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Biomedical subjects

G Varrassi

Publications and source records attributed to G Varrassi.

At least 19 recordsLinked to original sources
PubMed2004

Hemodynamic variations during thoracic and abdominal stop-flow regional chemotherapy.

AIMS: The aim of this study was to study hemodynamic modifications during thoracic and abdominal stop-flow regional chemotherapy and to evaluate the need for routine hemodynamic monitoring during such kind of procedures. METHODS: Thirty patients, aged 17-67 years, ASA physical status II-III, scheduled for thoracic (group A, n = 15), and abdominal (group B, n = 15) stop-flow regional chemotherapy were enrolled. Heart rate (HR), electrocardiogram lead I and V(5), end tidal carbon dioxide (ETCO(2)), arterial oxygen saturation (SaO(2)), systolic, diastolic and mean arterial pressure (SBP, DBP, MAP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac output (CO), stroke volume (SV), stroke index (SI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), left cardiac work (LCW), right cardiac work (RCW), left cardiac work index (LCWI), right cardiac work index (RCWI), cardiac index (CI), and body O(2) consumption (VO(2)) were recorded. RESULTS: After aortic and inferior vena cava endovascular occlusion (T(1)), a significant reduction of CO and SV, associated with an increase of CVP, MAP, PAPM and PCWP were observed. A concomitant reduction of CI and increase of SVR and PVR were registered. The VO(2) was significantly reduced compared to basal values in both groups. After deflating aortic and vena cava balloons (T(2)), CO, SV and CI increased with respect to basal value p < 0.05) whereas MAP, CVP, PAPM, PCWP and calculated parameters (SVR, PVR) showed a significant reduction compared to T(1). The oxygen consumption was significantly higher than that of basal values p < 0.05. After hemofiltration (T(3)), all hemodynamic variables were comparable with the basal values. Modifications of direct and calculated parameters, during the stop-flow period, showed a similar trend in both study groups, without any statistically significant difference. No ST modifications at ECG were noted during all perioperative period. CONCLUSIONS: The results of this study have confirmed in both groups, the safety of stop-flow regional chemotherapy procedure, despite endovascular occlusion of the aorta and inferior cava vein. The hemodynamic and oxygenation changes are reversible and did not produce any ST modifications at ECG during all perioperative period. Routine pulmonary artery catheterization is thus unnecessary, except in high cardiac risk patients.

Adolescent↗
PubMed2004

[Possible and proved benefits of peridural analgesia].

Regional anesthesia is supposed to be of some help in improving the outcome of surgical patients. Actually this assumption is largely accepted, even if clear scientific demonstrations have not been obtained. At present there are data showing the advantages, as to survival and complications, especially for major orthopedic surgery. These data have been shown by important and clarifying meta-analyses. Unfortunately, for other types of surgery, advantages have been scarcely demonstrated, due to the low number of patients involved in clinical trials. Anyway, it is underlined that regional anesthesia, and especially epidural block, is much more convenient for the patients than general anesthesia. It seems also convenient from the economic point of view, since the pharmaco-economic studies present in the literature showed the possibility to save money, using regional anesthesia and regional analgesia.

Analgesia↗
PubMed2002

[Investigation on BLS among public hospital physicians in Abruzzo].

BACKGROUND: The aim of this study is to determine the proportion of public hospital physicians in Abruzzo capable of performing basic life support manoeuvres, according to the latest guidelines. METHODS: A questionnaire was formulated, in order to investigate whether the persons interviewed 1) had ever performed a cardio-pulmonary resuscitation; 2) had ever taken any BLS courses involving dedicated dummies; 3) believed to be competent in performing cardio-pulmonary resuscitation correctly and if affirmative, the physician was asked to answer three further questions to verify the level of competence. The questionnaire was to be filled in at the proper working place without the aid of books or other material. RESULTS: Of the 1540 public hospital physicians contacted, 57.6% had participated in cardiopulmonary resuscitation manoeuvres, while only 30% had practised on dedicated dummies. Nevertheless, 69.5% believed to be able to perform the BLS techniques correctly. Of the latter, merely 18% answered all three additional questions correctly. CONCLUSIONS: Cardio-pulmonary arrest is the emergency during which the timeliness of the first resuscitation manoeuvres and their correct performance are the decisive factors for a successful outcome. Without attending regular courses, qualified to teach the proper techniques in depth and recall the acquired procedures, the efficacy of BLS techniques risk to fall below a level of acceptance. Therefore, in the emergency field, it is essential to guarantee a continued training.

Cardiopulmonary Resuscitation↗
PubMed2000

The epidural and intrathecal administration of somatotrophin-release inhibiting factor: native and synthetic analogues.

It is well-known that morphine is the king of analgesics. It is widely used, and administered in various ways for the control of acute and chronic pain states. There are, however, certain types of pain and certain clinical conditions in which morphine cannot be used due to the risk of possible complications. These are usually pain states associated with intracranial hypertension, the presence of serious respiratory problems, the onset of major opioid tolerance, persistent vomiting, and so on. The search for "alternative analgesics" has been in progress for a decade, alternatives that could be used alone or in combination for spinal administration in the treatment of complex chronic pain states and with a low incidence of secondary effects. Today, research is carefully assessing the clinical effectiveness and the side effects of a series of drugs for spinal administration, that is, epidural or intrathecal, such as the new narcotics, alpha-2 agonists, central muscle relaxants, calcitonin, and local anesthetics. In this alternative analgesic category we have to mention the somatotrophin-release inhibiting factor (SRIF), which is an ubiquitous native hormone with widespread, predominantly inhibitory actions, and octreotide, its synthetic analogue. In this article we review the literature on the natural drug and its synthetic analogue, paying particular attention to the problems connected with intraspinal administration and analgesic properties.

Chronic Disease↗
PubMed2000

Haemodynamic effects of intravenous clonidine on propofol or thiopental induction.

The study evaluated the effects of premedication with intravenous clonidine on thiopental or propofol requirements for induction and haemodynamic changes associated with both induction and endotracheal intubation. Clonidine administered intravenously before induction of anaesthesia reduced propofol or thiopental requirements. The association of clonidine and propofol caused, after injection of the induction drug, a decrease in mean arterial pressure which was significantly greater than with thiopental. Moreover, a major haemodynamic stability was registered before and after laryngoscopy in the clonidine-thiopental group. These findings might contraindicate the clonidine-propofol combination in patients with cardiovascular disease.

Adrenergic alpha-Agonists↗
PubMed1999

Intra-articular buprenorphine after knee arthroscopy. A randomised, prospective, double-blind study.

BACKGROUND: Demonstration of peripheral opioid receptors in inflamed synovia supports the concept of peripheral opioid analgesia. The aim of this study was to evaluate the analgesic effect of intra-articular administration of buprenorphine after knee arthroscopy. METHODS: In a double-blind randomised trial, 48 patients were assigned to four groups: group A patients received buprenorphine 100 micrograms i.a. and NaCl 0.9% i.m., group B patients received bupivacaine 0.25% 50 mg i.a. and NaCl 0.9% i.m., group C patients received NaCl 0.9% i.a. and buprenorphine 100 micrograms i.m., and group D patients received NaCl 0.9% i.a. and NaCl 0.9% i.m. Intensity of postoperative pain was evaluated by VAS at recovery (T0) and 1, 3, 6, 12, 24 h after operation (T1, T2, T3, T4, T5), at rest and during passive 10 degrees knee flexion. Total analgesic requirements and side effects related to study drugs were recorded. RESULTS: The VAS scores were significantly higher in groups C and D than in group A and B patients. The differences were significant at T0, T1, T2 and T3. At T1, group C and D patients had greater analgesic requirement than groups A and B. No patients developed side effects. CONCLUSION: Intra-articular buprenorphine and i.a. bupivacaine, both produced equally good postoperative pain control and allowed a significant reduction of analgesic requirement after knee arthroscopy.

Adult↗
PubMed1999

A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine: analgesic efficacy and tolerability after gynecologic surgery.

UNLABELLED: We assessed the relative morphine consumption in a combined analgesic regimen (on-demand morphine plus the nonopioids propacetamol or ketorolac) after gynecologic surgery. Two hundred women randomly received two i.v. doses of propacetamol 2 g or ketorolac 30 mg in a double-blinded, double-dummy trial. Patients were monitored for 12 h, and the following efficacy variables were assessed: total dose of morphine, pain intensity, and global efficacy. Safety and tolerability were evaluated by the occurrence of adverse events, especially the presence and intensity of gastrointestinal symptoms. Hemostatic variables were measured 30 and 60 min after the first infusion; arterial blood pressure, heart and respiratory rates, sedation scores, and renal and hepatic function were also assessed. Total morphine requirements were not significantly different between the propacetamol (10.6 +/- 4.8 mg) and ketorolac (10.2 +/- 4.4 mg) groups. The evolution of pain intensity and the global efficacy also showed similar patterns in the two groups: 70.2% of patients in the propacetamol group rated the efficacy as "good/ excellent" compared with 68.2% in the ketorolac group. There were no clinically significant changes in vital signs or laboratory values and no observed differences between the two groups, although ketorolac slightly, but not significantly, prolonged the bleeding time. Epigastric pain was present in 9% and 15% of patients receiving propacetamol and ketorolac, respectively. There were two adverse events in the propacetamol group and four in the ketorolac group. Propacetamol demonstrates an efficacy similar to that of ketorolac and has an excellent tolerability after gynecologic surgery. IMPLICATIONS: Propacetamol and ketorolac, combined with patient-controlled analgesia morphine, show similar analgesic efficacy after gynecologic surgery. Morphine consumption and pain scores were comparable in the two studied groups. Propacetamol is as effective as ketorolac and has an excellent tolerability after gynecologic surgery.

Acetaminophen↗
PubMed1999

[Quality control in anesthesia. A new frontier].

For several years now, the need for improving healthcare quality has determined the adoption of a businesslike philosophy in American hospitals, through quality control and improvement systems. In Italy, the introduction of this business concept in public healthcare is recent, while quality assurance is still widely ignored. The anesthesiology wards have a central role in making the DRG mechanism work and therefore need computerised systems that can guarantee correct evaluation of results, analysis of efficacy and quality assurance. The development of a quality control and assurance system in anesthesiology, can be achieved by following a few simple guidelines: to identify the indicators, sensitise the personnel towards an attitude of improvement, adopt a computerised database, verify and elaborate data, correct the defects, verify the changes made to the system.

Anesthesia↗
PubMed1998

An evaluation of propofol toxicity on mouse oocytes and preimplantation embryos.

Mouse biological assays were used to investigate potential adverse effects of propofol on the oocyte's competence to fuse with spermatozoa and on the embryo's ability to develop to the blastocyst stage. Cumulus-enclosed metaphase II oocytes were exposed for 1 h to 0.01, 0.1, 0.4, 1 and 10 microg/ml propofol (Diprivan) and subjected to a sperm-oocyte fusion test based on the dye (Hoechst 33342) transfer technique. Oocytes exposed to 0.4, 1 and 10 microg/ml propofol showed a significant reduction in the rate of sperm fusion and underwent pronuclei formation at a rate similar to that of sperm fusion. In a second trial, mouse 1-cell and 2-cell embryos were exposed to varying propofol concentrations for 14h and then checked for subsequent development. Although adverse effects were not observed in 2-cell embryos, treatment of 1-cell embryos with propofol concentrations ranging from 0.01 to 10 microg/ml resulted in the inhibition of cleavage to blastocyst stage. We conclude that propofol can negatively influence fertilization in the mouse by impairing the oocyte's ability to fuse with spermatozoa, without interfering with the sperm-induced activation of the cell cycle. Moreover, we document the peculiar sensitivity to propofol of mouse 1-cell embryos as compared with 2-cell embryos.

Anesthetics, Intravenous↗
PubMed1998

[Analgesia and anesthesia in obstetrics. Territorial investigation].

BACKGROUND: There is a more and more interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about local experiences. METHODS: This survey on obstetric anesthesia and analgesia in Abruzzo and Molise is based on data obtained from questionnaires of 28 questions sent to all the departments of anesthesiology in the two regions. DISCUSSION: Out of 24 questionnaires sent, 18 were returned. By analysing the replies obtained in this investigation it is clearly pointed out how the possibility of having peridural analgesia during labor is often not available. In fact, only one center is able to guarantee an operative service 24 hours a day. Many colleagues have reported this deficit and in order to improve the situation they have proposed to activate chargeable services for labor analgesia and to increase the staff of anesthetists. Also the data concerning treatment of post vaginal delivery pain are not satisfactory. With regard to the Caesarean sections, locoregional anesthesia is performed in 24% of all cases, while the highest scores are registered in the hospitals of Castel di Sangro and L'Aquila, where general anesthesia is practically never employed. Merely in 67% of all patients postoperative analgesia is carried out on a regular basis. CONCLUSIONS: The data obtained only confirm the extent of a well-known problem. In spite of the growing interest by the medical community, the attention shown for obstetric anesthesia and analgesia is, nevertheless, insufficient, especially due to financial and organizational problems which prevent from establishing a permanent pain therapy center.

Analgesia, Obstetrical↗
PubMed1994

Epidural morphine pretreatment for postepisiotomy pain.

OBJECTIVE/DESIGN: A randomized double-blind controlled study was conducted on two groups of 45 parturients to evaluate the importance of the timing of epidural morphine administration for the relief of postepisiotomy pain. Both groups had preemptive analgesia by continuous lumbar epidural bupivacaine blockade. Upon completion of the episiotomy repair and before the onset of pain, the patients received epidural injections of 3 ml saline with or without 2 mg morphine in groups A and B respectively. When pain appeared, group A patients received an epidural injection of 3 ml saline while group B patients received 2 mg morphine in 3 ml saline. Postepisiotomy pain level was evaluated by a visual analogue scale. RESULTS: The incidence of pain in group B women following epidural morphine administration was 68.6%. This was significantly higher than that of group A at 15.6% (p < 0.01). Furthermore, group B showed that the rate of effective pain relief after 2 mg epidural morphine significantly decreases as the level of pain intensity rises (p < 0.01). CONCLUSION: Epidural morphine for postepisiotomy pain is much more effective if administered before the onset of pain.

Analgesia, Epidural↗
PubMed1994

The effects of perioperative ketorolac infusion on postoperative pain and endocrine-metabolic response.

We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2 mg/h). The control group (n = 47) received an IM bolus of NaCl 0.9% (1 mL) followed by continuous saline infusion (2 mL/h) for 24 h. Operative blood losses, postoperative pain, sedation, and on-demand morphine consumption (patient-controlled analgesia [PCA]) were measured. The effects on plasma catecholamines, cortisol, potassium, creatinine, skin bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT) were also evaluated. Ketorolac improved pain scores (P < 0.05) and reduced plasma cortisol concentrations between 2 and 6 h (P < 0.05). No significant differences were observed concerning operative blood losses, glucose concentration, and renal and hemostatic functions. The ketorolac group required less morphine (not significant [NS]) than the control group and had less adverse effects (P = 0.002). Thus, perioperative ketorolac infusion improved the quality of postoperative pain relief, and had no major influence on endocrine-metabolic response and no negative influences on hemostatic and renal functions. This study suggests that preventive ketorolac administration, followed by a continuous infusion, is an easy, useful, and safe method for pain control after abdominal surgery.

Analgesics↗
PubMed1993

[Effects of clonidine vs trinitroglycerin on myocardial oxygen balance and on pulmonary gas exchange after myocardial revascularization].

The authors examined the effects of clonidine, a preferential alpha-adrenergic agonist, upon myocardial oxygen balance and pulmonary function during the perioperative period in patients undergoing CABG surgery. Anesthesia was provided by fentanyl infusion reaching the final dose of 100 micrograms.kg.min-1 in 10 minutes before skin incision. Ten patients received clonidine 0.125 mg intravenously after induction of anesthesia; a group of 10 patients was managed identically except for nitroglycerin infusion during the pre-CPB period, in order to keep the aortic pressure in the normal range. Intergroup differences in hemodynamics, respiratory data, rewarming time, post-operative ST-tract pattern and enzyme values were evaluated. Results are suggestive (in the clonidine group) for ameliorating myocardial oxygen balance by reducing oxygen consumption indexes (systolic aortic pressure, cardiac index, rate pressure product) and increasing coronary blood flow [coronary perfusion pressure (p < 0.01)] at the end of the surgery and intensive care. Global oxygen consumption reduction, recorded in the clonidine group patients, the oxygen available being unchanged, ameliorated the total oxygen balance mainly after sternotomy (p < 0.05) and at the end of bypass (p < 0.05). Cardiac index was greater during the awakening and rewarming period in intensive care and the ventilatory/perfusion ratio was improved, allowing a minor minute ventilation required in clonidine group patients, specially during admission to intensive care.

Clonidine↗