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Biomedical subjects

A Di Filippo

Publications and source records attributed to A Di Filippo.

At least 19 recordsLinked to original sources
PubMed1995

[High-dose vecuronium in "open-eye" emergency surgery].

BACKGROUND: Succinylcholine is contraindicated in "open eye" surgery because it raises intraocular pressure. High dose vecuronium reduces onset time for orothracheal intubation. The objective of the study was to evaluate clinical efficacy of high dose vecuronium (0.2 and 0.3 mg/kg) and its effects on intraocular pressure for its use in "open eye" emergency surgery. DESIGN: Randomized, prospective, clinical trial. SETTING: Eye clinic of University of Florence. PATIENTS: 40 patients scheduled for vitrectomy, excluding any drug action on IOP, subdivided into two groups: the first (20 patients) had 0.2 mg/kg vecuronium at the induction of anaesthesia, the second (20 patients) 0.3 mg/kg. ANAESTHESIA: Premedication: atropine 0.01 mg/kg. Preinduction: fentanyl 3 micrograms/kg. Induction: thiopentone 4 mg/kg+ after 1 minute) vecuronium. Orotracheal intubation after 90". MEASURES: IOP was obtained by applanation tonometry in three time: T0 = preinduction; T1 = 50" after thiopentone; T2 = 50" after vecuronium. Systodiatolic pressure was obtained at the same time. Neuromuscular function was evaluated by vocals cord relaxation and by clinical evaluation of response to ulnar nerve stimulation (by train of four). STATISTIC: "t"-Student. MAIN RESULTS AND CONCLUSIONS: No modification of IOP and systodiastolic pressure was caused by administration of vecuronium; no statistic differences are between T1 and T2 values. All patients were intubated after 90" vecuronium administration; the vocal cord relaxation was maxima in all the patients. High dose vecuronium seems to be useful in "open eye" emergency surgery when succinylcholine is contraindicated.

Adult↗
PubMed1995

[Variations of esophageal temperature during general anesthesia with a low-flow circuit].

BACKGROUND: Anaesthesia drugs cause the cutaneous vasodilatation that produces core temperature lowering at the beginning of general anaesthesia; when the thermal threshold for vasoconstriction is reached the cutaneous heat losses are decreased. Furthermore, the soda lime begins to produce water and heat after 40 minutes of closed circuit ventilation. WORK HYPOTHESIS: The technique of inhalatory anaesthesia affects the thermal loss of patients after some hours of ventilation. DESIGN: Prospective randomized clinical trial. SETTING: Surgical Clinical operating theatre of the University of Florence. PATIENTS: 50 patients submited to abdominal non vascular surgery, for longer than 2 hours, with xifo-pubic cut, subdivided into two groups with the same anthropometric characters and age; the first ventilated with open system, the second with low flow circuit (fresh gas flow 700 ml/min). STATISTIC: "t" Student test; MEASURES: Lower one third oesophageal and inspiratory jaw of the circuit temperatures recorded for three hours. MAIN RESULTS: The savings of low flow anaesthesia begin to be significant in the third hour of anaesthesia. CONCLUSIONS: The thermal saving of closed circuit anaesthesia is, very probably, related to the humidifying and the warming of inspired air by soda lime reaction; the effect is more evident if cutaneous losses are reduced.

Anesthesia, General↗
PubMed1995

[Vecuronium for anesthesia in developing countries].

BACKGROUND: Some authors affirm that vecuronium efficacy is modified by anthropometric characteristics of people. However this drug is useful in several clinical conditions, it has very few collateral effects and it is easily stored and carried. AIM OF THE WORK: To evaluate the difference in efficacy of vecuronium in Brasilian and Italian patients. PATIENTS AND SETTING: 48 patients (21 children) submitted to ophthalmological surgical procedures in San Francisco Hospital of Grajaù (Maranhao, Brazil) and in Eye Clinic of University of Florence. STATISTIC: Student "t" and chi 2 tests. MEASURES: Myorelaxation was evaluated by a clinical score of intubation, clinical evaluation of TOF response after induction of anesthesia, recovery time after decurarization. MAIN RESULTS AND CONCLUSIONS: The two adult people (Brazilian and Italian) had significantly different weight. Children had different age/weight correlation. No significant differences exist in myorelaxation evaluation. Our results don't confirm the vecuronium efficacy differences in anthropometrically different people.

Adolescent↗
PubMed1994

[Evaluation of an experimental model of multiple organ dysfunction].

OBJECTIVE: To perform an experimental model of Multiple Organ Dysfunction Syndrome (MODS) without employing bacteria or endotoxin stimulus and to follow its evolution in vivo by a Computerized Tomography analysis of the lungs. DESIGN: Rats were submitted to intraperitoneal injection of a 2.5% zymosan suspension in mineral oil (1 g/kg weight) or mineral oil alone; control rats received no treatment. METHODS: The observation period was 15 days. During this period symptoms and survival were noticed daily. CT scans of lungs were made at the 7th and 14th days; data were post-processed to obtain information on lung density. The rats were sacrificed at the 15th day by heart puncture; blood was utilized for determination of hemochrome, differential leukocyte count, thrombocytes, glycemia, uremia, bilirubin. Lungs, liver, spleen and kidney were dissected and weighted for determination of relative organ weight. DATA ANALYSIS: Data were compared by "t" Student's test for impaired data and Fisher Exact test. RESULTS: Symptoms, survival, blood analysis and relative organ weight agreed with a progressive, ingravescent, triphasic illness caused by a systemic inflammatory response involving remote organ too. The CT study proved able to monitoring and analyzing organ damage: a temporal sequence of evolution of damage exists; organ damage is localized in microcirculatory system (density augment) and in parenchyma (morphologic alterations and fibrosis). DISCUSSION: The described experimental model reproduces a MODS-like illness in zymosan receiving rats; the CT scan is effective to evaluate the evolution of organ damage.

Animals↗
PubMed1993

[Respiratory mechanics and gas exchange in anesthesia for laparoscopic cholecystectomy].

OBJECTIVE: To evaluate the influence of endoabdominal CO2 insufflation during anaesthesia for laparoscopic cholecystectomy on airway pressure, gas exchange and their relationships. DESIGN: Perspective; clinical investigation. SETTING: Operating room at a central general hospital. PATIENTS: 14 patients (3 males and 11 females) ASA 1-2, non smokers, without lung disease, scheduled for elective laparoscopic cholecystectomy. INTERVENTIONS: During balanced anaesthesia (N2O/O2, Fentanyl, Isoflurane), with fixed minute ventilation, endoperitoneal insufflation of CO2 held at constant pressure (21 cm H2O). MEASUREMENTS: Serial measurements of: Airway pressure, near-static compliance, ETCO2, CO2 minute production, blood gas analysis and derived data: P(a-A)O2, P(a-ET)CO2, Vd/Vt. MAIN RESULTS: During insufflation peak and pause pressures increased by 6 cm H2O and mean pressure; by 3 cm H2O; Compliance was reduced by 48%; PaO2 decreased evenly with time (p > 0.05) irrespective of the airway pressure. PaCO2, PECO2, VCO2 and Vd/Vt after a sharp increase stabilized at 30% (mean value) over the baseline. P(a-ET)CO2 and Vd/Vt fluctuate in the physiological range except for two short but significant changes (p > 0.05) at insufflation and desufflation time. CONCLUSIONS: Laparoscopic technique for cholecystectomy, at least in healthy patients, produces relevant changes in airway pressures but only minor modifications of gas exchange, similar to those seen during general anaesthesia. This technique can be safely used for routine operation with standard monitoring equipment.

Adult↗
PubMed1993

[The clinical evaluation and immunological response of a new measles vaccine].

For a number of years the measles vaccine has been tabled to be included among the compulsory vaccines with the not impossible aim of wiping out this disease. In practice, however, there have been isolated attempts to impose mass vaccination but, given that it is not compulsory, there has been a certain degree of resistance to the vaccine. In an attempt to interpret the reasons for this resistance we have identified three main causes: cultural heritage by family doctors and sometimes pediatricians ("a disease which is important to have had"). Limited information with underestimation of damaging effects of disease overemphasis of side-effects of vaccine and, among these, in particular fever which 30-35% of vaccinated children present between day 8-10, and the possible allergic reaction (chicken embryos-antibiotics). Using the latter as a starting point, we assessed the efficacy and tolerability of the Moraten Berna vaccine on 165 children aged between 10 months and 8 years. This vaccine is prepared using the Edmonston Zagreb strain cultured in diploid human cells, and does not therefore contain heterologous proteins, seroconversion was assessed in 54 of the vaccinated children (aged 10 months--3 years) by blood sample collected following an interval of between 40 and 120 days after vaccination. Anti-measles antibody titering was assayed using a neutralisation test on plates of cellular monostrate by assessing the titer (starting dilution of serum in test: 1:8). Seroconversion, as shown in table I, was obtained for all vaccinated subjects who presented a mean antibody titer of 916 mUI/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗
PubMed1993

[Combined anesthesia (epidural-general) in thoracic surgery: the cardiocirculatory response to induction. Propofol vs midazolam plus alfentanil].

Thoracic epidural block may unpredictably blunt the physiological sympathetic response to anaesthetic agents and profound hypotension could result at induction time. The authors evaluate two different induction regimens in 16 patients scheduled for major thoracic surgery in order to assess which of them would produce less hemodynamic changes. After the institution of high thoracic epidural block (6 ml lidocaine-CO2 2% + epinephrine 1/200,000 level: th.2-3), patients were randomly allocated in two induction groups: P and M. Group P received 2 mg/kg of propofol over 30 seconds; group M received midazolam 0.2 mg/kg plus alfentanil 30 mcg/kg. In Both groups induction was followed by a significant drop in blood pressure (-18% in group M and -37% i group P. In P group the fall in blood pressure is more pronounced than M group (p < 0.05). Noteworthy in both groups cardiac frequency do not increase and in M group significantly lowers. In the authors view the midazolam plus alfentanil induction technique compare well with propofol alone and would recommend its use in poor risk patients.

Adult↗
PubMed1992

[Alfentanyl and midazolam in combined anesthesia. Clinical evaluation].

We have evaluated the effectiveness of a technique of blended anaesthesia (epidural-general) in 31 patients undergoing major surgery. Thoracic epidural blockade with lidocaina CO2, adrenalin 1/200000, ensures analgesia while induction and hypnosis maintenance were obtained with midazolam, alfentanil, atracurium and N2O/O2. This technique seems able to protect the patients from endotracheal intubation and surgical stress and also to enable a rapid, quiet awakening. The dose of midazolam necessary to maintain hypnosis was inversely proportional to the patient's age. The reversal of hypnosis was necessary in 4 patients only.

Adult↗
PubMed1992

[Inhalation anesthesia in low-flow systems. Clinical evaluation of the kinetics of isoflurane in induction phase].

Closed circuit and low flow anaesthesia offer numerous advantages such as reduction of gas consumption, low cost, and less pollution in both the operating theatre and the environment. These procedures also offer increases in inspired gas humidity and temperature. However the time needed to attain the alveolar concentration MAC 95, is too long. Prefilling the whole circuit, the bellow and the bag with anaesthetic vapours shortens that time without overdosage.

Anesthesia, Closed-Circuit↗
PubMed1989

Treatment of reversible chronic airways obstruction with doxofylline compared with slow-release theophylline: a double-blind, randomized, multicentre trial.

A multicentre, double-blind, randomized trial was carried out in 11 Italian Pneumologic Clinics to investigate the therapeutic efficacy and tolerability of doxofylline compared with slow-release theophylline in 139 patients (86 males, 53 females) aged 17-77 years suffering from reversible chronic airways obstruction. The two groups of 69 patients on doxofylline and 70 patients on theophylline did not differ in their baseline clinical and functional parameters. After one week of wash-out, the two drugs were administered orally at a dose of 400 mg twice daily of doxofylline and 300 mg twice daily of theophylline. The treatment and follow-up lasted 28 days. Inhaled salbutamol on demand was allowed in the wash-out week and throughout the trial. The average serum levels at day 14 and 28 were: doxofylline 7.5 and 8.5 micrograms/ml; theophylline 10.4 and 7.95 micrograms/ml respectively. Both drugs significantly increased spirometric parameters (p less than 0.001 for all tests) and significantly reduced salbutamol consumption (p less than 0.001 for both drugs). Doxofylline was better tolerated than theophylline considering either the number of unwanted side-effects: (doxofylline 12; theophylline 37) or number of drop-outs due to side-effects (doxofylline 5; theophylline 10). From these results doxofylline seemed to be a good alternative to theophylline in the treatment of reversible chronic airway obstruction in view of its better safety profile.

Adolescent↗