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S Baroncini

Publications and source records attributed to S Baroncini.

At least 19 recordsLinked to original sources
PubMed2006

Thoracoscopy in children: anaesthesiological implications and case reports.

AIM: Videoassisted thoracic surgical technique in children is being used with increasing frequency for an extensive variety of diagnostic and therapeutic procedures. The aim of the study was to assess respiratory, cardiocirculatory and body temperature changes in children undergoing thoracoscopy and to identify if the trend of such changes was modifiable by factors such as lung exclusion, length of the thoracoscopy and preoperative respiratory compromise. METHODS: A total of 50 patients (38 boys and 12 girls) undergoing general anaesthesia for diagnostic and therapeutic thoracoscopic procedures were analysed. The values of the monitored parameters were compared at 6 specific times: T1 - at the end of anaesthesia induction (considered the basal level); T2 - after lateral position; T3 - before pleural CO2 insufflation; T4 - 10 min after pleural CO2 insufflation; T5 - before pleural deflation; T6 - 10 min after pleural deflation. RESULTS: All patients tolerated the thoracoscopy well, without intraoperative complications. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly lower, and end-tidal CO2 (PETCO(2) significantly higher during thoracoscopy. Body temperature (BT) had a statistically significant reduction during thoracoscopy and after pleural deflation. During one-lung ventilation the PETCO(2) increased compared to two-lung ventilation with intrapleural insufflation, while during two-lung ventilation with intrapleural insufflation SBP and DBP decreased compared to one-lung ventilation. The length of the thoracoscopy increased the PETCO(2) and reduced the BT. The preoperative respiratory compromise increased the PETCO(2). CONCLUSIONS: Although thoracoscopy in children brings about certain respiratory, cardiocirculatory and body temperature changes, it is nevertheless a safe and efficient surgical technique.

Adolescent↗
PubMed2004

Exposure of personnel to sevoflurane during paediatric anaesthesia: influence of professional role and anaesthetic procedure.

BACKGROUND AND OBJECTIVE: This study was performed to determine the individual exposure of paediatric operating theatre personnel to sevoflurane and to evaluate the impact of inhalation induction and various airway approaches on exposure to airborne sevoflurane. METHODS: Mean individual environmental (workplace air) exposure to sevoflurane and a biomarker of exposure (urinary sevoflurane) were monitored in 36 subjects (10 anaesthetists, 10 surgeons, 12 nurses and 4 auxiliary personnel) working in two paediatric operating rooms. RESULTS: Environmental and urinary values were significantly greater in anaesthetists compared with other groups, with median values of 0.65ppm (interquartile range 1.36; 95th percentile 4.36) for breathing zone sevoflurane and 2.1 microgL(-1) urine (interquartile range 2.6; 95th percentile 7.6) for urinary sevoflurane. Anaesthetists exceeded the 2ppm maximum allowed environmental concentration recommended by the National Institute for Occupational Safety and Health in 4 of 22 cases (18.1%). A positive correlation was found between the number of patients undergoing inhalational induction each day and mean values of breathing zone and urinary sevoflurane. An increase in the number of daily laryngeal mask insertions, or the use of rigid bronchoscopy, are statistically related to higher environmental and urinary values (P < 0.01 and <0.00001 for breathing zone sevoflurane, P < 0.05 and <0.01 for urinary sevoflurane, respectively). CONCLUSIONS: Anaesthesia with sevoflurane can pose a hazard of chronic exposure with anaesthetists having the highest risk. Endotracheal intubation offers considerable protection against exposure. Routine anaesthesia using a standard facemask, a laryngeal mask or rigid bronchoscopy are risk factors for increased anaesthetic exposure.

Adult↗
PubMed2003

A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures.

BACKGROUND AND OBJECTIVE: This prospective, randomized, observer-blinded study compared onset time and duration of epidural anaesthesia produced by with levobupivacaine and ropivacaine for lower limb surgery. METHODS: ASA I-III adult patients undergoing elective lower limb procedures were randomized to receive epidural levobupivacaine 0.5% 15 mL (n = 30) or epidural ropivacaine 0.75% 15 mL (n = 35). A blinded observer evaluated onset time and regression of motor and sensory block, and intraoperative needs for fentanyl supplementation (0.1 mg intravenously). RESULTS: With levobupivacaine, onset time was 29 +/- 24 min, with ropivacaine it was 25 +/- 22 min (P = 0.41). Complete resolution of motor block required 105 +/- 63 min with levobupivacaine and 95 +/- 48 min with ropivacaine (P = 0.86). The time for regression of sensory block to T12 was 185 +/- 77 min with levobupivacaine and 201 +/- 75 min with ropivacaine (P = 0.46). Analgesic supplementation was required in one patient receiving levobupivacaine (3.5%) and in two patients receiving ropivacaine (5.7%) (P = 0.99). CONCLUSIONS: In adults undergoing lower limb surgery, levobupivacaine 0.5% 15 mL produces an epidural block with the same clinical profile as ropivacaine 0.75% 15 mL.

Adult↗
PubMed2003

Latex allergy in children with oesophageal atresia.

BACKGROUND: Latex allergy is frequently found in children and patients with spina bifida and urogenital abnormalities and have been considered at risk for latex sensitization. The aim of the study was to evaluate the incidence of latex sensitization in patients with oesophageal atresia and undergoing three or more surgical procedures and to identify possible risk factors in the process of latex sensitization. METHODS: A total of 20 patients were analysed: 19 boys and one girl. The oesophageal atresias were as follows: type I in three children, type II in two and type III in 15 children. Surgical and anaesthetic procedures, intensive care management, age, type of oesophageal atresia, associated congenital malformations, Waterston and Montreal prognostic classifications were considered as risk factors that may be implicated in the process of sensitization. RESULTS: Five patients (25%) were considered sensitized to latex (group 1) and 15 (75%) nonsensitized (group 2). Among the five sensitized patients, three reported clinical reactions to latex, while the other two presented only specific IgE sensitization. The number of operations, the total hours of surgery, the number of drainages, the total days of drainage, the total days of central venous catheter were significantly greater in group 1 than in group 2. Both of the highest risk oesophageal atresia classes (Waterston C and Montreal II) were related to latex allergy. CONCLUSIONS: Oesophageal atresia, especially in cases of prolonged management, must be considered as a risk for the development of latex allergy.

Adolescent↗
PubMed2003

Ciaglia percutaneous dilational tracheostomy. Early and late complications and follow-up.

AIM: Evaluation of the safety of percutaneous dilational tracheostomy (PDT) for perioperative, early and late complications. METHODS DESIGN: we prospectively collected complications in patients who underwent PDT for mechanical ventilation; patients were interviewed 8 months after discharge, symptomatic cases underwent ENT control. SETTING: 10 bed general ICU in a 650 -bed general hospital treating 450 patients per year. PARTICIPANTS AND INTERVENTION: 181 patients admitted between July 1998 and June 2000 who underwent PDT for mechanical ventilation. Prospe-ctive collection of data on patients and procedures and screening by a phone interview for symptoms possibly related to the tracheostomy. Symptomatic patients were referred to the ENT specialist. RESULTA: We found 17 perioperative minor complications and 10 minor during hospital stay complications. We traced 83 patients, alive 8 months after discharge. Sixty-one patients (73.5%) were symptom free. Four (4.8) complained of minimal dysphonia. Eighteen patients (21.7%) complained of symptoms deserving ENT control. Eleven patients came to the ENT control that was positive in 5 cases. In 2 patients swallowing uncoordination was found, in 1 arytenoid movement uncoordination. In 1 case (1.2%) a 25% tracheal stenosis was found. The stenosis was asymptomatic. One patient (1.2%) had a severe tracheal stenosis and had a Montgomery tracheal stent in place. CONCLUSIONS: In our experience Ciaglia PDT had an overall low rate of complications (21.8%). No patient had severe early complication. We found only 1 (1.2%) severe late complication. In selected patients, Ciaglia PDT with endoscopic control guarantees a high safety standard.

Female↗
PubMed2002

[Epidural analgesia during labor: intermittent bolus or patient controlled administration?].

BACKGROUND: The aim of the study was to compare efficacy and side effects produced by two techniques of epidural analgesia during labor: intermittent bolus and patient-controlled epidural analgesia. METHODS: Eighty parturients were enrolled in this study: forty received intermittent bolus analgesia (first bolus: 20 mg of ropivacaine 0.1% + 10 gamma of sufentanil, next bolus: 10 mg of ropivacaine 0.1% during the first 4 hours, and then 10 mg of ropivacaine 0.1% + 2.5 gamma of sufentanil each time they complained of pain), and forty parturients received PCEA (starting with a bolus of 20 mg ropivacaine 0.1% + 10 gamma sufentanil, followed by administration with a pump programmed to deliver a continuous background infusion of ropivacaine 0,1% + 0.25 gamma/ml of sufentanil at 5 ml/h and 5 ml patient-triggered boluses with a 15 min lock-out interval; insufficient analgesia was treated by extra boluses of the same ropivacaine solution). In each group the efficacy of the analgesia (verbal numerical pain scores, amount of local anesthetics consumption), labor duration, side effects and patient satisfaction have been studied. RESULTS: There were no differences between the two different epidural techniques. CONCLUSIONS: This regimen of PCEA proves a viable and safe alternative for epidural analgesia during labor.

Adult↗
PubMed2002

Anaesthesia for laparoscopic surgery in paediatrics.

Laparoscopic surgery is an emerging procedure in the treatment of many surgical pathologies. Laparoscopy in the paediatric patient reduces surgical trauma and improves cosmetic RESULTS. Physiological changes during laparoscopic surgery are mainly related to the increased intra-abdominal pressure (IAP) associated with CO2 insufflation of the abdomen, the patient's postural modifications (head-up or head-down) and CO2 absorption and its general effects. Increases in IAP affect both ventilation and circulation. Increased IAP induces a mechanical compression of the diaphragm that reduces pulmonary compliance, vital capacity, functional residual capacity (FRC) and total lung volume. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The acute increase in IAP affects both preload and afterload, while the systolic cardiac performance remains unchanged. During anaesthesia for videolaparoscopy it is important not to exceed an intrabdominal pressure of 6 mmHg in newborns and infants and 12 mmHg in older children. In our clinical experience the respiratory, cardiocirculatory and temperature parameters have been slightly influenced during laparoscopy, but have always been maintained within the normal ranges. Laparoscopic videosurgery in newborns, infants and paediatric age group patients can be performed safely and with satisfactory clinical results.

Adolescent↗
PubMed2000

Cardiocirculatory changes during videolaparoscopy in children: an echocardiographic study.

We examined cardiovascular changes associated with intra-abdominal insufflation in 20 children (mean age 6.1+/-4.7 years, ASA physical status I or II) undergoing laparoscopic surgery with general anaesthesia using echocardiography with a transthoracic approach. Intra-abdominal pressure never exceeded 10 mmHg. Systolic blood pressure, diastolic blood pressure, endtidal CO2, peak, and mean airway pressure increased during intra-abdominal insufflation (P < 0.001). Pneumoperitoneum was associated with increases (P<0.001) in left ventricular enddiastolic volume, left ventricular end-systolic volume and left ventricular endsystolic meridional wall stress. In addition, before, during and after intra-abdominal insufflation, left ventricular fractional shortening and left ventricular ejection fraction, underwent slight, insignificant changes. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The sharp increase in intra-abdominal pressure affects both preload and afterload, while systolic cardiac performance remains unchanged.

Anesthesia, General↗
PubMed1999

Effects of sympathetic blockade on the efficiency of forced-air warming during combined spinal-epidural anesthesia for total hip arthroplasty.

STUDY OBJECTIVE: To evaluate if active cutaneous warming of the two upper limbs with reflex vasoconstriction is less effective in maintaining intraoperative normothermia than warming the vasodilated unoperated lower limb during combined spinal-epidural anesthesia (CSE). DESIGN: Prospective, randomized study. SETTING: Inpatient anesthesia at university departments of orthopedic surgery. PATIENTS: 48 ASA physical status I, II, and III patients, who were scheduled for elective total hip arthroplasty. INTERVENTIONS: Patients received CSE with intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine. All procedures started 8 to 10 AM, and operating room temperature was maintained between 21 degrees and 23 degrees C, with relative humidity ranging between 40% and 45%. For warming therapy, patients received active forced-air warming of either the two upper limbs (Group Upper body, n = 24), or the unoperated lower limb (Group Lower extremity, n = 24). Core temperature was measured before CSE placement (baseline), and then every 30 minutes until completion of surgery. Time for fulfillment of clinical discharging criteria from the recovery area was evaluated by a blinded observer. MEASUREMENTS AND MAIN RESULTS: Demographic data, duration of surgery, intraoperative blood losses, crystalloid infusion, and hemodynamic variables were similar in the two groups. Core temperature slightly decreased in both groups, but at the end of surgery the mean core temperature was 36.2 degrees +/- 0.5 degree C in Group Upper body and 36.3 +/- 0.5 in Group Lower extremity (NS). At recovery room arrival, seven patients in Group Upper body (29%) and three patients in Group Lower extremity (12.5%) had a core temperature less than 36 degrees C (NS). Shivering was observed in one patient in Group Upper body and in two patients in Group Lower extremity (NS). Clinical discharging criteria were fulfilled after 37 +/- 16 minutes in Group Upper body and 30 +/- 32 minutes in Group Lower extremity (NS). CONCLUSIONS: Forced-air cutaneous warming allows the anesthesiologist to maintain normothermia during CSE for total hip replacement even if the convective blanket is placed on a relatively small skin surface with reflex vasoconstriction. Placing the forced-air warming system on the vasodilated unoperated lower limb may be troublesome to the surgeons and does not offer clinically relevant advantages in warming efficiency.

Aged↗
PubMed1999

[Problems in anesthesia in pulmonary cystic adenomatosis].

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare disease. It is about an abnormal proliferation of mesenchymal elements and failure of maturation of bronchiolar structures, characterized by the replacement of normal pulmonary tissue with "cysts" in variable size and number. These lesions communicate with the tracheobronchial tree. During fetal period hydrops and polyhydramnios can be associated with CCAM. A cystic adenomatoid malformation can be detected by antenatal ultrasound, and, at the birth, it is confirmed by chest radiography. From January 1990 to December 1998, 24 cases with CCAM came to our observation; 16 of these patients underwent surgery and 14 have come to a complete recovery. The newborns, with CCAM, can show early acute respiratory distress for rapid expansion of the cysts leading to compression of normal lung and mediastinal shift. Conventional mechanical ventilation may cause further expansion of the involved lobe with a ball-valve effect: this take a clinical deterioration. Perioperative ventilatory management with high frequency oscillation (HFO) is useful to stabilize and to improve arterial blood gases of this patients. At the moment, thanks to the early prenatal sonographic diagnosis, it is possible, and strongly advisable, after adequate serial checkings during the pregnancy, to refer CCAM cases to a tertiary centre that is properly equipped, where a poly-specialist team consisting of obstetrician, neonatologist, pediatric anesthetist and pediatric surgeon, will be able to plan and arrange in the best treatment necessary for the newborn.

Anesthesia↗
PubMed1999

[Inhalation of foreign bodies].

Accidental aspiration of a foreign body (FB) is an event which is reasonably frequent and dramatic in children and is still today one of the main causes of death due to accidents at home in children up to three-four years of age. The severity of the clinical picture varies according to the size, shape, type and site of arrest of the material aspirated and can be associated with both severe asphyxial forms and forms with insidious and vague symptoms which are difficult to diagnose correctly. A late diagnosis is however a fairly common event in literature. An anamnesis suggesting probable aspiration in a child under the age of 3 should direct doctors towards diagnostic and operative endoscope examinations of the patient, even where there is a negative clinical and radiological picture. Organic material, mainly peanuts, represented 60-75% of the findings, particularly in the 0-3 year age-band. In the other of cases inorganic material was extracted from school-age children. Aspiration of a FB exposes the patient to risk of serious complications and sequelae. Antibiotic, dexamethasone therapy and the ventilation support in the CPAP helped to avoid post-extractive sequelae. Prevention should in any case be the primary aim as regards to aspiration of foreign bodies in children. This should be stimulated by appropriate educational campaigns to raise awareness. The study included 62 child patients observed in the Department of Anesthesia and Intensive Care of the S.Orsola-Malpighi Hospital of Bologna over the last 11 years who were admitted for suspected FB aspiration.

Asphyxia↗
PubMed1998

Salvage and reinfusion of chyle in closed chest injury.

The aim of this study was to describe a system of salvaging and reinfusing chyle which accumulated in the right pleural cavity of a patient after a thoracic duct lesion caused by a closed chest injury associated with amyelic fracture of the dorsal spine D10-D11. The chyle was collected in a reservoir (BT 844 Dideco), transferred by an electronic pump (BT 797 recovery Dideco) to a storage bag, microfiltered and then reinfused to the patient A solution was needed to prevent the patient with severe chylothorax, from having immunological and metabolic imbalance. The long period of conservative treatment with our system was imposed by the onset of acute post-traumatic myocardic infarction which delayed surgery. From experience gained, we can say that using total parenteral nutrition, chyle can not only be salvaged but also reinfused, respecting the strict rules of hygiene.

Chyle↗
PubMed1997

[Perioperative thermal homeostasis. A duty of the anesthesiologist].

Anaesthesia, surgical procedures and operating room temperature can deeply alter the human thermoregulatory system. Unexpected and sometimes serious perioperative complications can occur. Many studies have been carried out in order to describe and evaluate the detrimental effects produced by different anaesthesia procedures (whether by general, regional or integrated anaesthesia) on thermic homeostasis. More recently it has also been reported that perioperative hypothermia significantly affects patients' outcome, increasing intraoperative blood losses, incidence of postoperative wound infection, and hospital stay. Italian anaesthetists have still a poor consideration about intraoperative body temperature monitoring and patients' warming as basic important skills for a better anaesthesiologic patients management. According with the literature, we do believe that this is not a right opinion. The purpose of the present paper would be to point out the most important knowledges concerning thermic homeostasis management, in order to increase anaesthesiologist's awareness in this essential field of patients perioperative care.

Anesthesia↗