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M Solca

Publications and source records attributed to M Solca.

At least 19 recordsLinked to original sources
PubMed2000

Anaesthesia with desflurane-nitrous oxide in elderly patients. Comparison with isoflurane-nitrous oxide.

BACKGROUND: Desflurane is a new volatile anaesthetic, very little soluble. We wished to compare efficacy, safety, and emergence and recovers; profiles of desflurane-N2O versus isoflurane-N2O anaesthesia in elderly patients. METHODS EXPERIMENTAL DESIGN: single blind, prospective randomised study. SETTING: operating rooms of two major teaching hospitals affiliated with the University of Milan. PATIENTS: fifty-seven patients ASA physical status II or III, aged 65 or older, undergoing urological (non-endoscopic), orthopaedic or gynaecological (non-laparoscopic) surgery of at least one hour duration, were randomly assigned to receive general anaesthesia with either desflurane or isoflurane in 60% N2O- 40% O2, after standardised premedication and induction. MEASUREMENTS: vital signs, end-tidal agent, narcotic requirement, and adverse event appearance were monitored throughout the study. RESULTS: Twenty-eight patients received desflurane and 29 isoflurane. Demographics, anaesthesia duration and exposure, and intraoperative fentanyl requirement were comparable in the two groups. Immediate emergence from anaesthesia (time to extubation and hand grip on command) was faster in desflurane group, albeit not significantly (8.4 +/- 6.4 vs 11.0 +/- 6.5 min and 8.6 +/- 6.0 vs 11.8 +/- 6.0); on the contrary, early recovery (time to state the name and date of birth) was significantly shorter in patients receiving desflurane (11.1 +/- 6.2 vs 17.3 +/- 7.8 min and 13.1 +/- 6.0 vs 20.9 +/- 10.9 min). Only 24 patients (12 in desflurane and 12 in isoflurane group) did need postoperative fentanyl administration; among them, requirement was significantly higher in desflurane patients (3.4 +/- 1.1 vs 2.4 +/- 1.3 micrograms.kg-1. Total time in recovery room was not different between anaesthetics, as well as adverse event prevalence and severity. CONCLUSIONS: Early recovery in elderly patients is faster after desflurane than isoflurane anaesthesia; this might contribute to increased requirement of postoperative analgesia. Occurrence of adverse event is comparable between the two anaesthetics.

Aged↗
PubMed1996

Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure.

OBJECTIVES: To evaluate the effect of two commonly used heat and moisture exchangers on respiratory function and gas exchange in patients with acute respiratory failure during pressure-support ventilation. DESIGN: Prospective, randomized trial. SETTING: Intensive care unit of a university hospital. PATIENTS: Fourteen patients with moderate acute respiratory failure, receiving pressure-support ventilation. INTERVENTIONS: Patients were assigned randomly to two treatment groups, in which two different heat and moisture exchangers were used: Hygroster (DAR S.p.A., Mirandola, Italy) with higher deadspace and lower resistance (group 1, n = 7), and Hygrobac-S (DAR S.p.A.) with lower deadspace and higher resistance (group 2, n = 7). Patients were assessed at three pressure-support levels: a) baseline (10.3 +/- 2.4 cm H2O for group 1, 9.3 +/- 1.3 cm H2O for group 2); b) 5 cm H2O above baseline; and c) 5 cm H2O below baseline. Measurements obtained with the heat and moisture exchangers were compared with those values obtained using the standard heated hot water humidifier. MEASUREMENTS AND MAIN RESULTS: At baseline pressure-support ventilation, the insertion of both heat and moisture exchangers induced in all patients a significant increase in the following parameters: minute ventilation (12.4 +/- 3.2 to 15.0 +/- 2.6 L/min for group 1, and 11.8 +/- 3.6 to 14.2 +/- 3.5 L/min for group 2); static intrinsic positive end-expiratory pressure (2.9 +/- 2.0 to 5.1 +/- 3.2 cm H2O for group 1, and 2.9 +/- 1.7 to 5.5 +/- 3.0 cm H2O for group 2); ventilatory drive, expressed as P41 (2.7 +/- 2.0 to 5.2 +/- 4.0 cm H2O for group 1, and 3.3 +/- 2.0 to 5.3 +/- 3.0 cm H2O for group 2); and work of breathing, expressed as either power (8.8 +/- 9.4 to 14.5 +/- 10.3 joule/ min for group 1, and 10.5 +/- 7.4 to 16.6 +/- 11.0 joule/min for group 2) or work per liter of ventilation (0.6 +/- 0.6 to 1.0 +/- 0.7 joule/L for group 1, and 0.8 +/- 0.4 to 1.1 +/- 0.5 joule/L. for group 2). These increases also occurred when pressure-support ventilation was both above and below the baseline level, although at high pressure support the increase in work of breathing with heat and moisture exchangers was less evident. Gas exchange was unaffected by heat and moisture exchangers, as minute ventilation increased to compensate for the higher deadspace produced in the circuit by the insertion of heat and moisture exchangers. CONCLUSIONS: The tested heat and moisture exchangers should be used carefully in patients with acute respiratory failure during pressure-support ventilation, since these devices substantially increase minute ventilation, ventilatory drive, and work of breathing. However, an increase in pressure-support ventilation (5 to 10 cm H2O) may compensate for the increased work of breathing.

Acute Disease↗
PubMed1996

Flow cytometric analysis of bronchoalveolar lavage and venous blood lymphocyte phenotype for the diagnosis of acute graft rejection in lung transplant patients. The Lung Transplant Group, Ospedale Maggiore di Milano.

OBJECTIVE: To investigate modifications of phenotype in bronchoalveolar lavage (BAL) and venous blood lymphocytes as markers of acute organ rejection in lung transplant patients. STUDY DESIGN: Five consecutive patients receiving successful single lung transplants between March 1991 and April 1992 were followed for two years; serial bronchoscopies with BAL and transbronchial biopsies (TBBs) were performed. BAL and venous blood lymphocyte cytofluorimetry was performed at every procedure, and an index, (blood T4/T8)/(BAL T4/T8), was computed. RESULTS: The index was always > or = 3 in the two patients who did not have graft rejection and always < 3 in the two patients who had repeated episodes of acute rejection (even when no rejection was apparent). The index was frequently < 3 when cytomegalovirus infection was diagnosed. CONCLUSIONS: Since BAL is far less invasive and carries lower risks than TBB, the index might be considered, if our results are confirmed, for screening patients at high risk of acute rejection. TBB could be used as a confirmatory tool for patients who have an index < 3.

Adult↗
PubMed1995

A new device for mechanical ventilation of infants and small children.

A new device for use with adult ventilators to allow neonatal and paediatric mechanical ventilation is described. It met International Standards Organisation standards during in vitro evaluation and gave good results when applied in vivo to ten children undergoing elective surgery. The device provided a safe and cost-effective means of delivering mechanical ventilation by an adult ventilator to neonatal and paediatric patients receiving general anaesthesia.

Anesthesia, Inhalation↗
PubMed1995

[The use of high resolution computerized tomography (HRCT) for the diagnosis of rejection and for monitoring air-way anastomosis in patients who have undergone lung transplantation. Preliminary study].

March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not appear to be specific for bronchiolitis obliterans, it may be of value in suggesting the diagnosis of early bronchiolitis obliterans in lung transplant. HRCT should be used in all patients with bronchoscopic diagnosis of bronchial complication to study the lesion and its mediastinal spread.

Adult↗
PubMed1995

[Assisted ventilation: experimental evaluation in vitro].

OBJECTIVE: During assist-control mode ventilation (AMV), patients perform external excess work (Wex) to activate the mechanical ventilator itself. Aim of the study was to quantitate such a Wex and evaluate the best ventilator setting in order to minimize it. SETTING: In vitro study, connecting several commercially available mechanical ventilators, with different settings, to an active model lung, developed in our department. METHODS: Gas flow and volume, and airway pressure were measured and digitally recorded; Wex was computed by pressure-volume loops. The maximum negative pressure attained in the circuit (delta Pmax), before the endotracheal tube, the time necessary to reach such a pressure [t(delta Pmax)], from the start of the model lung inspiration, and the time to return to atmospheric pressure [t(P = 0)] after mechanical ventilator activation were also recorded. Different inspiratory flow waveforms (sinusoidal, square and inverted ramp) were tested. RESULTS: Wex was not different between ventilators. However, it was significantly (F8,24 = 2.697, p < 0.05) affected by different flow waveforms: Wex was markedly higher (p < 0.01) with sinusoidal (16.50 +/- 12.12 mJ) than with either square (1.17 +/- 0.96 mJ) or inverted ramp (0.60 +/- 0.70 mJ) inspiratory flow curve. Furthermore, Wex was significantly correlated (p < 0.001) with delta Pmax, t(delta Pmax) and t(p = 0). Those variables are dependent, although not uniquely, upon the trigger mechanism's sensitivity and the ventilator's response time; thus, Wex can be loosely correlated to them as well. CONCLUSIONS: Since AMV is targeted at farily critical patients, whose oxygen consumption might be marginal, every excess work has to be minimized, in order to avoid respiratory fatigue appearance, and worsening of respiratory failure. Prerequisites of a correct AMV application are thus sensitive trigger mechanism, rapid ventilator response to patient's inspiratory effort, and high initial inspiratory flow (inverted ramp or square waveform).

Air Pressure↗
PubMed1993

[Cardiorespiratory changes induced in man by the acute occlusion of the main bronchus].

Following the exclusion of the ventilation of a lung, perfusion is arrested as a consequence of the Von Euler and Liljestrand vasoconstrictive reflex. However it is as yet unknown how long this phenomenon takes to manifest itself in human beings. In order to verify whether hypoxic pulmonary vasoconstriction follows immediately on the arrest of ventilation or whether there is one some delay, in 21 candidates for pneumonectomy a bronchial block was provoked during fibrobronchoscopy and the hemogasanalytic modifications induced by the acute occlusion of the main bronchus have been studied. The analysis of the resulting data allows for the hypothesis that the exclusion of lung ventilation for 14 minutes is not sufficient to cause the complete manifestation of the hypoxic vasoconstrictive reflex.

Aged↗
PubMed1993

Performance of a hydrophobic heat and moisture exchanger at different ambient temperatures.

OBJECTIVE: To evaluate the effect of different room temperatures on hydrophobic heat and moisture exchangers (HME) humidifying capability and efficiency. METHODS: Stock HMEs were tested in vitro using an already described test model, with separation of inspiratory and expiratory gas. Absolute humidity (AH) was measured by means of dry-wet dual thermocouple, and HME efficiency was computed as the ratio between expired to inspired AH, at room temperature of 20 and 26 degrees C. RESULTS: Inspired gas temperature and AH were significantly higher at 26 than at 20 degrees C; since expired AH remained substantially unchanged, HME efficiency was also higher in warmer environment. CONCLUSIONS: Hydrophobic HMEs appear to be affected by room temperature, increasing their humidifying ability and their efficiency with its rise.

Cold Temperature↗
PubMed1993

[Endoscopic monitoring in lung transplantation. Transplantation Group of the Maggiore Policlinico Hospital of Milan].

During the period March 1991-June 1992 5 single lung transplantations were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent regular fibrobronchoscopies within the context of a complex follow-up programme in order to monitor the resolution of the bronchial anastomosis and identify the onset of intercurrent lung infections and rejections using bronchioalveolar lavage (BAL) and transbronchial biopsies (TBB). Forty-four fibrobronchoscopies were performed of which 24 for anastomotic follow-up, BAL and TBB, and 20 for the simple monitoring of the anastomosis. Fibrobronchoscopies confirmed the optimal resolution of bronchial anastomosis in 4 patients, whereas one patient showed a granulomatous anastomotic reaction which was successfully treated using local steroid injections. Although recovery was normal in one patient, kinking appeared in the bronchus of the receiving lung which was successfully treated by the insertion of Gianturco prosthesis. BAL enabled the identification of 2 CMV infections, one Pseudomonas aeruginosa, one Haemophilus influenzae and one Pneumocystis carinii infection. TBB allowed 3 cases of CMW lung infection and 7 episodes of rejection to be diagnosed. The authors' personal experience confirms the decisive role played by bronchoscopy in the follow-up of lung transplant patients. This procedure allowed bronchial anastomosis to be closely monitored and was of vital importance in the diagnosis of lung infections and rejection.

Adult↗
PubMed1991

Combined use of mask CPAP and minitracheotomy as an alternative to endotracheal intubation. Preliminary observation.

We describe the combined use of mask CPAP (continuous positive airway pressure) and minitracheotomy as an alternative to conventional endotracheal intubation in 3 patients requiring CPAP, secretion removal and diagnostic procedures such as bronchoalveolar lavage and bronchial cultures. These requirements were fulfilled with the combined technique approach, thus preserving glottic function and avoiding the disadvantages of endotracheal intubation of tracheotomy. This approach seems particularly suitable in the treatment of immunocompromised patients because of its reduced invasiveness.

Adult↗
PubMed1990

Intrathecal morphine as an adjunct to anesthesia for head and neck surgery.

Within the past 15 years, the use of spinal opiates has gained acceptance as a means of achieving postoperative analgesia during various surgical procedures, though little has been reported concerning such use in head and neck surgery. Our experience with intrathecal morphine for eight patients who have had head and neck surgery is reviewed. Mechanisms of pain and possible sites of action of intrathecal morphine as they pertain to these patients are discussed. Adequate postoperative analgesia was achieved in seven of our eight patients. Only one patient required supplemental intravenous narcotics during the initial 24-hour postoperative period. This patient had a history of chronic narcotic use, suggesting that such patients may be tolerant to intrathecal narcotics as they are to narcotics given by other routes.

Aged↗
PubMed1990

Postoperative analgesia. Use of intrathecal morphine in children.

The identification of opiate receptors in the spinal cord gave rise to the suggestion that the use of intrathecal and epidural narcotics may provide effective and safe postoperative analgesia. The authors retrospectively reviewed the records of ten children who received intrathecal morphine as part of their anesthetic care over the last 2 years. Preservative-free morphine (Duramorph) in a dose of 0.02 mg/kg was administered to all patients in the lumbar intrathecal space before the start of the surgical procedure. Adequate postoperative analgesia was achieved in the ten children. No patient required supplemental analgesic agents for the initial 15-hour postoperative period. Surgical procedures included exploratory laparotomy, laryngotracheoplasty, and craniofacial reconstruction. As with narcotics administered by any route, intrathecal morphine can cause respiratory depression, and such depression may be delayed for up to 24 hours after the dose. Therefore, the postoperative respiratory status of these children should be monitored for 24 hours after the dose, preferably in an intensive care unit. With this caveat, the use of intrathecal morphine provides safe and effective postoperative analgesia in children undergoing major surgery.

Child↗