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Biomedical subjects

M Gemma

Publications and source records attributed to M Gemma.

At least 19 recordsLinked to original sources
PubMed2005

An Italian survey of severe head trauma management during extracranial surgery.

BACKGROUND AND OBJECTIVE: Anaesthetic drugs and procedures interfere with secondary brain injury following severe head trauma, yet studies regarding the anaesthetic management of these patients are lacking. We investigated the behaviour of Italian anaesthetists regarding this topic. METHODS: A questionnaire investigating the approach to a patient with severe head trauma requiring an urgent splenectomy for ruptured spleen was sent to 250 Italian anaesthetists. Questions regarded the pre-, intra- and postoperative phases, and concerned the rationale use and availability of specific monitoring systems, and indications for invasive procedures and use of drugs, fluids and blood products. RESULTS: There were 162 (64.8%) responders. Seventy-five percent believed that early tracheal intubation within the emergency room was necessary, while 25% postponed it to the operating room. Basic monitoring was defined as essential by all responders, 147 (90.7%) considered invasive arterial pressure monitoring to be essential. Fifty-seven (84%) anaesthetists working in hospitals without neurosurgical facilities would have transferred the patient after splenectomy. Prophylactic hyperventilation was frequently used (36%). Sixty-eight percent of responders would have preferred in intracranial pressure monitoring inserted before laparotomy, but only 35% actually had this possibility. In case of acute intraoperative arterial hypotension after splenectomy, 54% of the responders advocated the use of blood or blood products to optimize peripheral oxygen transport. CONCLUSIONS: More widespread knowledge of certain areas of severe head trauma management such as early tracheal intubation, avoidance of prophylactic hyperventilation, adequate invasive monitoring, appropriate use of blood products, and timing of transfer to hospitals with neurosurgical facilities is needed.

Anesthesia↗
PubMed2002

Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up.

BACKGROUND: To compare surgical tracheostomy (ST) versus percutaneous dilatational tracheostomy (PDT) in terms of complication rates. In particular we specifically studied the late tracheal complications of both methods by means of endoscopic controls of patients up to 6 months after the procedures. METHODS DESIGN: prospective-randomized clinical study. SETTING: University-affiliated tertiary care referral hospital. PATIENTS: 50 consecutive translaryngeally intubated patients with respiratory failure were randomized to undergo either ST (25 patients) or endoscopic guided PDT (25 patients). RESULTS: ST was performed in 41+/-14 min versus 14+/-6 min for PDT (p<0.0001). There was no procedure-related death. In the ST group there were no intraoperative complications. In the PDT group 2 intraoperative complications (minor hemorrhages) were observed. In the ST group 9 early postoperative complications occurred: one minor bleeding, 7 stomal infections and one accidental decannulation. In the PDT group only one early postoperative complication (minor bleeding) occurred. Early postoperative complication rates were 36% for ST and 4% for PDT. In the ST group there were no late tracheal complications. In the PDT group 2 late tracheal complications (one segmental malacia and one stenosis at the level of the stoma) were observed. CONCLUSIONS: This study confirms that PDT is a simpler and quicker procedure than ST and that it has a lower rate of early postoperative complications. Late tracheal complications were more frequent, although the difference was not statistically-significant, in the PDT group. Further investigations of long-term outcome following PDT are therefore necessary.

Adult↗
PubMed1998

Complications of internal jugular vein retrograde catheterization.

We report on the incidence of complications of 172 internal jugular vein retrograde catheterizations (IJVRCs) performed on 126 patients. Standard cannulation and X-ray control of the catheter tip placement were performed. Difficulties encountered during the manouvre were registered. Patients with a jugular catheter in place for more than one day had neck echography on catheter removal and one week later. Carotid artery puncture occurred in 20 (12%) cases and lymphatic vessel puncture in one. In 13 (8%) cases IJVRC failed due to difficulties in advancing the guide. X-ray films documented catheter misplacement in 39 (23%) cases: loop into the internal jugular vein in 11 (6%); paravertebral venous plexus cannulated in one; other extracranial jugular afferent cannulated in 4 (2%); catheter tip into the jugular lumen in 10 (6%); catheter tip beyond the jugular bulb in 13 (8%). First neck echography documented: one perivascular hematoma (absent one week later); 3 (4%) jugular vein thrombosis (2 asymptomatic and absent one week later; one symptomatic and still evident one week later). Positive neck echography was not associated with difficulties, length of catheterization, diameter of the catheter. IJVRC is a simple and safe procedure with a low incidence of serious complications.

Adult↗
PubMed1998

[Seizures associated with acute subarachnoid hemorrhage. Emergency diagnosis and treatment].

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.

Acute Disease↗
PubMed1997

7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures.

This prospective randomized clinical study was designed to compare the effects of equal volumes of 7.5% hypertonic saline solution (HS) or 20% mannitol (M) on brain bulk and lumbar cerebrospinal fluid pressure (CSFP) during elective neurosurgical procedures (aneurysm, arteriovenous malformation, or tumor). After informed consent, 50 American Society of Anesthesiologists physical Status I (ASA I) patients were randomly assigned to M (n = 25) or HS (n = 25) groups. Anesthesia protocol was identical for both, and variables monitored included mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), CSF pressure (CSFP), arterial blood gases (PaCO2 30-35 mm Hg), serum sodium, potassium, and osmolality, and diuresis. The study period started before hypertonic solution administration (T0) and ended at the opening of the dura mater or 60 min after T0. Data were assessed with repeated measures analysis of variance and Student t test with Bonferroni correction (p < or = 0.05). MAP and CVP were the same in the two groups. After treatment, osmolality increased, and the increase at T15 was higher in HS-treated patients [316.6 +/- 9.3 vs. 304.0 +/- 12.0 (SD) mOsmol/kg; p < 0.001]. Sodium decreased after M and increased after HS. During the study, brain bulk was always considered satisfactory. CSFP was not different between M and HS groups and significantly decreased overtime (p = 0.0056) with no difference between treatments. The results of the present study demonstrate that hypertonic saline is as effective as mannitol in reducing the brain bulk and the CSFP during elective neurosurgical procedures under general anesthesia.

Blood Pressure↗
PubMed1996

Hypertonic saline fluid therapy following brain stem trauma.

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.

Accidents, Traffic↗
PubMed1994

Neurologic symptoms after epidural anaesthesia. Report of three cases.

We describe 3 patients, who exhibited neurological symptoms after single dose epidural anaesthesia. In patient 1 an unrecognized spinal arteriovenous fistula (AVF) caused paraparesis following epidural block. The dilated veins draining an AVF are space-occupying structures and the injection of the anaesthetic solution may have precipitated latent ischaemic hypoxia of the spinal cord due to raised venous pressure. In patient 2, epidural block was followed by postoperative permanent saddle pain and hypoaesthesia. The injection of the anaesthetic in a narrow spinal canal with multiple discal protrusions and restriction of interlaminar foramina may have acutely produced mechanical compression of the spinal cord or roots. Patient 3 exhibited post-epidural block spinal arachnoiditis. Although the few reported cases of this syndrome exhibit severe neurological damage, our patient presented with scarse symptoms. Our cases point out the importance of accurate neurological history and examination of candidates for epidural anaesthesia and of accurate anaesthetic history for neurological patients.

Adult↗
PubMed1993

Combined central and peripheral acute demyelination.

We describe a patient with multiple sclerosis who had a bout of central demyelination associated with an acute inflammatory demyelinating polyneuropathy. The contemporary involvement of central and peripheral nervous system due to a demyelinating disease has been reported anecdotically in humans, and can be induced experimentally in animals. It may be sustained by a common pathogenetic factor.

Adult↗
PubMed1992

Neurological examination in patients recovering from general anesthesia.

We performed serial neurological evaluations on 86 patients who underwent surgery for herniated lumbar disk during the first 3 hours after the end of anesthesia (isoflurane-N20-02 for 25 patients, halothane-N20-02 for 38, fentanyl-droperidol-N20-02 for 23). At time 0, the idiomuscular response to percussion of the extensor carpi muscle was present in every patient, while tendon reflexes were always absent. Hyperreflexia was as frequent as shivering, but it took place earlier; we could determine no correlation between these two phenomena. There was no correlation between shivering and rectal temperature of the patients. Although almost all the patients were cooperative and could correctly calculate 100-7, the post-hyperventilation-apnea test was positive in 35 patients at time 120 minutes: this suggests that many patients considered "awake" still exhibit neurological abnormalities, such as inadequate respiratory drive.

Adolescent↗