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Biomedical subjects

G Varrassi

Publications and source records attributed to G Varrassi.

At least 55 records · Page 3Linked to original sources
PubMed1982

[Analytical findings in the X-ray fluorescence of blood levels of bromine in subjects anesthetized with halothane].

Bromine concentration in the blood of seven patients anesthetized with Halothane are determined at different time before, during and after anesthetic induction. X.R.F. technique was employed in the analytical determinations using a new background correction method which assume a linear relationship between primary Compton in matrix of monocromathic source radiation and background counts. Mini mun Detectable Limits are of - 5 p.p.m. and accuracy of 3% at 20-30 p.p.m. concentration. 24 h after anesthesia Bromine levels are always significantly high (-20 p.p.m.); the clinical importance of these data are discussed.

Anesthesia↗
PubMed1980

[Chemical rhizotomy using phenol in the treatment of perineal pain of neoplastic origin].

The Authors report the results obtained in 53 patients treated with intrathecal injections of 5% phenol in glycerin for the control of serve pain caused by rectal and genital cancer. The method used for determining the sensory roots to be blocked and the technique of drug administration are described. The effects of subarachnoid phenol blockade have been evaluated on the basis of pain relief (measured by the visual analogue test) and improved general well being. The observed results indicate that this is one of the most effective and safest procedures in the management of perineal cancer cancer pain.

Denervation↗
PubMed1980

[Althesin-induced EEG changes in patients with central nervous system lesions].

The EEG changes produced by Althesin (75 microliter/kg intravenously administered over 60 sec) were evaluated in 18 unpremedicated patients wih CNS diseases who were scheduled for cerebral angiography. Three parameters were analyzed: the EEG patterns of anaesthesia, the appearance of a fast activity during stabilized burst suppression (Level V), and enhancement of the registered epileptiform abnormalities. The EEG depth of anaesthesia was correlated with the EEG pattern at rest and the preexisting neurological signs. The 15 Hz fast activity which occurred during the suppression phase of Level V was recorded unilaterally over the healthy hemisphere, while it was observed bilaterally in a case involving lesion of the midline structures. The exaltation of the epileptiform EEG discharges following Althesin administration suggests that this agent might be utilized as a convenient provocative test in the diagnosis of epilepsy.

Alfaxalone Alfadolone Mixture↗
PubMedDate not supplied

Epidural mepivacaine for cesarean section: effects of a pH-adjusted solution.

STUDY OBJECTIVE: To determine the clinical effects of the alkalinization of 2% mepivacaine with epinephrine used for epidural block during cesarean section. DESIGN: Randomized, double-blind, placebo-controlled (standard commercial preparation of 2% mepivacaine with epinephrine) study. SETTING: Inpatient obstetric department at a general hospital. PATIENTS: Seventy patients scheduled for elective cesarean section under epidural anesthesia. INTERVENTIONS: Two groups of 35 patients each receiving either the standard commercial preparation of mepivacaine or the pH-adjusted solution (prepared with the addition of 0.1 meq/ml of sodium bicarbonate to the standard commercial solution). MEASUREMENTS AND MAIN RESULTS: Measurements of sensory (pinprick) and motor (Bromage's criteria) block were taken at 1- to 2-minute intervals beginning after the completion of the epidural injection. Increasing the pH of the mepivacaine resulted in a significant shortening of the time of analgesia onset (9.3 minutes compared with 16.01 minutes, p less than 0.01) and of peak effect (11.1 minutes compared with 21.2 minutes, p less than 0.01). The alkalinization did not affect duration of the block, intensity of motor block, or mean dose of local anesthetic used. CONCLUSION: The alkalinization allowed the surgery to proceed more rapidly, significantly decreasing the time interval between epidural block and delivery of the infant.

Adult↗
PubMedDate not supplied

Which induction drug for cesarean section? A comparison of thiopental sodium, propofol, and midazolam.

STUDY OBJECTIVE: To determine maternal and neonatal effects of three different induction drugs (thiopental sodium, propofol, and midazolam) for cesarean section. DESIGN: Randomized, double-blind study. SETTING: Inpatient obstetric department at a general hospital. PATIENTS: 90 healthy patients undergoing elective cesarean section with general anesthesia. INTERVENTIONS: 3 groups of 30 patients each receiving thiopental 5 mg/kg, propofol 2.4 mg/kg, or midazolam 0.3 mg/kg for induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Time to induce anesthesia, hemodynamic changes, depth of anesthesia, recovery after anesthesia, placental transfer, and neonatal outcome (Apgar and neurobehavioral examinations) were studied. In the thiopental and midazolam groups, systolic blood pressure and heart rate rose following endotracheal intubation and skin incision (p < 0.001 and p < 0.0025, respectively), while in the propofol group, there was significant hypotension after induction (p < 0.005). Electroencephalographic patterns showed a light depth of anesthesia with propofol and midazolam between anesthesia induction and delivery, confirmed by the presence of clinical signs of light anesthesia in 50% of propofol patients and 43% of midazolam patients. Time to induce anesthesia was longer with midazolam (p < 0.0001). Neonates in the midazolam and propofol groups had lower Apgar and neurobehavioral scores than those in the thiopental group. Umbilical artery to umbilical vein ratios were above 1 in the propofol and midazolam groups. CONCLUSION: Thiopental still remains the first-choice induction drug for cesarean section. The slow induction time with midazolam may put the mother at risk for pulmonary inhalation. A plane of anesthesia that may risk awareness and potential neonatal depression is the main drawback of the two newer induction drugs.

Adult↗
PubMedDate not supplied

Nutrition support after total laryngectomy.

This study was performed to evaluate the influence of different nutrition supports (enteral vs parenteral) on nutritional status, postoperative complications, and length of hospitalization in patients undergoing total laryngectomy. Forty-eight patients were divided at random into two groups and received enteral nutrition support by percutaneous endoscopic gastrostomy with a casein and soy-based polymeric formula blended with a modular protein (group A) or a balanced formula in total parenteral nutrition given through a subclavian venous catheter (group B). The results show a satisfactory preservation of nutritional status after total laryngectomy and no significant differences in the nutritional parameters between groups fed enterally or parenterally; however, percutaneous endoscopic gastrostomy could avoid many problems related to enteral nutrition support for patients undergoing laryngectomy. This route of administration was well tolerated by all the patients and, moreover, the percutaneous endoscopic gastrostomy-related complications were clinically less significant than those associated with total parenteral nutrition; this fact could explain the longer hospitalization for group B (34 +/- 11 vs 26 +/- 11 days) (p < .05).

Aged↗
PubMedDate not supplied

[The current status of obstetric analgesia and anesthesia in Italy].

BACKGROUND: There is a more and more vivid interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about the Italian reality. Aim of the study was to evaluate the current state of obstetric analgesia and anesthesia and create an interest for anesthesiologists in a professionally and scientifically interesting field. METHODS DESIGN: transversal study of clinical observation of the Italian situation based on questionnaires composed of 20 multiple choice and closed questions, addressed to chief anesthesiologists of 220 randomized Italian hospitals. SETTING: 220 Italian hospitals having a capacity of more than 100 beds. RESULTS: Out of the 220 questionnaires, 91 were returned. Merely 17 hospitals guaranteed a permanent peridural analgesic service. To improve this situation, anesthesiologists call for introducing chargeable services and increasing the medical staff. In spite of the widely documented advantages that regional anesthesia offers for maternal and fetal well-being, this technique is practised in only 26% of cesarean sections. This percentage is greatly higher than that obtained from a similar experience in 1991, where the use of regional anesthesia technique was of 3-4%. In 11 hospitals postoperative analgesia is not carried out on a regular basis. CONCLUSIONS: Even though the general opinion is showing a growing interest for obstetric analgesia and anesthesia, it has not yet reached the same dignity as in other countries.

Analgesia, Obstetrical↗
PubMedDate not supplied

[Use of remifentanil in ambulatory obstetric-gynecologic surgery. A dose-effect study].

BACKGROUND: Remifentanil, a recently commercialised opioid, is characterised by a predictable and non cumulative effect which vanishes rapidly without determining side effects in the long term. These characteristics make remifentanil an ideal opioid in continuous infusion for the ambulatory surgery setting. Aim of this study was to assess the ideal dose of remifentanil, administered in bolus before propofol, in patients undergoing uterine curettage and assisted by mask ventilation in 100% oxygen. METHODS: Sixty patients, ASA status I-II, scheduled for uterine curettage, were divided into three study groups according to the bolus dose of remifentanil received before the induction agent: group A (n = 20) 1 microgram/kg; group B (n = 20) 2 micrograms/kg; group C (n = 20) 2 micrograms/kg. All patients were assisted by 100% oxygen ventilation with facial mask. During surgery the following were recorded: time to spontaneous ventilation (in case of post induction apnea); incidence of somatic and autonomic responses to surgical stress (treated with remifentanil in bolus). At the end of surgery the times to response to simple verbal commands, to discharge from the recovery room (by Aldrete score every 5') and to discharge from hospital (by PADSS score every 30') were registered. RESULTS: All patients presented post-induction apnea with a significantly more rapid return to spontaneous ventilation in group A. Six patients of group A responded to surgical stress while in groups B and C there was no need for supplementary boluses (p < 0.05). Five patients of group C were treated with atropine for bradycardia, in four of group C it was necessary to administer succinylcholine for thoracic rigidity. No significant differences regarding the anesthesia recovery times were observed. All patients were discharged from the recovery room after 10' from the end of surgery. Overall, the qualification for discharge from hospital was obtained at the second PADSS score control, except for one group A patient who incurred in metrorrhagia. CONCLUSIONS: The administration in bolus of remifentanil, before the inducing agent, permits short-term surgery in ambulatory surgery settings thanks to the rapid recovery of vital functions. Compared to the other doses, the 1.5 micrograms/kg dose guaranteed a good control over surgical stress without influencing the speed of awakening and without determining uncomfortable side effects.

Adult↗
PubMedDate not supplied

[Clinical use of spinal or epidural steroids].

Steroids, drugs with potent antiinflammatory properties on the damaged nervous roots, have been especially used as adjuvants of local anesthetics, by spinal route, in the treatments of low-back pain. Spinal route was chosen to obtain a higher local concentration of drug, with few systemic side effects and to improve drug's action mechanism. Steroids seem to interact with GABA receptors and thus control neural excitability through a stabilising effect on membranes, modification of nervous conduction and membrane hyperpolarization, in supraspinal and spinal site. Epidural steroids are especially used in the treatment of low back pain due to irritation of nervous roots. They have been administered alone or in association with local anesthetics and/or saline solution. Slow release formulations have been generally used (methylprednisolone acetate, and triamcinolone diacetate). Other indications of epidural steroids are: postoperative hemilaminectomy pain, prevention of post herpetic neuralgia, degenerative ostheoartrithis. Intra-thecal steroids have been frequently used in the treatment of lumbar radiculopathy due to discopathy, as an alternative treatment when epidural administration is ineffective. Positive results have been obtained with methylprednisolone acetate, alone or in association with local anesthetics. Complications related to intraspinal steroids injections are due to execution of the block and side effects of drugs. Complications associated with intrathecal steroids are more frequent and severe than epidural injections and include: adhesive arachnoiditis, aseptic meningitis, cauda equina syndrome. Steroidal toxicity seems to be related to the polyethylenic glycole vehicle. Anyway, slow release formulations contain less concentrated polyethylenic glycole. The epidural administration, a correct dilution of steroid with local anesthetics solution and/or saline solution, and a limited number of injections (no more than three) allows a significant reduction of steroid neurotoxicity.

Analgesia, Epidural↗
PubMedDate not supplied

Parenteral nutrition in ventilated patients with chronic obstructive pulmonary disease: long chain vs medium chain triglycerides.

AIM: The aim of this study was to assess the usefulness of a lipid formulation containing a physical mixture of medium (MCT) and long chain triglycerides (LCT) compared with a long chain triglycerides emulsion in patients affected by chronic obstructive pulmonary disease with acute respiratory failure. METHODS: Twenty-four patients requiring mechanical ventilation were randomly selected in 2 groups and received total parenteral nutrition. Twelve patients received a MCT/LCT emulsion (50:50), the others used a 100% LCT emulsion. Nutritional status, metabolic rate, time of ventilatory support and weaning were evaluated. RESULTS: Both groups showed an improvement of all nutritional parameters evaluated; oxygen uptake, carbon dioxide output and respiratory gas exchange ratio were similar in both groups. The duration of mechanical ventilation was not significantly different; however, the time of weaning in the MCT/LCT group was significantly shorter. The longer weaning time in the LCT group patients could be related to vasoactive intermediates deriving from long chain fatty acids. The T-cell subsets, which were evaluated for both groups, showed a significant decrease of T helper-T suppressor ratio in the LCT group. CONCLUSION: MCT/LCT emulsion is an effective lipid supplementation and should be considered the therapy of choice in COPD patients; however, the relationship between lipid emulsions administered and length of weaning requires further investigations.

Aged↗
PubMedDate not supplied

[Diazepam versus midazolam for "wakeful sedation" in oral surgery].

I.v. midazolam was compared with diazepam in 112 dental outpatients in order to obtain a control of sedation. Midazolam has shown better results in all the parameters evaluated (memory scale, pharmacokinetics and pharmacodynamics values) and in controlling sedation. The Authors consider midazolam as a preferred drug in dental outpatients and hope to get it available also in Italy.

Adolescent↗