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Biomedical subjects

M Marsili

Publications and source records attributed to M Marsili.

At least 19 recordsLinked to original sources
PubMed1999

Searching for a general anaesthesia protocol for rapid detoxification from opioids.

The technique for ultra rapid opioid detoxification is designed to shorten the detoxification period by precipitating withdrawal by the administration of opioid antagonists such as naloxone or naltrexone. This procedure is performed under deep sedation or general anaesthesia to ensure that the patient does not consciously experience the acute withdrawal phase. This strategy has aroused controversy regarding the risk of sedation or anaesthesia in this situation. In the present study, ultra rapid opioid detoxification was carried out in 12 opiate-addicted patients by infusion of naloxone 4 mg for a period of 5 h using controlled ventilation during general anaesthesia, induced and maintained with midazolam, propofol and atracurium. Invasive cardiovascular and respiratory monitoring was performed, and withdrawal signs were evaluated using a graduated scale. Anaesthesia was maintained for another hour after the completion of the naloxone infusion. The validity of this anaesthesia protocol was confirmed by the relative lack of change in the patients' haemodynamic values associated with mild signs of withdrawal.

Adult↗
PubMed1995

Anaesthesia for urological endoscopic procedures in adult outpatients.

The aim of this study was to establish whether propofol in combination with fentanyl or ketamine provides a good quality of anaesthesia and recovery time in urological endoscopic outpatient surgery. Sixty patients (ASA I-II) were assigned randomly to receive either 2.5 micrograms kg-1 fentanyl or 1 mg kg-1 ketamine. In both groups anaesthesia was induced with propofol 1.5 mg kg-1 and maintained with 7 mg kg-1 h-1. Patients breathed nitrous oxide and oxygen 3:2 spontaneously. Cardiovascular parameters were more stable after ketamine. The most important side effect was the presence of apnoea lasting longer than 60 s in 14 patients receiving fentanyl. The time to establish alertness was shorter in the ketamine group, who also had a better (P < 0.05) as well as post-anaesthetic recovery room score.

Aged↗
PubMed1995

Haemodynamic and haemoximetric aspects of experimental orthotopic liver transplantation: comparison between two different doses of propofol.

OBJECTIVE: Evaluation of haemodynamic and gas exchange modifications using propofolnitrous oxide anaesthesia after ketamine induction during experimental orthotopic liver transplantation (OLT). DESIGN: Measurements of haemodynamic and haemoximetric effects of two anaesthesiological conditions, differing each other for the different dose of propofol, performed in an experimental model characterized by temporary anhepatism followed by revascularization. SETTING: Surgical experimental laboratory of the University Hospital of Florence. ANIMALS: Thirty experimental OLT on female pigs (weight 30 +/- 2 kg) were performed. MEASUREMENTS AND MAIN RESULTS: The following haemodynamic: HR, MAP, MPAP, PCWP, CI, SI, RVSWI, LVSWI, SVR, PVR, RPP and gas-exchange parameters: PaCO2, etCO2, D(aA)CO2, PaO2/PAO2, VD/VTphys, HB, PaO2, SaO2, DO2, O2ER, VO2, SvO2, VO2/DO2 relationship were evaluated. Anaesthesia was induced by ketamine and maintained by N2O and propofol infusion using 0.28 mg x kg(-1)x min(-1) (Group 1) and 0.19mg x kg(-1) x min(-1) (Group 2). During the anhepatic phase we used cavalportal-jugular by-pass (CPJ). Haemodynamic preoperative data confirmed the absence of any myocardial depressant effect at the lower dose of propofol. During the most critical stages of surgery a progressive decrease of CI associated with low values of PCWP was observed. The decrease of etCO2 during the anhepatic phase is due to the VD/VT increase following CI reduction and CO2 production decrease. VO2 decreased significantly during the anhepatic phase and successively increased during the reperfusion phase whereas CI remained low, during both surgical phases. These results demonstrated that VO2 was largely independent from DO2 because cellular O2ER gradually increased as DO2 remained constantly low, thus indicating a good cellular metabolism reuptake. The decrease of SVO2 is related to the decrease of CI and to the increase of VO2 and O2ER. CONCLUSION: The VO2/DO2 relationship showed a complete O2 supply-non-dependency suggesting an adequate cellular metabolism maintenance during the anhepatic and postanhepatic phases. According to these results, the authors suggest that propofol, within the two different anaesthesiological protocols at two different doses, surely favoured a good cellular perfusion also under low cardiac output conditions, undoubtedly contributing to the realization of stress-resistant conditions and influencing a good recovery and postoperative outcome.

Anesthetics, Inhalation↗
PubMed1993

Aspirin effect on early and late changes in acute lung injury in sheep.

OBJECTIVE: There have been several studies that have already explored the potential beneficial role of cyclo-oxygenase (CO) inhibitors on oleic acid (OA)-induced lung injury in different species. These studies report no significant effect of CO inhibition, though thromboxane B2 (TxB2) was effectively blocked. However, recent studies indicate that pre-treatment with aspirin (ASA) preserve gas exchange in OA lung injury in dogs. Aim of our study has been to evaluate the potential beneficial effects of the pre-treatment with low doses of ASA on gas exchange, hemodynamics, respiratory mechanics, prostanoids and lung histology in OA-induced lung injury in sheep. DESIGN: 0.09 ml/kg of OA was administered into the right atrium of 14 anaesthetized sheep. Six received a bolus of ASA (10 mg/kg i.v.) 30 min before OA, the others saline as placebo. MEASUREMENTS AND RESULTS: Pulmonary and tissue gas exchange, pulmonary and systematic hemodynamics, respiratory system mechanics, TxB2 and 6-keto-PGF1 alpha, leukocytes and platelets concentrations were measured throughout the subsequent 3 h and lung histology was effected at end-experiment. The principal findings of our study are: 1) ASA reduces OA-induced early pulmonary vasoconstriction and bronchoconstriction, parallelled by a suppression of TxB2 generation; 2) the late increase in pulmonary artery pressure and airway resistance due to OA is not inhibited by ASA; 3) the early disturbance in pulmonary gas exchange is reduced by ASA, whereas the late severe deterioration is exaggerated by ASA; 4) the stability of tissue exchange ratio (R) at approximately 1 in ASA-group compared to its fall to approximately 0.7 in controls. CONCLUSION: Our findings suggest that ASA: 1) is only effective to treat the very transient TxB2-induced pulmonary vasoconstriction resulting in hydrostatic edema, and it is ineffective, even accentuates, the subsequent major pulmonary endothelial cell injury leading to alveolar flooding that is unrelated to TxB2; 2) has a transient protective effect on the TxB2-induced early bronchospasm; 3) has a biphasic behaviour on gas exchange, with a benefit which lasts only one hour and then results in a worse gas exchange; 4) has an immediate, stabilizing, persisting effect on R, contrasting with its transient effect on pulmonary hemodynamics and PaO2.

6-Ketoprostaglandin F1 alpha↗
PubMed1993

Hemangioma-associated rhinophyma. Report of a case with successful treatment using carbon dioxide laser surgery.

BACKGROUND: Rosacea is a disorder characterized by erythematous papules, pustules, and telangiectases involving the nose, chin, cheeks, and forehead that may progress to rhinophyma. Although the etiology of rosacea remains unclear, a common theme in pathogenesis is vasodilation. Rosacea has been associated with both idiopathic flushing as well as that induced secondarily. OBJECTIVE: To report clinical and histologic features of rhinophyma that developed in association with a longstanding cavernous hemangioma. RESULT: The patient is a 57-year-old Hispanic man with a congenital port-wine stain that had developed into a nodular, cavernous hemangioma over the course of years. Clinically, in the site of the angioma there was marked soft-tissue overgrowth with sebaceous hyperplasia. These changes were confined to the angiomatosis areas and were sharply demarcated from the surrounding normal skin. Histologically, there was marked fibroplasia; numerous small cysts, some with focal rupture and inflammation; dilated follicular ostia; and prominent sebaceous gland hyperplasia in addition to numerous ectatic blood vessels, which were a component of the hemangioma. In contrast, normal-appearing skin adjacent to this site revealed only normal sebaceous glands and no fibroplasia. Treatment consisted of CO2 laser excision of the nodular components of the hemangioma with a tightly focused beam, followed by resculpting of the natural facial contour with laser abrasion of hypertrophic soft tissues with a broad, unfocused beam. The treated area healed well, with a skin tone of a more natural color than the original hemangioma. CONCLUSION: Our findings suggest that rhinophyma may develop secondary to the vasodilation seen in large hemangiomas and that the CO2 laser offers excellent treatment for both the vascular and stromal components of the lesion.

Hemangioma, Cavernous↗
PubMed1993

Prevention of anaphylactic-anaphylactoid reactions to anesthetics in high-risk allergic patients.

To confirm the role of preventive procedures in high-risk allergic patients, immunological tests in vivo for anesthetics were carried out in 251 atopic patients. The 6-month follow-up showed a complete absence of adverse reactions during the clinical use of hypnotic and muscle relaxant drugs. In the case of local anesthetics, five adverse reactions were observed after dental treatment--four were related to a psychogenic mechanism, and one could not be clearly linked to the local anesthetic. It is possible to confirm that the use of a tested drug that yields negative results has a lower probability of inducing anaphylactic-anaphylactoid reactions during anesthesia.

Adolescent↗
PubMed1991

A new surgical model of acute liver failure in the pig: experimental procedure and analysis of liver injury.

In this research, the effects of portocaval shunt plus 70% partial hepatectomy were evaluated in 11 pigs. Hepatic coma and death from progressive liver failure occurred in 5 pigs between 14 and 64 h from surgery, whereas 3 pigs, which also showed symptoms of progressive liver failure, died of presumed gastric hemorrhage between 17 and 19 h after surgery. In 3 pigs, transient liver failure was followed by complete recovery, as judged by clinical, electroencephalographic and biochemical parameters. No case of death occurred among the pigs treated with portocaval shunt alone or 70% partial hepatectomy alone as controls. This new model for acute liver failure is reproducible, seems to be potentially reversible, causes death due to hepatic failure after a time period sufficiently long to allow for the institution of support procedures, is applied to a large animal and lacks relevant biohazard. Therefore, this model may be used to evaluate possible support procedures during acute liver failure.

Ammonia↗