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I Salvo

Publications and source records attributed to I Salvo.

At least 19 recordsLinked to original sources
PubMed2006

Caudal anesthesia in pediatrics: an update.

AIM: Caudal anesthesia is one of the most used-popular regional blocks in children. This technique is a useful adjunct during general anesthesia and for providing postoperative analgesia after infraumbilical operations. The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug. Although it is a versatile block, one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. The most frequently used method to further prolong postoperative analgesia following caudal block is to add different adjunct drugs to the local anesthetics solution. Only few studies evaluated quality and duration of caudal block against the volume of the local anaesthetic applied. After reviewing recent scientific literature, the authors compare the duration of postoperative analgesia in children scheduled for hypospadia repair when 2two different volumes and concentrations of a fixed dose of ropivacaine are used. METHODS: After informed parental consent, 30 children (ASA I, 1-5 years old) were enrolled in a multicentre, perspective, not randomized, observational study conducted in two 2 children hospitals. After premedication with midazolam, anesthesia was induced with thiopental and maintained with sevoflurane in oxygen/air. After induction, patients received a caudal blockade either with ropivacaine 0.375% at 0.5 mL/kg (Low Volume High Concentration Group, LVHC; n = 15), or ropivacaine 0.1% at 1.8 mLl/kg (High Volume Low Concentration Group, HVLC; n = 15). Surgery was allowed to begin 10ten minutes after performing the block. MAC-hour was calculated. In the recovery room, pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). In addition, the motor block was scored. After transferral to the ward, the patients were observed for 24 hours for signs of postoperative pain. The time period to first supplemental analgesic demand, i.e., from establishment of the block until the first registration of a CHEOPS score = or > 9, was considered the primary endpoint of the study. The time periods were compared using analysis of variance adjusted for age, weight and duration of surgical procedure as covariates. RESULTS: All patients were judged to have sufficient intraoperative analgesia, and none of them received additional analgesics intraoperatively. Patients' characteristics were similar, besides the age (32+/-10 vs 24 +/- 9 months; P < 0.05) and weigh (15.13 +/- 3.92 vs 11.93 +/- 1.83; P = 0.08). Analgesics were needed after 520 +/- 480 min in the LVHC and 952 +/- 506 min in the HVLC group (P < 0.05). Motor block was less in the HVLC group. CONCLUSIONS: In children undergoing hypospadia repair, caudal block with a ''high volume, low concentration'' regimen produces prolonged analgesia and less motor block, compared to a ''low volume, high concentration'' regimen.

Analgesia↗
PubMed2002

[Sedation with magnetic resonance imaging in pediatric patients].

219 children (ASA I-II, age 30 days-12 yrs), underwent deep sedation with intravenous thiopental for magnetic resonance imaging in a hospital setting. Sedation strategies and monitoring are described. The procedure showed to be safe for the patients and cause low artefacts by movements.

Artifacts↗
PubMed2000

Anaesthesia with desflurane-nitrous oxide in elderly patients. Comparison with isoflurane-nitrous oxide.

BACKGROUND: Desflurane is a new volatile anaesthetic, very little soluble. We wished to compare efficacy, safety, and emergence and recovers; profiles of desflurane-N2O versus isoflurane-N2O anaesthesia in elderly patients. METHODS EXPERIMENTAL DESIGN: single blind, prospective randomised study. SETTING: operating rooms of two major teaching hospitals affiliated with the University of Milan. PATIENTS: fifty-seven patients ASA physical status II or III, aged 65 or older, undergoing urological (non-endoscopic), orthopaedic or gynaecological (non-laparoscopic) surgery of at least one hour duration, were randomly assigned to receive general anaesthesia with either desflurane or isoflurane in 60% N2O- 40% O2, after standardised premedication and induction. MEASUREMENTS: vital signs, end-tidal agent, narcotic requirement, and adverse event appearance were monitored throughout the study. RESULTS: Twenty-eight patients received desflurane and 29 isoflurane. Demographics, anaesthesia duration and exposure, and intraoperative fentanyl requirement were comparable in the two groups. Immediate emergence from anaesthesia (time to extubation and hand grip on command) was faster in desflurane group, albeit not significantly (8.4 +/- 6.4 vs 11.0 +/- 6.5 min and 8.6 +/- 6.0 vs 11.8 +/- 6.0); on the contrary, early recovery (time to state the name and date of birth) was significantly shorter in patients receiving desflurane (11.1 +/- 6.2 vs 17.3 +/- 7.8 min and 13.1 +/- 6.0 vs 20.9 +/- 10.9 min). Only 24 patients (12 in desflurane and 12 in isoflurane group) did need postoperative fentanyl administration; among them, requirement was significantly higher in desflurane patients (3.4 +/- 1.1 vs 2.4 +/- 1.3 micrograms.kg-1. Total time in recovery room was not different between anaesthetics, as well as adverse event prevalence and severity. CONCLUSIONS: Early recovery in elderly patients is faster after desflurane than isoflurane anaesthesia; this might contribute to increased requirement of postoperative analgesia. Occurrence of adverse event is comparable between the two anaesthetics.

Aged↗
PubMed1999

[One day anesthesia in pediatrics].

The paper includes a short review on paediatric anaesthesia in day surgery. It discussed on why day surgery in children is so popular since the beginning of the century; the Italian laws on this item and the guidelines of the Italian Society of Anaesthesiology on "day surgery" and "preoperatives of children".

Ambulatory Surgical Procedures↗
PubMed1997

Arterial to end-tidal carbon dioxide gradient and physiological dead space monitoring during general anaesthesia: effects of patients' position.

METHODS: One hundred and five ASA I-II patients, scheduled for elective surgical procedures were studied in order to evaluate the effect of different surgical postures on physiological pulmonary dead space (VDphys/ VT) and arterial to end-tidal carbon dioxide gradient [P(a-Et)CO2]. Patients were divided into four groups according to their position on the operating table: supine position (acting as control group, n = 33), 20 degree Trendelenburg position (n = 24), lateral position (n = 24) and prone position with convex saddle frame (n = 24). Physiologic dead space was measured using Enghoff modification of Bohr equation. Arterial CO2 partial pressure was measured by blood gas analysis and end tidal CO2 was measured by means of an infrared CO2 analyser. All measurements were performed 20 minutes after general anaesthesia induction, with patients mechanically ventilated by a constant inspiratory flow (TV = 8 ml kg-1, RR = 10-14, EIP = 10%) in order to reach a steady state end tidal CO2 ranging between 32 and 36 mmHg; afterwards surgery started. RESULTS: Arterial blood pressure showed a mean decrease of about 5-10% compared to baseline values, but no significant differences in arterial pressure decrease were found between the four groups. A significant VDphys/VT increase in postures other than supine was observed, unless it was statistically significant in lateral and prone position only; while P(a-Et)CO2 was higher in all postures compared to supine. Changes of intrapulmonary gas and blood distribution due to patients' posture are probably responsible for the observed physiologic dead space and CO2 gradient differences. CONCLUSIONS: In conclusion, the clinical practice of predicting PaCO2 from EtCO2 must be tempered by recognition of the potential magnitude of P(a-Et)CO2 gradient, which is higher than normal during general anaesthesia and further increased when positioning the patient other than supine.

Adult↗
PubMed1995

The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock.

This prospective, multicenter, epidemiological study was carried out in 99 Italian ICUs, distributed throughout the country, from April 1993 to March 1994. In the study, we applied the new ACCP/SCCM classification system for sepsis (SIRS, sepsis, severe sepsis and septic shock) and determined the prevalence, incidence, evolution and outcome of these categories in critically ill patients. The preliminary analysis of 1101 patients showed that on admission SIRS accounted for about half of the diagnoses (52%) with sepsis, severe sepsis and septic shock accounting for 4.5%, 2.1% and 3% of patients, respectively. Patients with severe sepsis or septic shock more frequently had high SAPS scores than patients without sepsis. Mortality rates were similar in patients with SIRS (26.5%) and without SIRS or infection (24%), but rose to 36% in patients with sepsis, to 52% in those with severe sepsis and to 81.8% in those with septic shock. Sepsis, severe sepsis and septic shock were more common in patients with medical diagnoses, and neither severe sepsis nor septic shock was observed in trauma patients. With respect to evolution, the incidence of septic shock was progressively higher in patients admitted with more severe "sepsis-related" diagnoses, while only a trivial difference in rates of incidence was observed between SIRS patients and those admitted without SIRS or any septic disorder (nil). The breakdown of the various ACCP/SCCM "sepsis-related" diagnoses at any time during the study was: SIRS in 58% of the population, sepsis in 16.3%, severe sepsis in 5.5% and septic shock in 6.1%. It seems reasonable to expect from the final evaluation of our study answers to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between "sepsis-related" diagnosis, severity score, organ dysfunction score and outcome.

Hospital Mortality↗
PubMed1994

[Respiratory exchange during laparoscopic and laparotomic cholecystectomy].

The utility of laparoscopic cholecystectomy in reducing postoperative pain and patient's hospital discharge is already known. Nevertheless peritoneal gas insufflation required by surgical procedure can modify respiratory homeostasis during general anesthesia. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy on pulmonary dead spaces and alveolar gas exchange during inhalation anesthesia compared with traditional laparotomic cholecystectomy. With the approval of Hospital Ethical Committee, thirty-one patients undergoing isoflurane general anesthesia for laparoscopic (CL-S, n = 16) and open (CL-T, n = 15) cholecystectomy were prospectively evaluated in order to asses modifications in physiological (VDphy/VT), anatomical (VDan/VT) and alveolar (VDalv/VT) dead space to tidal volume ratio, arterial to end-tidal carbon dioxide partial pressure difference [P(a-Et)CO2] and alveolar to arterial oxygen partial pressure difference (A-aDO2). Patients, 21-64 years-old, ASA I-II, had no cardiopulmonary diseases. The CL-S group required peritoneal insufflation of carbon dioxide with an intraabdominal pressure (IAP) of about 10-14 mmHg and antitrendelenburg positioning (15-20 degree). Expired gas measurements and arterial blood gas sample for pulmonary dead spaces and arterial to alveolar CO2 and O2 gradient calculation were performed 20 min after a steady state condition. VDphy/VT, VDalv/VT, P(a-Et)CO2 and A-aDO2 increased significantly in the CL-S compared to the CL-T group (p < 0.05). No differences were found in the VDan/VT. These results can be explained by analteration of the ventilation to perfusion ratio (VA/Q) with an increase of high VA/Q regions due to the antitrendelenburg positioning with a redistribution of blood flow towards basal zones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Streptococcus pyogenes toxic shock. A clinical case].

Toxic shock-like syndrome (TSLS) due to Streptococcus pyogenes has been recently reported in both children and adults. This syndrome is characterized by hypotension or shock, fever, multiorgan system involvement and death in 30 to 60% of patients. This syndrome closely resembles the more frequent staphylococcal TSLS. Only one case of TSLS caused by streptococcus has been reported, up to now, in our Country. We describe a second case of fatal streptococcus pyogenes TSLS in a 64-year-old man, in which the site of infection was in the soft tissues. The illness was characterized by rapid progression of shock, erythematous rash, multisystem organ involvement and finally death. Clinicians must be aware of the presentation of this disease as its incidence appears to be increasing.

Humans↗