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Biomedical subjects

F Agrò

Publications and source records attributed to F Agrò.

At least 37 records · Page 2Linked to original sources
PubMed2000

COPA as an aid for tracheal intubation.

The purpose of this study is to verify the usefulness of the cuffed oropharyngeal airway (COPA) as a device to guide a tracheal tube using a semiblind technique with a lightwand. Ten anaesthetised patients (ASA I-II, aged 35-67) undergoing to an elective surgery were analysed. We selected and positioned a correct size of COPA for each patient. A lightwand (Trachlight) was then inserted into the COPA to confirm correct placement of this device. The lightwand was then removed and the first portion of a tube exchanger (TE) was inserted and connected by a 15-mm connector with the breathing circuit and its position was confirmed by End Tidal CO(2) values during ventilation. The patients were then paralysed and ventilation through the first portion of the TE reconfirmed. The COPA was removed, and the second portion of the TE was connected and used as a guide for a tracheal intubation. This combined technique had a success rate of six out of ten patients and could be used for airway management if a fibre optic scope or other devices such as a Combitube, LMA or LMA Fastrach were not available. The preliminary data from this study are not indicative of the statistical validity of this technique. Further studies should be performed to verify the statistical reliability of the technique.

Adult↗
PubMed2000

Retrograde nasotracheal intubation with a new tracheal tube: a feasibility study.

We have assessed the feasibility of retrograde nasotracheal intubation using a flexometallic tracheal tube with a detachable pilot balloon and connector in a study of 20 consecutive adult patients undergoing oropharyngeal surgery. The technique consisted of: (1) laryngoscope-guided orotracheal intubation; (2) insertion of an 18-gauge Foley catheter through the nose and retraction into the mouth; (3) detachment of the anaesthesia circuit, pilot balloon and connector; (4) insertion of the Foley catheter tip into the proximal end of the tracheal tube and inflation of the Foley catheter cuff; (5) withdrawal of the Foley catheter and attached tracheal tube back through the nose; (6) deflation of the Foley catheter cuff; and (7) re-attachment of the pilot balloon, connector and anaesthesia circuit. The technique was successful at the first attempt in all patients. Mean time taken to insert the Foley catheter and retract it into the mouth was 19 (range 12-30) s. Mean time taken from disconnection to reconnection of the anaesthesia circuit was 8 (6-10) s. Heart rate increased after intubation, but there were no significant changes in arterial pressure. Nasal bleeding, airway problems and hypoxic events did not occur. No anatomical abnormalities or nasal trauma were detected at rhinoscopy. We conclude that retrograde nasotracheal intubation is feasible using a flexometallic tracheal tube with a detachable pilot balloon and connector.

Adult↗
PubMed2000

A pilot study of pharyngeal pulse oximetry with the laryngeal mask airway: a comparison with finger oximetry and arterial saturation measurements in healthy anesthetized patients.

UNLABELLED: We compared pharyngeal SpO(2) by using the laryngeal mask airway (LMA) to finger SpO(2) and oxygen saturation from arterial blood samples (SaO(2)). We studied 20 hemodynamically stable, well oxygenated, anesthetized patients (ASA physical status I-III, aged 18-80 yr). A single-use pediatric pulse oximeter was attached to the back plate of a size 5 LMA. Pharyngeal and finger SpO(2) (dominant index finger) and SaO(2) (nondominant radial artery) were measured with the cuff volume at 0-40 mL in the neutral position. The intracuff pressure was then set at 60 cm H(2)O in the neutral position, and readings were taken with the head-neck flexed, extended, and rotated. SaO(2) was the same as pharyngeal SpO(2) at 20 and 30 mL cuff volume, but higher than pharyngeal SpO(2) at all other cuff volumes and head-neck positions (P < 0.04). SaO(2) was always higher than finger SpO(2) (P < 0.01). Pharyngeal SpO(2) was higher than finger SpO(2) at cuff volumes 10-40 mL and in the flexed and rotated head-neck positions (all: P < 0.007), but was lower at 0 cuff volume (P < 0.0001) and similar in the extended head-neck position. There was an increase in pharyngeal SpO(2) between 0 and 10 mL cuff volume (P < 0.0001), but no changes thereafter. Pharyngeal SpO(2) was similar in the flexed, rotated and extended head-neck positions. Pharyngeal SpO(2) agrees more closely with SaO(2) (mean difference < 0.7%) than finger SpO(2) (mean difference > 1.1%) at 10-40 mL cuff volume and in head-neck flexion. The standard error of limits was identical (0.09) for both finger SpO(2) and pharyngeal SpO(2) if data at 0 cuff volume are excluded. We conclude that pharyngeal SpO(2) with the LMA is feasible and generally provides more accurate readings than finger SpO(2) in hemodynamically stable, well oxygenated, anesthetized patients. IMPLICATIONS: Pharyngeal oximetry with the laryngeal mask airway is feasible and generally provides more accurate readings than finger oximetry in hemodynamically stable, well oxygenated, anesthetized patients.

Adult↗
PubMed1999

Pulse oximetry with the laryngeal mask airway.

This study evaluated the accuracy of pulse oximetry measured by a modified laryngeal mask airway (LMA). Ten anaesthetized patients (ASA I-II, aged 18-45) undergoing elective knee arthroscopies (mean-duration 40 min) were studied. A transmission pulse oximeter probe/sound OHMEDA was attached on the back of LMA (sizes 4 and 5) in an area in contact with the floor of the laryngeal part of the pharynx. Pharyngeal pulse oximetry as well as LMA cuff pressure were monitored and recorded every 5 min from the time of insertion (T0) to removal (T8) and were compared to simultaneous finger pulse oximeter readings. At T2 the cuff was over-inflated to obtain a 100 cm H2O intracuff pressure. At T3 the cuff pressure was decreased at 60 cm H2O. Pharyngeal pulse oximetry correlated with finger pulse oximetry throughout the study and was not effected by over-inflation of the LMA. This modification of the LMA provides an accurate method of measuring pulse oximetry which may be of use in a variety of circumstances.

Adult↗
PubMed1999

The intubating laryngeal mask for maxillo-facial trauma.

We report the successful use of the intubating laryngeal mask airway in a patient with maxillo-facial trauma for whom the facemask and laryngoscope were relatively contraindicated and the fibreoptic scope potentially difficult to use.

Adolescent↗
PubMed1999

A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery.

UNLABELLED: We assessed the relative morphine consumption in a combined analgesic regimen (on-demand morphine plus the nonopioids propacetamol or ketorolac) after gynecologic surgery. Two hundred women randomly received two i.v. doses of propacetamol 2 g or ketorolac 30 mg in a double-blinded, double-dummy trial. Patients were monitored for 12 h, and the following efficacy variables were assessed: total dose of morphine, pain intensity, and global efficacy. Safety and tolerability were evaluated by the occurrence of adverse events, especially the presence and intensity of gastrointestinal symptoms. Hemostatic variables were measured 30 and 60 min after the first infusion; arterial blood pressure, heart and respiratory rates, sedation scores, and renal and hepatic function were also assessed. Total morphine requirements were not significantly different between the propacetamol (10.6 +/- 4.8 mg) and ketorolac (10.2 +/- 4.4 mg) groups. The evolution of pain intensity and the global efficacy also showed similar patterns in the two groups: 70.2% of patients in the propacetamol group rated the efficacy as "good/ excellent" compared with 68.2% in the ketorolac group. There were no clinically significant changes in vital signs or laboratory values and no observed differences between the two groups, although ketorolac slightly, but not significantly, prolonged the bleeding time. Epigastric pain was present in 9% and 15% of patients receiving propacetamol and ketorolac, respectively. There were two adverse events in the propacetamol group and four in the ketorolac group. Propacetamol demonstrates an efficacy similar to that of ketorolac and has an excellent tolerability after gynecologic surgery. IMPLICATIONS: Propacetamol and ketorolac, combined with patient-controlled analgesia morphine, show similar analgesic efficacy after gynecologic surgery. Morphine consumption and pain scores were comparable in the two studied groups. Propacetamol is as effective as ketorolac and has an excellent tolerability after gynecologic surgery.

Acetaminophen↗
PubMed1998

Use of a lighted stylet for intubation via the laryngeal mask airway.

PURPOSE: To assess a new technique for intubation via the laryngeal mask airway (LMA) in which a lighted stylet is used to optimise the position of the LMA before intubation. METHODS: In 114 patients, following LMA insertion, the lighted stylet (Trachlight Wand) with mounted tracheal tube (TT) was advanced 1.5 cm beyond the mask aperture bars and the anterior neck observed for a distinct central point of light at the cricothyroid membrane (CTM). If this was not seen, the LMA was repositioned in the pharynx, depending on the location of the light, by manually advancing, withdrawing or rotating the device, manipulating the head/neck or trying an alternative size. Tracheal intubation was attempted only when transillumination was correct. The TT with lighted stylet was advanced until the supra-sternal notch was transilluminated. RESULTS: In 89 patients (78%) the CTM was transilluminated without repositioning, in 12 (10%) a single positional adjustment was required, and in 10 (9%) a change of LMA size was required. In three patients (3%) transillumination of the CTM was impossible. In the 97% of patients in whom transillumination was correct, tracheal intubation was successful in all at the first attempt without the need for further repositioning or size change. CONCLUSION: The lighted stylet is useful in facilitating intubation via the LMA in anaesthetised adult patients when used as a guide to optimal LMA position.

Adult↗
PubMed1998

The intubating laryngeal mask. Clinical appraisal of ventilation and blind tracheal intubation in 110 patients.

This study assesses the efficacy of the intubating laryngeal mask as a ventilation device and blind intubation guide. Following induction of anaesthesia with propofol, the device was successfully inserted at the first attempt in 110/110 (100%) patients. Placement took less than 10 s in all patients. Size selection was based on nose-chin distance. Adequate ventilation was achieved in 104/110 (95%) patients. Blind tracheal intubation using an 8-mm internal diameter straight silicone cuffed tracheal tube was attempted 3 min after the administration of vecuronium. Passage of a lighted stylet through the intubating laryngeal mask was used to determine the position of the intubating laryngeal mask cuff before blind intubation. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used, based on the depth at which resistance occurred. Tracheal intubation was possible in 104/104 (100%) patients. In 42 (40%) patients, no resistance was encountered and the trachea was intubated at the first attempt. Sixty-two (60%) patients required one adjusting manoeuvre. The mean (range) time taken to successful intubation, i.e. the time from disconnection of the intubating laryngeal mask from the breathing system to successful tracheal intubation, was 79 (12-315) s. Six patients with potential or known intubation problems were included in the study. The tracheas of all six patients were successfully intubated. We conclude that the intubating laryngeal mask is an effective ventilation device and intubation guide with potential for use in patients who may present difficulty in tracheal intubation.

Adult↗
PubMed1998

Laryngeal mask airway and incidence of gastro-oesophageal reflux in paralysed patients undergoing ventilation for elective orthopaedic surgery.

We have studied the incidence of gastro-oesophageal reflux associated with the laryngeal mask airway (LMA) in 82 paralysed patients undergoing ventilation for elective orthopaedic surgery. Anaesthesia was managed by skilled LMA users. A pH-sensitive probe was passed nasally into the oesophagus before induction and recordings made during five phases of anaesthesia. Anaesthesia was induced with propofol and fentanyl and maintained with 0.5-1.5% isoflurane and nitrous oxide in oxygen. Neuromuscular block was produced with vecuronium and the train-of-four count maintained at < or = 1. Towards the end of surgery, neuromuscular function was allowed to recover spontaneously. All LMAs were inserted at the first attempt and ventilation was successful in all patients. There were no adverse airway events. Mean oesophageal pH values during each phase of anaesthesia were: before insertion 5.88 (SD 0.77), placement 5.85 (0.74), maintenance 5.89 (0.73), emergence 5.71 (0.78) and removal 5.82 (0.75). There were no reflux events (pH < 4.0) during any phase of anaesthesia. We conclude that the incidence of gastro-oesophageal reflux is low in paralysed patients undergoing ventilation for elective orthopaedic surgery when antagonism of neuromuscular block is avoided. The validity of these findings for unskilled LMA users is unknown.

Adult↗
PubMed1984

Pulse-radiolysis studies on the interaction of one-electron reduced species with blue oxidases. Reduction of type-2-copper-depleted ascorbate oxidase.

The interaction of one-electron reduced metronidazole (ArNO2.-) with native and Type-2-copper-depleted ascorbate oxidase were studied in buffered aqueous solution at pH 6.0 and 7.4 by using the technique of pulse radiolysis. With ArNO2.-, reduction of Type 1 copper of the native enzyme and of the Type-2-copper-depleted ascorbate oxidase occurs via a bimolecular step and at the same rate. Whereas the native protein accepts, in the absence of O2, 6-7 reducing equivalents, Type-2-copper-depleted ascorbate oxidase accepts only 3 reducing equivalents with stoichiometric reduction of Type 1 copper. On reaction of O2.- with ascorbate oxidase under conditions of [O2.-] much greater than [ascorbate oxidase], removal of Type 2 copper results in reduction of all the Type 1 copper atoms, in contrast with reduction of the equivalent of only one Type 1 copper atom in the holoprotein. From observations at 610 nm, the rate of reduction of ascorbate oxidase by O2.- is not dependent on the presence of Type 2 copper. For the holoprotein, no significant optical-absorption changes were observed at 330 nm. It is proposed that electrons enter the protein via Type 1 copper in a rate-determining step followed by a fast intramolecular transfer of electrons within the protein. For the Type-2-copper-depleted protein, intramolecular transfer within the protein, however, is slow or does not occur. In the presence of O2, it is also suggested that re-oxidation of the partially reduced holoprotein occurs at steady state, as inferred from the observations at 330 nm and 610 nm. The role of Type 2 copper in ascorbate oxidase is discussed in terms of its involvement in redistribution of electrons within the protein or structural considerations.

Ascorbate Oxidase↗