Search results for "Pain Medicine"
showing 10 items of 1037 documents
Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-science and expert consensus
2021
Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for good clinical practice on the use of vasopressors and inotropes, and on the management of critically ill patients with shock. A panel of 16 experts in the field of intensive care medicine and hemodynamics has been established. Systematic review of the available literature was performed based on PICO questions. Basing on available evidence, the panel prepared a summary of evidences and then wrote…
Laryngeal Mask Airway Position and the Risk of Gastric Insufflation
1998
A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage.The objective of the present study was to assess the incidence of LMA malpositions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyngeal air leakage. One hundred eight patients were studied after the induction of anesthesia, before any surgical manipulations. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 40 cm H2 O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relatio…
Differential expression patterns of cytokines in complex regional pain syndrome.
2007
Complex regional pain syndromes (CRPS) are characterized by persistent and severe pain after trauma or surgery. Neuro-immune alterations are assumed to play a pathophysiological role. Here we set out to investigate whether patients with CRPS have altered systemic pro- and anti-inflammatory cytokine profiles compared to controls on mRNA and protein level. We studied blood cytokine mRNA and protein levels of the pro-inflammatory cytokines tumor necrosis factor-alpha (TNF), interleukin-2 (IL-2) and IL-8 and the anti-inflammatory cytokines IL-4, IL-10, and transforming growth factor-beta1 (TGF beta 1) in 40 prospectively recruited patients with CRPS I, two patients with CRPS II, and 34 controls…
Prevention and treatment of intracranial hypertension
2007
Intracranial pressure (ICP) is the pressure exerted by cranial contents on the dural envelope. It comprises the partial pressures of brain, blood and cerebrospinal fluid (CSF). Normal intracranial pressure is somewhere below 10 mmHg; it may increase as a result of traumatic brain injury, stroke, neoplasm, Reye's syndrome, hepatic coma, or other pathologies. When ICP increases above 20 mmHg it may damage neurons and jeopardize cerebral perfusion. If such a condition persists, treatment is indicated. Control of ICP requires measurement, which can only be performed invasively. Standard techniques include direct ventricular manometry or measurement in the parenchyma with electronic or fiberopti…
Rapid Titration With Intravenous Oxycodone for Severe Cancer Pain and Oral Conversion Ratio.
2022
to assess a dose titration with intravenous oxycodone to achieve rapid pain relief of cancer pain of severe intensity. The second objective was to provide a conversion ratio with the oral route.Cancer patients admitted for severe pain were prospectively assessed. At admission (T0) previous opioid doses were recorded. Edmonton symptom assessment scale (ESAS) was collected from T0 until the conclusion of the observation. Intravenous boluses of oxycodone were given until the initial signs of significant analgesia were detected. The effective dose was multiplied for six and given as intravenous continuous infusion. When the patient was considered stabilized the intravenous daily dose was conver…
Evaluation of Psychometric and Linguistic Properties of the Italian Adolescent Pain Assessment Scales: A Systematic Review
2018
Introduction: Adolescents’ pain experiences are complex and multidimensional, and evaluating pain only from a sensory and affective point of view may be in many instances limiting and inadequate; this is the reason why it is of paramount importance to identify the tools which can better assess the pain experienced by young patients. A person-oriented approach is highly encouraged, as it may better investigate the cognitive and behavioral development typical of this age group. The aim of this review paper is to describe the available tools which are able to adequately assess pain intensity in adolescents, in particular those validated in Italian. Methods: We conducted a systematic review usi…
Effect of depth of neuromuscular blockade on the abdominal space during pneumoperitoneum establishment in laparoscopic surgery.
2015
To evaluate the effect of neuromuscular blockade (NMB) upon the abdominal space during pneumoperitoneum establishment in laparoscopic surgery, comparing moderate NMB and deep NMB.Prospective, randomized, crossover clinical trial.Operating room.Seventy-six American Society of Anesthesiologists 1 to 2 patients scheduled for elective laparoscopic surgery.Two independent evaluations were performed at the establishment of pneumoperitoneum for a preset intraabdominal pressures (IAPs) of 8 and 12 mm Hg, both during moderate NMB (train-of-four count, 1-3) and deep NMB (posttetanic count,5). Rocuronium was used to induce NMB, and sugammadex was used for reversal.We evaluated (i) the volume of CO2 in…
High-intensity transient signals during laparoscopic surgery in children.
2009
Background Laparoscopic interventions in children gain increasing popularity. Pneumoperitoneum as applied during laparoscopic surgery can induce gas emboli formation, but it is unclear whether this is associated with cerebral embolic events. To investigate the hypothesis that pneumoperitoneum causes cerebral emboli in children, the number and intensity of high-intensity transient signals (HITS) detected using transcranial Doppler ultrasonography were assessed before and after induction of pneumoperitoneum. Methods Twenty children were monitored during laparoscopic surgery. General anaesthesia was performed using sevoflurane and sufentanil or alfentanil. Pressure-controlled ventilation was a…
Nitrous oxide in abdominal surgery
2001
Abstract Inhalation anaesthesia has traditionally been the method of choice for abdominal surgery. While most surgical interventions in the lower abdomen can be performed under regional anaesthesia, a general anaesthetic technique is frequently chosen for upper abdominal procedures. This explains the almost routine use of nitrous oxide (N 2 O) for abdominal surgery. In addition to well-known contra-indications such as ileus and abdominal wall defects in infants, there is substantial scientific evidence against the application of N 2 O in abdominal surgery. N 2 O has an important role in the development of post-operative nausea and vomiting (PONV).
Gastric insufflation pressure, air leakage and respiratory mechanics in the use of the laryngeal mask airway (LMA) in children.
2004
Summary Background : The objective of the present study was to evaluate the prelaryngeal position of the laryngeal mask airway (LMATM) in children, and to determine the influence of mask positioning on gastric insufflation and oropharyngeal air leakage. Methods : A total of 100 children, 3–11 years old, scheduled for surgical procedures in the supine position under general anaesthesia were studied. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 30 cmH2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using…