Seizures and convulsive status in patients with subarachnoid haemorrhage are an emergency. They a... more Seizures and convulsive status in patients with subarachnoid haemorrhage are an emergency. They are not only known to increase cerebral metabolic rate but also cerebral blood flow and intracranial pressure and rebleeding can occur in patients with an unclipped aneurysm. The goal of therapy is to stop the seizures minimizing the risk of secondary brain damage (hypoxia, hypotension, hypercarbia, hyperthermia). Several active drugs are available for treating seizures, it is important to identify the cause, prompt administration, monitoring the patients and choosing the one with less side effects.
... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonic... more ... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonica, miastenia ecc.) il deficit di deglutizione si pre-senta chiaramente correlato all'ipostenia della musco-latura interessata. 572--Marco Gemma Page 5. ...
The Journal of Trauma: Injury, Infection, and Critical Care, 1996
... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fr... more ... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fractures of the partially mineralized thyroid cartilage. Ann Otol Rhinol Laryngol 101:76, 1992. Cited Here... 6. Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trails ...
To the Editor: In their multicenter trial of transfusion re-quirements in critical care, Hébert e... more To the Editor: In their multicenter trial of transfusion re-quirements in critical care, Hébert et al. (Feb. 11 issue)1 demonstrate that, in the case of red-cell transfusion, the adage more is better is not always true. However, their recommendation of a threshold for red-cell ...
Methods: After Ethical Committee approval and informed consent, consecutive patients admitted to ... more Methods: After Ethical Committee approval and informed consent, consecutive patients admitted to our Neurointensive Care Unit were enrolled in the study. Patients were included if plasma glucose was≤ 150 mg/dl, blood urea nitrogen (BUN)< 50 mg/dl, did not receive ...
Intravenous hypertonic fluid therapy has been proposed to improve secondary ischemic injury after... more Intravenous hypertonic fluid therapy has been proposed to improve secondary ischemic injury after cerebrospinal trauma. We report the case of a 14-year-old boy with vasospasm of the intracranial vertebral arteries and ischemic brain stem damage following head trauma. The patient presented with severe tetraparesis and somatosensory (SSEPs) and brain stem auditory evoked potentials (BAEPs) impairment. The patient was treated with two subsequent hypertonic saline (HS) infusions, 2.7% and 5.4%, respectively, for a period of 48 sp, followed by standard hypervolemic therapy. After the first treatment with 2.7% HS, improvement of SSEPs without neurological improvement was apparent. Relative hypervolemia was subsequently maintained by administration of crystalloids and 20% albumin for 48 h. During standard hypervolemic therapy, no clinical and/or electrophysiological change occurred. The second infusion of 5.4% HS was concomitant with further amelioration of SSEPs and improvement of motor performance. Twelve hours after the second HS infusion, the neurological status returned to preinfusion levels, while SSEPs showed no further changes. BAEPs never changed during fluid therapy. No complication occurred secondary to the infusion of HS. This case report suggests that local improvement of brain stem perfusion following hypertonic fluid therapy accounts for or relevantly contributes to the neurological and SSEPs improvement of the patient.
In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure,... more In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure, because it can increase intracranial pressure (ICP). The purpose of this prospective nonrandomized study was to evaluate the impact of ETS on intracranial dynamics in the acute phase of head injury. Seventeen patients with severe head injury (Glasgow Coma Score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 8, range 4-8), sedated and mechanically ventilated, were studied during the first week after trauma. Single-pass ETS maneuver (with a 16-French catheter, negative pressure of 100 mm Hg, and duration of less than 30 seconds) was performed 60 seconds after the FiO2 was increased to 100%. After ETS, FiO2 was maintained at 100% for another 30 seconds. Before and after ETS, arterial blood gases and jugular oxygen saturation (S(j)O2), ICP, and mean arterial pressure (MAP) were measured and cerebral perfusion pressure (CPP) was calculated. A total of 131 ETS episodes, which consisted of repeated assessment of each patient, were analyzed. Six patients in 20 cases coughed and/or moved during ETS because of inadequate sedation. After ETS, ICP increased from 20 +/- 12 to 22 +/- 13 mm Hg in well-sedated patients and from 15 +/- 9 to 28 +/- 9 mm Hg in patients who coughed and/or moved (mean change, 2 +/- 6 versus 13 +/- 6 mm Hg, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). CPP and S(j)O2 increased in well-sedated patients (from 78 +/- 16 to 83 +/- 19 mm Hg, and from 71 +/- 10 to 73 +/- 13%, respectively) and decreased in patients who reacted to ETS (from 79 +/- 14 to 72 +/- 14 mm Hg and from 69 +/- 7 to 66 +/- 9%, respectively), and the differences were significant (mean change, CPP: 5 +/- 14 versus -7 +/- 15 mm Hg, P =.003; (S(j)O2) 2 +/- 5 vs. -3 +/- 5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). In well-sedated patients, endotracheal suctioning caused an increase in ICP, CPP, and S j O 2 without evidence of ischemia. In contrast, in patients who coughed or moved in response to suctioning, there was a slight and significant decrease in CPP and S(j)O2. In the case of patients with head injuries who coughed or moved during endotracheal suctioning, we strongly suggest deepening the level of sedation before completing the procedure to reduce the risk of adverse effects.
BACKGROUND AND STUDY: Combined use of opiates and benzodiazepines often results in delayed discha... more BACKGROUND AND STUDY: Combined use of opiates and benzodiazepines often results in delayed discharge after colonoscopy. To compare sedation quality of two dosages of patient controlled analgesia remifentanil with one another and with that of a midazolam-meperidine association during colonoscopy. Ninety patients undergoing colonoscopy were randomly assigned to three groups. Group M received a meperidine bolus (0.7 mg/kg) and sham patient controlled analgesia. Group R1 received remifentanil 0.5 μg/kg and group R2 remifentanil 0.8 μg/kg together with a patient-controlled analgesia pump injecting further boluses (2-min lock-out). Technical difficulties of the examination, gastroenterologist&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s and patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s satisfaction with sedoanalgesia were evaluated after colonoscopy on a 100 mm Visual Analogue Scale. Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s satisfaction was assessed 24 h later. Group M had more adverse events (p = 0.044), required more rescue boluses (p = 0.0010), had lower Observer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Assessment of Alertness and Sedation Scale score at the end of the procedure (p = 0.0016) and longer discharge time (p = 0.0001). Groups R1 and R2 did not differ with respect to these variables. Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s degree of pain and satisfaction with sedo-analgesia, endoscopist&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s technical difficulty and satisfaction were not different among groups. Remifentanil patient controlled analgesia is a safe approach to sedation for colonoscopy.
... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonic... more ... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonica, miastenia ecc.) il deficit di deglutizione si pre-senta chiaramente correlato all&#x27;ipostenia della musco-latura interessata. 572--Marco Gemma Page 5. ...
In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure,... more In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure, because it can increase intracranial pressure (ICP). The purpose of this prospective nonrandomized study was to evaluate the impact of ETS on intracranial ...
... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fr... more ... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fractures of the partially mineralized thyroid cartilage. Ann Otol Rhinol Laryngol 101:76, 1992. Cited Here... 6. Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trails ...
Seizures and convulsive status in patients with subarachnoid haemorrhage are an emergency. They a... more Seizures and convulsive status in patients with subarachnoid haemorrhage are an emergency. They are not only known to increase cerebral metabolic rate but also cerebral blood flow and intracranial pressure and rebleeding can occur in patients with an unclipped aneurysm. The goal of therapy is to stop the seizures minimizing the risk of secondary brain damage (hypoxia, hypotension, hypercarbia, hyperthermia). Several active drugs are available for treating seizures, it is important to identify the cause, prompt administration, monitoring the patients and choosing the one with less side effects.
... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonic... more ... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonica, miastenia ecc.) il deficit di deglutizione si pre-senta chiaramente correlato all&#x27;ipostenia della musco-latura interessata. 572--Marco Gemma Page 5. ...
The Journal of Trauma: Injury, Infection, and Critical Care, 1996
... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fr... more ... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fractures of the partially mineralized thyroid cartilage. Ann Otol Rhinol Laryngol 101:76, 1992. Cited Here... 6. Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trails ...
To the Editor: In their multicenter trial of transfusion re-quirements in critical care, Hébert e... more To the Editor: In their multicenter trial of transfusion re-quirements in critical care, Hébert et al. (Feb. 11 issue)1 demonstrate that, in the case of red-cell transfusion, the adage more is better is not always true. However, their recommendation of a threshold for red-cell ...
Methods: After Ethical Committee approval and informed consent, consecutive patients admitted to ... more Methods: After Ethical Committee approval and informed consent, consecutive patients admitted to our Neurointensive Care Unit were enrolled in the study. Patients were included if plasma glucose was≤ 150 mg/dl, blood urea nitrogen (BUN)< 50 mg/dl, did not receive ...
Intravenous hypertonic fluid therapy has been proposed to improve secondary ischemic injury after... more Intravenous hypertonic fluid therapy has been proposed to improve secondary ischemic injury after cerebrospinal trauma. We report the case of a 14-year-old boy with vasospasm of the intracranial vertebral arteries and ischemic brain stem damage following head trauma. The patient presented with severe tetraparesis and somatosensory (SSEPs) and brain stem auditory evoked potentials (BAEPs) impairment. The patient was treated with two subsequent hypertonic saline (HS) infusions, 2.7% and 5.4%, respectively, for a period of 48 sp, followed by standard hypervolemic therapy. After the first treatment with 2.7% HS, improvement of SSEPs without neurological improvement was apparent. Relative hypervolemia was subsequently maintained by administration of crystalloids and 20% albumin for 48 h. During standard hypervolemic therapy, no clinical and/or electrophysiological change occurred. The second infusion of 5.4% HS was concomitant with further amelioration of SSEPs and improvement of motor performance. Twelve hours after the second HS infusion, the neurological status returned to preinfusion levels, while SSEPs showed no further changes. BAEPs never changed during fluid therapy. No complication occurred secondary to the infusion of HS. This case report suggests that local improvement of brain stem perfusion following hypertonic fluid therapy accounts for or relevantly contributes to the neurological and SSEPs improvement of the patient.
In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure,... more In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure, because it can increase intracranial pressure (ICP). The purpose of this prospective nonrandomized study was to evaluate the impact of ETS on intracranial dynamics in the acute phase of head injury. Seventeen patients with severe head injury (Glasgow Coma Score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 8, range 4-8), sedated and mechanically ventilated, were studied during the first week after trauma. Single-pass ETS maneuver (with a 16-French catheter, negative pressure of 100 mm Hg, and duration of less than 30 seconds) was performed 60 seconds after the FiO2 was increased to 100%. After ETS, FiO2 was maintained at 100% for another 30 seconds. Before and after ETS, arterial blood gases and jugular oxygen saturation (S(j)O2), ICP, and mean arterial pressure (MAP) were measured and cerebral perfusion pressure (CPP) was calculated. A total of 131 ETS episodes, which consisted of repeated assessment of each patient, were analyzed. Six patients in 20 cases coughed and/or moved during ETS because of inadequate sedation. After ETS, ICP increased from 20 +/- 12 to 22 +/- 13 mm Hg in well-sedated patients and from 15 +/- 9 to 28 +/- 9 mm Hg in patients who coughed and/or moved (mean change, 2 +/- 6 versus 13 +/- 6 mm Hg, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). CPP and S(j)O2 increased in well-sedated patients (from 78 +/- 16 to 83 +/- 19 mm Hg, and from 71 +/- 10 to 73 +/- 13%, respectively) and decreased in patients who reacted to ETS (from 79 +/- 14 to 72 +/- 14 mm Hg and from 69 +/- 7 to 66 +/- 9%, respectively), and the differences were significant (mean change, CPP: 5 +/- 14 versus -7 +/- 15 mm Hg, P =.003; (S(j)O2) 2 +/- 5 vs. -3 +/- 5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). In well-sedated patients, endotracheal suctioning caused an increase in ICP, CPP, and S j O 2 without evidence of ischemia. In contrast, in patients who coughed or moved in response to suctioning, there was a slight and significant decrease in CPP and S(j)O2. In the case of patients with head injuries who coughed or moved during endotracheal suctioning, we strongly suggest deepening the level of sedation before completing the procedure to reduce the risk of adverse effects.
BACKGROUND AND STUDY: Combined use of opiates and benzodiazepines often results in delayed discha... more BACKGROUND AND STUDY: Combined use of opiates and benzodiazepines often results in delayed discharge after colonoscopy. To compare sedation quality of two dosages of patient controlled analgesia remifentanil with one another and with that of a midazolam-meperidine association during colonoscopy. Ninety patients undergoing colonoscopy were randomly assigned to three groups. Group M received a meperidine bolus (0.7 mg/kg) and sham patient controlled analgesia. Group R1 received remifentanil 0.5 μg/kg and group R2 remifentanil 0.8 μg/kg together with a patient-controlled analgesia pump injecting further boluses (2-min lock-out). Technical difficulties of the examination, gastroenterologist&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s and patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s satisfaction with sedoanalgesia were evaluated after colonoscopy on a 100 mm Visual Analogue Scale. Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s satisfaction was assessed 24 h later. Group M had more adverse events (p = 0.044), required more rescue boluses (p = 0.0010), had lower Observer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Assessment of Alertness and Sedation Scale score at the end of the procedure (p = 0.0016) and longer discharge time (p = 0.0001). Groups R1 and R2 did not differ with respect to these variables. Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s degree of pain and satisfaction with sedo-analgesia, endoscopist&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s technical difficulty and satisfaction were not different among groups. Remifentanil patient controlled analgesia is a safe approach to sedation for colonoscopy.
... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonic... more ... In diverse malattie muscolari o della giunzione neuromuscolare (distrofia muscolare mio-tonica, miastenia ecc.) il deficit di deglutizione si pre-senta chiaramente correlato all&#x27;ipostenia della musco-latura interessata. 572--Marco Gemma Page 5. ...
In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure,... more In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure, because it can increase intracranial pressure (ICP). The purpose of this prospective nonrandomized study was to evaluate the impact of ETS on intracranial ...
... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fr... more ... J Trauma 30:87, 1990. ... 5. Austin JR, Stanley RB, Cooper DS: Stable internal fixation of fractures of the partially mineralized thyroid cartilage. Ann Otol Rhinol Laryngol 101:76, 1992. Cited Here... 6. Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trails ...
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