelin might be a useful marker of endothelial dysfunction occurring in acute lung injury.

Adult↗
PubMed1992

[The physiopathology of oxygen venous saturation].

The paper underlines the importance of continuous SvO2 monitoring by means of the insertion of a modified Swan-Ganz optic fibre catheter into the pulmonary artery. Following an analysis of the factors which regulate O2 transport and ATP formation, together with metabolism self-regulating mechanisms which intervene in periods of stress to guarantee cellular metabolic activity, the Authors underline the importance of SvO2 as an indicator of the balance between O2 demand and supply. Real-time SvO2 monitoring is therefore considered a valuable and early marker of rapidly degenerating biological processes in critical patients.

Catheterization, Swan-Ganz↗