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Biomedical subjects

E Mondello

Publications and source records attributed to E Mondello.

17 recordsLinked to original sources
PubMed2004

Sciatic nerve block with lateral popliteal approach for hallux vagus correction. Comparison between 0.5% bupivacaine and 0.75% ropivacaine.

AIM: In this study the authors compared the clinical profile of 2 local anesthetic drugs in the sciatic nerve block used during hallux valgus correction, a surgical procedure known to be post-operatively extremely painful. Since hallux valgus correction is painful post-operatively, many attempts have been tried to ensure a long-lasting analgesia. Block of the sciatic nerve appears to be the right choice balancing ease to performance, satisfaction of the patient and duration of action. METHODS: The authors investigated the use of 20 ml of 0.5% bupivacaine or 0.75% ropivacaine regarding the speed of onset, quality and length of duration of sciatic nerve block performed with a lateral popliteal approach. Sixty ASA I-III patients (aged 19-73 years) were enrolled in this trial. Written informed consent was asked and obtained. A 20 G 50 mm Teflon coated Crawford needle, delivering 0.5 mA at 2 Hz, was used to locate and block the sciatic nerve in the popliteal fossa with a lateral approach. RESULTS: Patients in the ropivacaine group required about 13 minutes to achieve a complete block and about 16 minutes were needed in the bupivacaine group for the anesthesia to be complete. The length of analgesia was 16 h for the ropivacaine group and 13 h for the bupivacaine group. This kind of approach to block the sciatic nerve appeared to the authors to be very easy to perform, with the patient lying in a natural position. Surgical anesthesia required less than 30 min in both groups to be ready, while the ropivacaine group had a longer length of analgesia compared to the bupivacaine group. CONCLUSIONS: Patient satisfaction was high in both groups.

Adult↗
PubMed2003

A prospective, observational evaluation of a new supraglottic airway: the PAXpress.

AIM: Little information is available on efficacy and safety of the new supraglottic device, PA(Xpress), in anesthetized patients. The aim of this prospective observational study was to evaluate the use of this new supraglottic device in clinical practice. METHODS: Ninety-one patients (mean age: 45+/-11 years) undergoing extremity or minor peri-phery procedures (mean duration 53+/-18 min), with a supraglottic airway were prospectively studied in 10 hospitals, using a simple questionnaire with data concerning anthropometric variables, surgical procedure, and occurrence of untoward events during PA(Xpress) placement, anesthesia maintenance, or postoperative period. RESULTS: First attempt placement was achieved in 74 patients (82.2%), while 9 patients (10%) required 2 attempts, and 7 patients (7.7%) required more than 2 attempts. In only 2 patients (2%) airway control was not achieved with the studied device. The mean time required to achieve successful placement was 49+/-18 s (range 4-300 s). Mechanical ventilation was effectively maintained in all studied patients, and no severe adverse events were reported during the procedure. Blood on the device was observed in 54% of cases, and this was associated with an incidence of sore throat of 26% in the recovery area and 13% after 6 hours from the end of surgery. CONCLUSION: Although further comparative, randomized studies should be advocated to better evaluate the use of this new supraglottic device, this prospective, observational study demonstrated that PA(Xpress) provides safe and effective airway control during mechanical ventilation in up to 98% of cases.

Adolescent↗
PubMed2002

[Topical anesthesia for cataract surgery with phacoemulsification: lidocaine 2% vs ropivacaine 1%. Preliminary results].

BACKGROUND: The safety, tolerability and efficacy of ropivacaine 1% vs lidocaine 2% for phacoemulsification using topical anesthesia during cataract surgery, are compared. METHODS: A prospective, randomized, double-blind study comparing two agents for topical anesthesia is reported. ENVIRONMENT: Operative Unit of Ophthalmology, general Hospital. 1893 consecutively patients were studied (ASA 1-3, 738 males, 1155 females, age 71.8+/-9.7 years, range 35-90 years) undergoing routine phacoemulsification under topical 2% lidocaine (group I) and 1% ropivacaine (group II). The mains outcome measures of the study were: - the total dose of local anesthetic for obtaining a reduction of corneal sensation measured with the Cochet-Bonnet esthesiometer (value>3); - the pain recorded with visual analogic scale and verbal scale at: T1 = the first injection of local anesthetic; T2 = corneal incision; T3 = the end of surgery; T4 = 1h after surgery; T5 = the first postoperative day; - any requirement for additional intraoperative injection anesthesia and systemic sedation when needed; - surgeon assessments of operative conditions and patient cooperation; - patients' subjective level of comfort; - complications. RESULTS: Topical anesthesia using lidocaine 2% was significantly more painful than the ropivacaine 1%. The onset of anesthesia adequate for surgery was similar in all two groups. There were differences between the groups with respect to perioperative analgesia because the VAS was significantly higher in lidocaine group than in ropivacaine group. There were no statistically differences between the two groups at the follow-up. Inadequate anesthesia was seen in 8.05% (74/919 patients) cases of group I vs 0.9% (22/974 patients) of group II. Sedation was needed only in 10 patients and 6 patients of group I and II respectively. The surgeon assessment showed more patient cooperation in the ropivacaine group (83%). Satisfactory comfort (level 1) was reported by 60.4% in the lidocaine group and 86.8% in the ropivacaine group. In both groups there were cases of postoperative epithelial edema (29 patients in group I vs 36 patients in group II) although it decreased after the first postoperative day. No other significant side-effects were observed with the use of either formulations. CONCLUSIONS: Lidocaine 2% and ropivacaine 1% were safe and effective agents in patients having phacoemulsification with IOL implantation. However, ropivacaine provides more good operative conditions than lidocaine for the surgeon and comfortable surgical circumstances for the patient.

Administration, Topical↗
PubMed2000

A case of central nervous system vasculitis related to an episode of Guillain-Barrè syndrome.

The authors report their knowledge about an uncommon case of isolated vasculitis, restricted to the left sylvian artery during an auto-immune Guillain-Barrè syndrome (GBS), sustained by cytomegalovirus (CMV). An acute cardiopulmonary failure requiring a ventilator and vasopressor support manifested, notwithstanding plasma exchanging and immune-modulating therapy. An IgM-enriched formula administration coincided with a rapid amelioration of GBS and vasculitis to a complete recovery the next month after her discharge to a rehabilitation centre.

Adjuvants, Immunologic↗
PubMed1979

Direct sagittal computed tomography of the brain.

The first results of a simple method for obtaining direct sagittal computed tomography scans of the brain with a Pfizer 200 FS scanner are presented with a brief discussion of the advantages and applications of this technique.

Brain↗
PubMedDate not supplied

BIS and Ramsay score in critically ill patient: what future?

BACKGROUND: The recent introduction of BIS has improved the concept of utilizing it as a method for the assessment of the sedation level, thus opening new frontiers in critically ill patients care. Its validity in measuring the hypnotic drug effects has been repeatedly proved, but it has rarely been used in ICU. The aim of this paper is to evaluate the correlation between BIS and Ramsay score and its fluctuations with the sedative dosage variations, as a possible utilization in ICU. METHODS: In this study, 20 patients with severe lung disease requiring ventilator support, were recruited. All patients were sedated with propofol and/or midazolam to maintain a Ramsay score of 4. Continuous infusion techniques were commonly used. At time 0 and every half an hour, the patients were evaluated by 2 investigators, using the Ramsay score and the BIS simultaneously. The BIS was calculated by a 1-min recording every time that the sedation score was recorded, for a total of 960 observations. In addition BIS was continuously recorded to establish a baseline value, when the patient was not stimulated. Ventilator settings, medications and vital signs were also recorded. RESULTS: With the increase of the Ramsay score there was a progressive decrease in the BIS score (Ramsay score=2, BIS=88 +/- 15.1; Ramsay score=6, BIS=52.2 +/- 10.7); between BIS and Propofol dosages and between Ramsay score and systolic pressure. CONCLUSIONS: The data obtained show a good correlation between Ramsay score and BIS.

Critical Care↗