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L Pavanelli

Publications and source records attributed to L Pavanelli.

12 recordsLinked to original sources
PubMed2002

A new method of preemptive analgesia in laparoscopic cholecystectomy.

BACKGROUND: Although laparoscopic cholecystectomy (LC) results in less pain then open cholecystectomy, it is not a pain-free procedure. The aim of this study was to test a new method of preemptive analgesia. METHODS: By simple randomization 60 patients were assigned to two groups (30 in each group). Group A, the placebo group, received 200 ml of 0.9% saline, and group B received 5 mg/kg of a local anesthetic solution (ropivacaine) in 200 ml of 0.9% saline. Local anesthetic or placebo solution were administer before creation of the pneumoperitoneum. RESULTS: Pain intensity, as rated by visual analog and verbal rating scales, and stress response data were significantly less in the group receiving ropivacaine than in the placebo group. No patients in treatment group received an additional dose of analgesic, whereas two patients in placebo group needed an additional analgesic. CONCLUSIONS: Our results support the clinical validity of preemptive analgesia, but the timing of intraperitoneal administration of local anesthetic is very important. Only application before creation of the pneumoperitoneum may preempt every neuronal central sensitization.

Amides↗
PubMed1998

Plasma dopamine concentration and effects of low dopamine doses on urinary output after major vascular surgery.

To evaluate plasma dopamine concentration and the effects of low doses infusion on urinary output after abdominal vascular surgery in patients with renal function impairment we performed a prospective clinical study. Twenty hemodynamically stable patients (mean age 66.6 years), with serum creatinine concentration < 2 mg %, who undergoing general anesthesia for major vascular surgery participated. A low dose of dopamine (3 micrograms/kg/min) was administrated to patients with postoperative protracted urinary output < 0.5 ml/kg/hr for at least eight hours. Plasmatic determinations were taken at T0 (no dopamine administration), when urinary output began to increase, or if not, after two hours (T1), at eight (T2), and 24 (T3) hours after the beginning of infusion. After 24 hours the dopamine infusion was stopped and the patient's plasmatic level was measured four hours later (T4). Dopamine plasma concentrations were measured using high-performance liquid chromatography. Plasma dopamine concentration increased in all patients and reached a steady state at T2 (T2 = 76.41 +/- 16.84 ng/ml). Dopamine induced a concentration-dependent increase in urinary output (T0 = 0.45 +/- 0.14; T1 = 1.49 +/- 1.11; T2 = 2.34 +/- 1.44; T3 = 1.57 +/- 0.57; T4 = 0.85 +/- 0.7 ml/kg/hr). Three patients did not have an enhanced urinary output after dopamine infusion; they did have a prolonged clamping time and operation time (162 +/- 24 and 570 +/ 30 min, respectively). We conclude that low dose dopamine induces a dose-dependent increase of urinary output. This phenomenon also has been found in patients when their plasma concentration had not yet reached the steady-state. Lack of responsiveness to dopamine suggests a renal function impairment probably due to the prolonged aortic clamping time.

Acute Kidney Injury↗
PubMed1993

Abdominal aortic aneurysmectomy associated with a native iliac kidney. Case report.

Abdominal aortic aneurysm (AAA) repair associated with a pelvic kidney is extremely rare. To date only 14 cases have been reported in the literature. The main problem during aortic cross clamping is kidney preservation. The purpose of this article is to record and additional case of AAA repair associated with a native pelvic kidney. The preservation has been successfully achieved by a distal aortic double clamping.

Aged↗
PubMed1990

[Low T3 syndrome (3,3',5-triiodothyronine) in relation to the extent of surgical trauma].

Thirty patients undergoing extra-thyroid surgery were divided into two groups (A and B) according to the extent of surgical stress (Group A: major surgery; Group B; minor surgery). Thyroid hormone levels were measured before the operation and up to the 3rd postoperative day in Group B and up to the 7th postoperative day in Group A. A low T3 syndrome was observed in all 30 patients examined of the first postoperative day (reduction of T3 and increase in rT3 without alterations of total thyroxin or signs of hypothyroidism) with normalisation of thyroid values by 3rd postoperative in Group B and later in Group A. The persistence of the syndrome in the latter group was due to the extent of surgical stress, the duration of anesthesia, the presence of stress factors such as staying in intensive therapy, painful symptoms and a negative energy balance during the first days following operation. This syndrome is indicative of a physiological adaptation process to reduce O2 consumption, basal metabolism and in particular protein catabolism.

Adult↗
PubMed1989

Extraperitoneal aorticobifemoral grafts.

Out of 436 patients operated on using aorticobifemoral grafting, 60 cases (mean age 66) had an extra-peritoneal approach to the abdominal aorta. 28 patients underwent aorticobifemoral revascularization, three of them had, in addition visceral artery grafts. In the 60 cases, perioperative mortality was 1.7%. The extra-peritoneal approach to the abdominal aorta is safer than the intraperitoneal approach, because it reduces the risk of shock connected with the large laparotomy. It is emphasized that, by using an extraperitoneal approach, a greater number of elderly patients can be considered suitable for aorticobifemoral grafts.

Adult↗
PubMed1985

[Severe arterial spasm and secondary thromboses of the limbs in chronic ergotism].

A 40 year old woman who took a daily dose of 2-4 mg of Ergotamine Tartrate (Cafergot) regularly for 6 years to combat persistent migraine, was treated for a non-atherosclerotic arterial disease, severe arteriospasm of the great limb arteries, hyperplasia of the intima and segmental thrombosis. Binding of adrenergic alpha and beta receptors was investigated. Surprisingly it was found that the number of adrenergic beta receptors was significantly lower thant that of a healthy woman of the same age used as a control while the number of alpha receptors was not significantly different. This action of ergotamine on beta receptors could be explained by a dopamine-mimetic stimulation, due to the central nervous system, that could lead to the preferential regulation of beta receptors rather than alpha receptors, almost as a protective mechanism of alpha receptors.

Adult↗
PubMed1979

[Use of Ro5-4200 in bronchoscopy].

A simple technique employing i.v. Ro5-4200 and a local anaesthetic to obtain general anaesthesia prior to bronchoscopy, particularly after chest operations, is described. The optimal sedation offered by Ro5-4200 enables this trying examination to be performed without risk and with the best possible degree of comfort for the patient and the operator.

Adult↗
PubMed1978

[Hemodynamics in venous diseases of the lower limbs].

Venous diseases of the lower extremities have been studied haemodynamically by analysis of variations in dynamic venous pressure, which is held to be a fundamental parameter. Pressure modifications point to the state of the deep venous system, the valves and the subfascial communicating veins or to the efficiency or otherwise of the muscular pump of the lower extremities. The venous pressure curve is a reliable indicator of the various clinical stages of chronic venous insufficiency and postphlebitis syndrome. As a clinical parameter, venous pressure is sensitive to all pathological changes in the venous system of the lower extremities. It presents variations proportional to the gravity of pure phlebopathies and of venous diseases secondary to congenital dysplasias (e.g. Klippel-Trenauny syndrome) and to congenital or acquired arteriovenous shunts. An attempt is made to classify venous diseases of the lower extremities on the basis of this parameter and examples are given of dynamic venous pressure curves encountered in the various disease pictures observed.

Chronic Disease↗
PubMedDate not supplied

Thrombosis of the superior vena cava due to a central catheter for total parenteral nutrition.

Total parenteral nutrition (TPN) today is a fundamental procedure in the treatment of critically ill patients, especially if they have serious gastrointestinal diseases. However, use of the central venous catheter is connected with a very important morbidity. At the "Istituto di Patologia Chirurgica" and at the "Intensive Care Unit" of the University of Ferrara, we analyzed 59 cases of deaths from different diseases, on whom a postmortem examination had been performed. Twenty-seven patients had had no central venous catheter: none of them presented thrombosis of the central veins. Thirty-two patients had had a central venous catheter for TPN: five of them presented thrombosis of the central veins at the post-mortem examination. Except for one case who had thrombosis connected with a carcinoma of the right main bronchus, four cases (12.9%) presented thrombosis due to the central venous catheter. The subclavian vein seems to be more commonly connected with thrombosis than the jugular vein.

Adult↗