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Biomedical subjects

I Pagani

Publications and source records attributed to I Pagani.

At least 19 recordsLinked to original sources
PubMed1998

Maintenance and recovery characteristics of sevoflurane anaesthesia in adult patients. A multicenter, randomized comparison with isoflurane.

BACKGROUND: The goal of the present multicenter, prospective, randomized clinical investigation was to compare the clinical efficacy and safety of sevoflurane and isoflurane during maintenance of and recovery from general anaesthesia in adult patients. METHODS: With the approval of the Ethical Committee and the patient informed consent, 143 ASA physical status I-II patients, aged 18-65 years, were randomized in order to receive either isoflurane (n = 71) or sevoflurane (n = 72) as the main general anaesthetic. After an oral diazepam (0.1-0.2 mg kg-1) and atropine (0.007-0.01 mg kg-1) premedication and a standardized intravenous induction, general anaesthesia was maintained by adjusting the end-tidal concentrations of the inhalational agent for the maintainance of cardiovascular stability. At the end of surgery the anaesthetic vapours were discontinued, and the neuromuscular block was reversed; the following times were recorded: time of eyes opening, time of command response and suitability for discharge from the recovery area. The occurrence of any untoward event was also recorded. Preoperatively and 24 hr after surgery, blood was collected in order to assess renal an hepatic functions. RESULTS: No differences in demography, duration of surgery, exposure to the inhalational agent and haemodynamic effects were observed between the two groups. Patients receiving sevoflurane showed shorter times for the achievement of extubation (median: 9 min versus 13 min, p = 0.002), eyes opening (median: 10 min versus 13 min, p = 0.002), command response (11 min versus 15 min, p = 0.002) and suitability for discharge from recovery room (median: 19 min versus 22 min, p < 0.05) than those receiving isofluorane. No intra- and intergroup differences were observed in pre- and post-operative laboratory testing of renal and hepatic function. DISCUSSION: We conclude that sevoflurane, when compared to isoflurane, provides a similarly safe maintenance but allows for a more rapid emergence from general anaesthesia.

Adolescent↗
PubMed1992

Evidence of alpha-N-acetyl beta-endorphin in human cerebrospinal fluid.

Alpha-N-acetyl-beta-endorphin (Ac-beta-EP) is a post-translational product of beta-endorphin (beta-EP) with no analgesic properties. Ac beta-EP is present in human fetal and adult pituitary gland and cross-reacts in all available beta-EP assays. This study evaluates levels of Ac-beta-EP in the cerebrospinal fluid (CSF) of 22 normal subjects and 15 chronic headache sufferers. Since dopamine may play a role in the acetylation process, homovanillic acid levels were also determined. After extraction and high performance liquid chromatographic (HPLC) fractionation of CSF, an immunoreactive Ac-beta-EP peak was detected coeluting with reference peptide. Ac-beta-EP was detectable in all but 5 normal subjects. In headache sufferers, Ac-beta-EP levels were always detectable and their mean value was significantly higher than that of healthy subjects (11.6 +/- 11.8 vs 3.9 +/- 3.6 fmol/ml; P less than 0.01). Conversely, CSF beta-endorphin (beta-EP) concentrations were decreased in headache patients (9.8 +/- 9.4 vs 15.7 +/- 9.7 fmol/ml; P less than 0.05), and as a consequence the beta-EP/Ac-beta-EP ratio was also markedly reduced (P less than 0.005). No difference was observed for CSF homovanillic acid concentrations. These data demonstrate that HPLC coupled to radioimmunoassay allows the identification of low but significant amounts of Ac beta-EP in human CSF. This compound represents a confounding factor when beta-EP immunoreactivity is assessed by conventional methods. In headache sufferers, Ac-beta-EP levels were higher than normal, whereas beta-EP concentrations were lower.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Isolated postoperative myoglobinuria as the only sign of malignant hyperthermia. Value of spinal anesthesia with bupivacaine in a posterior surgical intervention].

The Authors report a case of biopsy-proven malignant hyperthermia in a pediatric patient who underwent general anesthesia with halothane and succinylcholine for foot surgery, in whom the presenting symptom was isolated postoperative myoglobinuria. The above syndrome, in the absence of a positive family history, may present itself with a set of minor and atypical symptoms, thus being often underestimate. The need for further investigating all the cases of postoperative myoglobinuria is stressed by the Authors, which also consider muscular biopsy for inclusion among routine investigations. In the case reported here, six months later, a new surgical operation was done safely with spinal anesthesia using hyperbaric bupivacaine.

Anesthesia, Spinal↗
PubMed1990

[Use of atracurium for the prevention of fasciculations and succinylcholine myalgia in athletes undergoing orthopedic surgery].

The Authors report their clinical experience about the use of atracurium besylate in preventing succinylcholine-induced fasciculations and postoperative myalgias in fifty athletes (ASA class 1), submitted to arthroscopic meniscectomy. The patients were pretreated with atracurium 5 mg i.v. or saline solution in a double-blind fashion. After 2.5 minutes, succinylcholine 1.3 mg/kg was administered, and fasciculations were recorded on a scale ranging from 0 to 3. Twenty-four hours after surgery all subjects were questioned about myalgias occurrence, scored by a 0-3 scale. Fasciculations occurred in all patients who received saline and in 44% of those treated with atracurium. Myalgias on the postoperative day were observed in 80% of patients treated with saline solution, but only in 36% of patients who received atracurium. The difference between atracurium and saline solution was statistically significant (p less than 0.001) either for fasciculations or myalgias incidence. These findings show that atracurium 5 mg i.v. is effective in preventing succinylcholine-induced fasciculations and postoperative myalgias, and suggest atracurium as the drug of choice for this purpose, particularly in muscular subjects.

Adolescent↗
PubMed1990

[The preventive minitracheotomy as support in difficult intubations: a proposition. Description of a clinical case].

The authors suggest preventive minitracheotomy as a support technique in difficult endotracheal intubation, and report their experience in a case of surgical operation to remove a bony neoformation of C1 and C2 posterior arcs. Endotracheal intubation, difficult because no part of the glottis could be seen, was made possible by preventive minitracheotomy. In this way sedation, myorelaxation and excellent oxygenation during following manoeuvre that resulted atraumatic, were obtained. The small cannula of minitracheotomy was maintained closed during the operation and open for 24 hours thereafter to prevent obstructive complications. It was then removed.

Adult↗
PubMed1989

Pharmacokinetics of dextromoramide in surgical patients.

The pharmacokinetics of the narcotic analgesic dextromoramide was investigated by means of a specific GC-MS method in 9 patients who were given a single oral dose of the drug (7.5 mg) together with an anticholinergic before undergoing minor orthopedic surgery. Dextromoramide was rapidly absorbed from the gastrointestinal tract, with peak plasma levels between 68 and 177 micrograms/L usually achieved within 0.5-4.0 h after dosing. In 5 patients, the decline of plasma concentrations after the peak followed a biphasic pattern, with half-lives of 0.4-1.6 h for the first phase and 6.3-21.8 h for the terminal phase. In the remaining patients, no clear-cut biphasic pattern was seen and half-lives calculated over the period between 4 h and 10 h after administration ranged from 1.5 to 4.7 h. Apparent clearance and volume of distribution values ranged from 0.06 to 0.36 1.h-1.kg-1 and from 0.6 to 2.4 l.kg-1, respectively. Less than 0.06% of the dose was excreted unchanged in urine within 8 h of administration. The concentration of the drug in a CSF sample collected 1 h after dosing was below the limit of detection (2 micrograms/L) in all subjects.

Adolescent↗
PubMed1981

[Double-blind study of lysine acetylsalicylate in the control of postoperative pain of somatic origin].

In 61 patients submitted to subdural anesthesia for orthopedic operations, postoperative somatic pain was treated by double-blind iv injection of lysine acetylsalicylate 1.8 g or placebo randomly. Patients with persistent pain received methadone 10 mg im. No placebo response was obtained; LAS had similar but shorter effects than methadone. No significant side effect was observed.

Adult↗