Biomedical subjects

Paolo Pelaia

Publications and source records attributed to Paolo Pelaia.

10 recordsLinked to original sources

PubMed2006

Bispectral index and spectral entropy in neuroanesthesia.

Spectral Entropy (SpEn) is an alternative tool to the bispectral index (BIS) for monitoring depth of hypnosis. SpEn measures response entropy (RE) and state entropy (SE). This open-label prospective study was designed to evaluate SpEn and BIS in 20 patients undergoing elective supratentorial neurosurgery with craniotomy and resection of brain tumors. SpEn and BIS were obtained continuously by Datex Ohmeda M-entropy module S/5 (Helsinki, Finland) and Aspect Medical System BIS (Newton), respectively. Total intravenous anesthesia was performed in all patients by Fresenius Vial infusion system (Brezins, France) to maintain a plasma concentration of propofol of 2.5 to 5 microg mL(-1) and sufentanil of 0.2 to 0.4 etag mL(-1). SpEn, BIS, the estimated propofol effect-site concentrations (Ce), the mean arterial pressure (MAP), and the heart rate (HR) were recorded during 12 specific events: induction of anesthesia, patient stop counting, loss of blinking reflex, intubation, mayfield pinning, craniotomy, termination of propofol infusion, recovery of blinking reflex, coughing, limb movement, order execution, and extubation. Stated that prediction probability or P(K) represents an indicator probability to predict correctly the rank order of an arbitrary pair of distinct observed indices of depth of hypnosis (ie, clinical settings and SpEn indices, or BIS, Ce, MAP, HR), PK of BIS, SE, RE, and Ce provided a better depth of hypnosis than MAP and HR; RE being the best for rapidity, SE for sensitivity, and BIS for specificity. There is good correlation between the 3 hypnosis indices and Ce. This study demonstrates that SpEn provides a reproducible hypnosis index for patients undergoing supratentorial neurosurgical procedures.

Adolescent↗

PubMed2005

Terlipressin versus norepinephrine to counteract anesthesia-induced hypotension in patients treated with renin-angiotensin system inhibitors: effects on systemic and regional hemodynamics.

BACKGROUND: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia. METHODS: Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg of terlipressin (n = 16) or norepinephrine infusion (n = 16) to counteract anesthesia-induced hypotension. A laser Doppler probe was introduced into the gastric lumen. All measurements were performed just before surgery, during hypotension, at 30 min, and at 4 h. RESULTS: Terlipressin produced an increase in mean arterial pressure and a decrease in gastric mucosal perfusion detected by laser Doppler flowmetry (P < 0.05) over 30 min that were sustained for 4 h. During the infusion, norepinephrine produced an increase in mean arterial pressure and in gastric mucosal perfusion detected by laser Doppler flowmetry (P < 0.05). If compared to norepinephrine, terlipressin reduced oxygen delivery and oxygen consumption (P < 0.05) and increased arterial lactate concentrations (P < 0.05). CONCLUSION: This study showed the efficacy of terlipressin in the treatment of hypotension episodes in anesthetized patients chronically treated with renin-angiotensin system inhibitors, angiotensin converting-enzyme inhibitors, and angiotensin II receptor antagonists. However, the negative effects on gastric mucosal perfusion and the risk of iatrogenic oxygen supply dependency of terlipressin need to be taken into account.

Aged↗

PubMed2004

Initial distribution volume of glucose as noninvasive indicator of cardiac preload: comparison with intrathoracic blood volume.

OBJECTIVE: To analyze the correlation between initial distribution volume of glucose (IDVGI) and intrathoracic blood volume measured by single indicator dilution technique. DESIGN AND SETTING: Prospective clinical study conducted in the intensive care unit of a university hospital. PATIENTS AND METHODS: We enrolled 20 consecutive adult patients requiring hemodynamic monitoring with arterial pulse contour analysis system (PiCCO) and without any underlying pathology inducing generalized protein capillary leakage and/or marked peripheral edema. Cardiac output, intrathoracic blood volume, extravascular lung water were recorded. IDVGI was measured once per day for the first 5 days after PiCCO positioning by administering a bolus of 25 ml 20% glucose (5 g) over 30 s through a central venous catheter. The relationship between IDVGI and other variables was studied by regression analysis. Receiver operating characteristic curves were used to study the relationship between changes in IDVGI and changes in cardiac index, intrathoracic blood volume, and central venous pressure. RESULTS: A good linear correlation was obtained between intrathoracic blood volume and IDVGI ( R(2)=0.79). Receiver operating characteristic curve analysis showed a good ability of initial distribution volume of glucose variations to reflect cardiac index variations. CONCLUSIONS: Our results indicate that IDVGI can serve as noninvasive indicator of cardiac preload.

Adult↗

PubMed2004

Effects of short-term fenoldopam infusion on gastric mucosal blood flow in septic shock.

BACKGROUND: Inadequate splanchnic perfusion in septic shock is associated with increased morbidity and mortality. As result of splanchnic ischemia, mucosal permeability increases. Considering the implication of improved mucosal perfusion in terms of maintenance of mucosal barrier integrity, dopamine-1 receptor stimulation could be helpful in septic shock. The goal of the current study was to determine the effects of fenoldopam on systemic hemodynamic parameters and gastric mucosal perfusion in patients with septic shock. Furthermore, the authors tested the hypothesis that the addition of fenoldopam (0.1 microg x kg(-1) x min(-1)) to a combination of norepinephrine and dobutamine (5 microg x kg(-1) x min(-1)) may improve gastric mucosal perfusion in septic shock. METHODS: Patients with septic shock were randomized to a double-blind 2-h infusion of fenoldopam (n = 20) or placebo (n = 20). Each group received dobutamine (5 microg x kg(-1) x min(-1)), and the dosage of norepinephrine was adjusted to achieve a mean arterial pressure between 70 and 80 mmHg. A laser-Doppler probe and tonometer were introduced into the gastric lumen. RESULTS: A significant increase in gastric mucosal perfusion, detected by laser-Doppler flowmetry, was observed in the group treated with fenoldopam (P < 0.05). In addition, this increase in microcirculatory flow occurred despite the fact that systemic flow remained unchanged. Differences in gastroarterial partial pressure of carbon dioxide values were not statistically significant in the fenoldopam and placebo groups. CONCLUSIONS: The study showed that, for the same mean arterial pressure, short-term fenoldopam infusion increased gastric mucosal perfusion in patients with septic shock.

Adrenergic beta-Agonists↗

PubMed2004

A comparison among portal lactate, intramucosal sigmoid Ph, and deltaCO2 (PaCO2 - regional Pco2) as indices of complications in patients undergoing abdominal aortic aneurysm surgery.

Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative organ failure and intraoperative changes in arterial and portal blood lactate; changes in intramucosal sigmoid pH (pHi); differences between sigmoid Pco(2) and arterial Pco(2) (DeltaCO(2)); and hemoglobin (Hb). Hb, arterial blood lactate concentrations, pHi, and DeltaCO(2) (air tonometry) were recorded at the start of anesthesia (T0), before aorta clamping (T1), 30 minutes after clamping (T2), and at the end of surgery (T3). Portal venous lactate concentrations were recorded at T1 and T2. Patients were stratified into two groups: group A patients had no postoperative organ failure, and group B patients had one or more organ failures. As compared with group A (n = 16), group B patients (n = 13) had a lower pHi value at T2 and T3 and a higher DeltaCO(2) at T3. A pHi value of <7.15 was a predictor of organ failure, with a sensitivity of 92.3%, a specificity of 68.8%, and positive and negative predictive values of 70.6% and 91.7%, respectively, whereas a DeltaCO(2) value of >28 mm Hg predicted later organ failure with a sensitivity of 92.3%, a specificity of 62.5%, and positive and negative predictive values of 66.6% and 90.9%, respectively. Portal venous lactate concentrations were larger in group B at T2 (P < 0.001), and an increase >or=5 g/dL predicted later postoperative organ failure with a sensitivity of 92.3%, a specificity of 100%, and positive and negative predictive values of 100% and 94.1%, respectively. The comparison of the receiving operator characteristic curves to test the discrimination of each variable and the logistic regression analysis revealed that the increase in portal lactate was the best predictor for the development of postoperative organ failure. Hb concentration was significantly smaller in group B at T0 (13.8 +/- 1.0 g/dL versus 12.2 +/- 2.2 g/dL) and T2 (10.9 +/- 1.2 g/dL versus 9.1 +/- 1.9 g/dL). In conclusion, both pHi and DeltaCO(2) are reasonably sensitive prognostic indices of organ failures after AAA surgery, but they are less specific and accurate than portal venous lactate.

Aged↗

PubMed2003

Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock.

OBJECTIVES: To determine the effects of an intravenous bolus dose of a vasopressin analogue, terlipressin (1 mg), on systemic haemodynamic parameters and gastric mucosal perfusion (GMP) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique. DESIGN: Prospective open label study. SETTINGS: Two multidisciplinary intensive care units. PATIENTS: Fifteen patients with norepinephrine-treated septic shock. INTERVENTIONS: Every patient with mean arterial pressure between 50 and 55 mmHg treated with high dose norepinephrine received an intravenous bolus dose of terlipressin as last resort therapy. A laser-Doppler probe and tonometer were introduced into the gastric lumen. MEASUREMENTS AND MAIN RESULTS: Terlipressin produced a decrease in cardiac output ( p<0.05), a progressive increase in mean arterial pressure ( p<0.05) and in GMP, detected by laser-Doppler flowmetry ( p<0.05) over 30 min and sustained for at least 24 h. The ratio of GMP to systemic oxygen delivery increased after terlipressin bolus dose ( p<0.05). The gradient between gastric mucosal and arterial PCO(2) tended to be lower after terlipressin, and the difference was statistically significant ( p<0.05) after 8 h. Terlipressin administration significantly increased ( p<0.05) urine output compared to baseline and higher values were found at each set of measurement. The terlipressin-induced increase in urine output was associated with a significantly increased creatinine clearance ( p<0.05). Reduction of the high-dose norepinephrine was observed in all patients ( p<0.05). CONCLUSIONS: Our findings showed that, in patients with norepinephrine-treated septic shock, terlipressin increased GMP, urine output and creatinine clearance by an increase in mean arterial pressure.

Aged↗

PubMed2003

Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure.

OBJECTIVE: To compare the efficacy of early administration of noninvasive continuous positive airway pressure (nCPAP) delivered by the helmet vs. face mask to treat hematological malignancy patients with fever, pulmonary infiltrates, and hypoxemic acute respiratory failure. DESIGN AND SETTING: Prospective clinical study with historical matched controls in the hematology department of a university hospital. PATIENTS AND INTERVENTIONS: Seventeen hematological malignancy patients with hypoxemic acute respiratory failure defined as: moderate to severe dyspnea, tachypnea (>30-35 breaths/min), use of accessory muscles and paradoxical abdominal motion, and PaO2/FIO2 ratio less than 200. Each patient was treated with nCPAP by helmet outside the ICU in the hematological ward. Arterial oxygen saturation, heart rate, respiratory rate, and blood pressure were monitored to identify early nCPAP failure. Seventeen historical-matched controls treated in the same department with face mask CPAP were selected as control population; matching criteria were age, sex, diagnosis, and PaO2/FIO2 ratio. Primary end-points were improvement in gas exchanges and the need for endotracheal intubation. RESULTS: Oxygenation improved in all patients after nCPAP. No patient failed helmet nCPAP because of intolerance while eigh patients in the mask group did so. nCPAP could be applied continuously for a longer period of time in the helmet group (28.44+/-0.20 vs. 7.5+/-0.45 h). CONCLUSIONS: Early nCPAP with helmet improves oxygenation in selected immunosuppressed patients with hypoxemic acute respiratory failure. Tolerance of helmet nCPAP seems better than that of nCPAP delivered by mask.

Acute Disease↗

PubMed2003

[Fenoldopam and kidney function in a case of abdominal aortic pseudoaneurysm with supra-renal clamping in an emergency protocol].

The renal haematic flow decrease, the vasoconstriction and the local vascular resistance increase, associated with descending aortic cross-clamping, before the origin of renal arteries, can be contrasted by continuous infusion of fenoldopam, a dopamine analog with selective action on DA1-receptors. The renal effects of this molecule are renal plasmatic flow increase and local vascular resistance decrease, without important haemodynamic changes, with mild cardiovascular modification, even at high doses, in hypertensive and non hypertensive patients, also in normal volume condition and hypovolemic condition. This selective action at renal level allows the use of fenoldopam also in surgical emergencies, in patients with low cardiovascular function. The case report here presented demonstrated a beneficial renal effects of continuous infusion of fenoldopam and its easy to use, in emergency situations. These findings could be extrapolated for other patients or suggested for additional research.

Acute Kidney Injury↗

PubMed2002

Does methylene blue administration to septic shock patients affect vascular permeability and blood volume?

OBJECTIVE: To assess the effects of the inhibition of guanylate cyclase, an enzyme involved in sepsis-related vascular and myocardial dysfunctions, on hemodynamic variables including blood volume and pulmonary vascular permeability during septic shock. DESIGN: Prospective, open study with repeated measurements. SETTING: A medicosurgical intensive care unit of a university hospital. PATIENTS: Fifteen patients with septic shock associated with persisting hypotension despite conventional treatment including fluid loading, vasopressors, and inotropes. INTERVENTIONS: A fiberoptic catheter was inserted for the determination of blood and extravascular volumes by the thermal-dye double indicator technique, using indocyanine green (COLD system). A bolus dose of methylene blue (3 mg/kg) was infused intravenously over 10 mins. COLD-derived variables were recorded before methylene blue and 20 mins, 1 hr, and 2 hrs after the end of methylene blue infusion. MEASUREMENTS AND MAIN RESULTS: Standard hemodynamic and oxygen-derived variables; total, intrathoracic, systolic, and diastolic cardiac blood volumes; extravascular lung water; plasma osmolarity; and lactate and protein concentrations were recorded. Mean arterial and pulmonary artery pressures, systemic and pulmonary vascular resistances, and left ventricular stroke work index increased, and blood lactate transiently decreased after methylene blue (p <.05). The other variables recorded were unchanged during the 2-hr period following methylene blue infusion. CONCLUSIONS: This study confirmed the acute vasoconstrictive and positive inotropic effects of methylene blue during septic shock. These effects were not associated with changes in blood volume, myocardial diastolic function, or pulmonary vascular permeability assessed by extravascular lung water.

Adult↗

PubMed1993

Hyperbaric oxygen therapy in cluster headache.

Preliminary reports have shown that hyperbaric oxygen (HBO) interrupts cluster headache (CH) attacks. In the present study, 6 of 7 patients with episodic cluster headache who were treated with hyperbaric oxygen experienced an interruption of the attack. In 3 of 6 responders the florid period of the cluster headache was interrupted. The other 3 patients remained without pain attacks for a period lasting from 3 to 6 days. In 6 different patients, a placebo treatment had no effect. The present findings clearly indicate that hyperbaric oxygen has not only a symptomatic effect on a single attack of cluster headache, but it also could prevent the occurrence of subsequent attacks.

Adult↗