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Biomedical subjects

P Busoni

Publications and source records attributed to P Busoni.

At least 19 recordsLinked to original sources
PubMed2004

Incidence of vomiting in susceptible children under regional analgesia with two different anaesthetic techniques.

BACKGROUND: Postoperative vomiting (POV) is a frequent side-effect of paediatric surgery and a leading cause of unplanned admission. Many antiemetic drugs have been studied, but less attention has been given to the effects on POV of the anaesthetic technique adopted. The aim of this study was to compare two different anaesthetic techniques in children under regional analgesia at risk for POV. METHODS: We studied 135 children suffering from motion sickness or with a previous history of POV. The patients were randomized to receive inhalation anaesthesia (group S) with sevoflurane by LMA or intravenous (i.v.) anaesthesia with ketamine and propofol (group P). All the patients were treated with an ilio-inguinal block after induction of anaesthesia. Postoperatively, the children were followed by the nursing staff and by their parents, none of whom were aware of the anaesthesia technique used. RESULTS: A significant decrease was observed in the incidence of early (0-6 h) and delayed (6-24 h) POV in those children who received i.v. sedation. There was no difference between the two groups in the level of analgesia either at the end of surgery or 2 h postoperatively. CONCLUSIONS: Anaesthesia based on propofol and ketamine is better than inhalation anaesthesia with sevoflurane by LMA for reducing POV in children at risk under an ilio-inguinal block. Tailoring the anaesthetic to the specific needs of children susceptible to POV should be considered before resorting to the routine use of expensive antiemetic prophylaxis.

Anesthesia, Conduction↗
PubMed2002

The use of the cuffed oropharyngeal airway in paediatric patients.

BACKGROUND: The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suitable for anaesthetized adult patients undergoing either spontaneous or mechanical ventilation. There are few reports on the use of the COPA in children. In this study, the authors assessed the COPA in paediatric patients undergoing minor surgery. METHODS: The same anaesthesiologist inserted the COPA in 40 consecutive paediatric patients, ASA I and II, aged 1.8-15.3 years. (7.4 +/- 3.9), after induction of anaesthesia with N2O/O2/sevoflurane. COPA size was chosen by measuring the distal tip of the device at the angle of the jaw with the COPA perpendicular to the patient's bed. The proper positioning of the COPA was assessed by observing thoracoabdominal movements, regular capnograph trace, the reservoir bag movements and SpO2 > 94% with a fraction of inspired oxygen of 0.5. Anaesthesia was maintained with 1 MAC halothane, sevoflurane, or isoflurane in N2O/O2 (50%) and the patients were spontaneously breathing. The stability of the COPA following changes in head, neck and body position was tested. We recorded the duration time for COPA insertion, the side-effects of placement of the COPA and during the intraoperative period, the number of attempts, the type of manipulation in order to provide an effective airway and postoperative symptoms, such as the presence of blood on the device, sore throat, neckache, jaw pain and PONV. RESULTS: Successful COPA insertion at the first attempt was 90% and at the second attempt in the remaining 10%. The most frequent airway manipulations were head tilt in 27.5% (obtained by a pillow under shoulders) and chin lift in 5%. No complications both at COPA placement nor during the intraoperative period were observed. On the basis of weight and age, the COPA size was no. 8 in 50%, no. 9 in 30%, no. 10 in 12.5%, and no. 11 in 7.5%. The COPA demonstrated stability after changes in head, neck and body position. Postoperative complications were the presence of blood stains in one case and PONV in six cases (15%). CONCLUSIONS: The COPA is an extratracheal airway device suitable in paediatric patients undergoing general anaesthesia with spontaneous ventilation for minor surgery and other painful procedures. This study shows that for paediatric patients: (i) complications seem to be rare; (ii) the COPA allows hands free anaesthesia; (iii) specific indication for the COPA could be obese patients with a small mouth; and (iv) COPA sizing can be easily established by the weight or age of the patients.

Adolescent↗
PubMed2000

Vomiting and common paediatric surgery.

Postoperative vomiting is a common and unpleasant complication. The purpose of the present study was to verify if dexamethasone reduces the incidence of vomiting when injected IV in children anaesthetized with halothane for common paediatric operations. We also studied the incidence of vomiting when sevoflurane was used instead. Five hundred and 69 boys, aged 2-12 years (ASA physical status I, II), scheduled for inguinal field surgery were randomly assigned to receive halothane, halothane and dexamethasone and sevoflurane in three groups: halothane (n=180), halothane and IV dexamethasone (n=188) and sevoflurane (n=201). Anaesthesia was induced by inhalation of halothane or sevoflurane in oxygen and nitrous oxide and was maintained at minimum alveolar concentration of each agent throughout the surgery. For intra- and postoperative pain control iliac crest block was used in all the boys. Vomiting was defined as any expulsion of liquid gastric contents. The incidence of postoperative vomiting was 23% in the halothane group, which was significantly greater than that in the other groups (halothane and dexamethasone group, 9%; sevoflurane group, 13%). In conclusion, dexamethasone reduces the incidence and frequency of multiple emetic episodes when administered intravenously after halothane anaesthesia; sevoflurane reduces the overall incidence of vomiting, but not multiple emetic episodes.

Anesthetics, Inhalation↗
PubMed1997

[Perioperative thermal homeostasis. A duty of the anesthesiologist].

Anaesthesia, surgical procedures and operating room temperature can deeply alter the human thermoregulatory system. Unexpected and sometimes serious perioperative complications can occur. Many studies have been carried out in order to describe and evaluate the detrimental effects produced by different anaesthesia procedures (whether by general, regional or integrated anaesthesia) on thermic homeostasis. More recently it has also been reported that perioperative hypothermia significantly affects patients' outcome, increasing intraoperative blood losses, incidence of postoperative wound infection, and hospital stay. Italian anaesthetists have still a poor consideration about intraoperative body temperature monitoring and patients' warming as basic important skills for a better anaesthesiologic patients management. According with the literature, we do believe that this is not a right opinion. The purpose of the present paper would be to point out the most important knowledges concerning thermic homeostasis management, in order to increase anaesthesiologist's awareness in this essential field of patients perioperative care.

Anesthesia↗
PubMed1996

Arrhythmias and ischemia-like ECG changes in Reye's syndrome.

We report a fatal case of a child presenting Reye's syndrome associated with a variety of arrhythmias and ischemia-like ST-T ECG changes. At autopsy, fatty infiltration and patchy myocytolysis were detected in sections of the heart. This case report emphasizes cardiac involvement in Reye's syndrome and the possible mechanisms of arrhythmias in this disease.

Arrhythmias, Cardiac↗
PubMed1994

[Effects of ondansetron and metoclopramide on postoperative nausea and vomiting after epidural anesthesia in children].

We studied the preventive effect on postoperative nausea and vomiting (PONV) of ondansetron, metoclopramide and placebo associated with epidural anaesthesia. Sixty children, ASA I or II, 4 to 12 yr old underwent surgery for inguinal hernia repair (n = 30) or orchidopexy (n = 30). Children were randomly assigned to a postinduction intravenous medication group, ondansetron (5 mg.m-2), metoclopramide (0,12 mg.kg-1) or a saline solution placebo. After a general anaesthesia was obtained with halothane, nitrous oxide and oxygen delivered by mask, caudal or lumbar epidural anaesthesia was performed with plain mepivacaine. General performed with plain mepivacaine. General anaesthesia was interrupted and light narcosis maintained with diazepam during surgery. There were no significant differences in age and weight between the three groups. There were no adverse reactions to either ondansetron or metoclopramide. vomiting was not present in ondansetron group. The incidence of postoperative emesis in the metoclopramide group was 25%, whereas that of placebo group was 10%. The administration of ondansetron was associated with a lower (P = 0.017) incidence of postoperative vomiting if compared to the metoclopramide group. In conclusion ondansetron given preoperatively had proven to be an effective treatment for PONV after epidural block for lower abdominal surgery.

Anesthesia, Epidural↗
PubMed1992

[Trans-sacral extradural anesthesia in pediatrics].

Between 1988 and 1991 1,714 extradural anaesthesias by the transsacral or lumbosacral route have been performed. The anesthetic has always been mepivacaine 1%. Puncture between sacral vertebrae was practiced in 1,308 cases and by the lumbosacral approach in 406. Anaesthesia was for urogenital surgery in the majority of cases but also for orthopedic, abdominal and thoracic surgery. There have been 12 failures (0.7%) and a total of failures and complications was registered numbering 42 or 2.47%. No serious complication occurred.

Anesthesia, Caudal↗
PubMed1991

The lumbosacral epidural block: a modified Taylor approach for abdominal urologic surgery in children.

We describe the lumbosacral epidural approach in 97 children undergoing abdominal urologic surgical procedures. Due to the rudimentary spinous process of the first sacral vertebra and the less prominent sacral angle, an appropriate upward inclination of the Tuohy needle in the midline is always possible in infants and small children. A catheter was easily inserted in every case and the technique was shown to be useful and safe for providing adequate intraoperative and postoperative pain control.

Adolescent↗