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Biomedical subjects

R Ranieri

Publications and source records attributed to R Ranieri.

At least 19 recordsLinked to original sources
PubMed2005

Impact of influenza vaccine on response to vaccination with pneumococcal vaccine in HIV patients.

The clinical effectiveness of 23-valent pneumococcal vaccine in human immunodeficiency virus (HIV)-infected patients is controversial, because of the low immunological response in these subjects. We studied the clinical response of pneumococcal vaccine and the relative impact of influenza vaccine by administering both pneumococcal and influenza vaccine in a group of 150 HIV patients belonging to all CDC categories. In the group of 90 HIV-infected patients vaccinated against both pneumonia and influenza virus, there was a low incidence of mild influenza (13.3%) and no case of pneumococcal pneumonia. On the contrary, among 60 nonvaccinated HIV patients, 61.6% underwent mild to severe influenza and two developed pneumococcal pneumonia. 23-valent pneumococcal vaccine (PV) seems to be clinically effective in preventing pneumonia in HIV-infected patients, and even more if strengthened by influenza vaccine.

Adult↗
PubMed2002

Effects of remifentanil infusion bis-titrated on early recovery for obese outpatients undergoing laparoscopic cholecystectomy.

BACKGROUND: In obese patients functional residual capacity comes down with a possible hypoxemia in postoperative period. In fact many studies has been begun to determine optimum ventilation regulation and the best position for these patients, but the question has not been solved. As remifentanil can reduce of 50% the inhalatory anaesthetic request and reverse Trendelemburg position is extremely useful for these patients, we hypothesized that use of a continuous remifentanil infusion during balanced anaesthesia with sevoflurane, BIS-titrated, associated to reverse Trendelem-burg position could facilitate emergence from anaesthesia in obese patients undergoing laparascopic cholecystectomy. METHODS: We studied 40 patients, ASA II class, with higher than 30 kg/m2 body mass index, undergoing to laparoscopic cholecystectomy. All the patients, in operating room, received standard monitoring and BIS sensor application. All the data were continuously collected. Induction of anaesthesia has been with a refracted bolus in 120 sec of remifentanil 1 mg/kg, followed by propofol 1.5 mg/kg and cisatracurium 0.15 mg/kg. Maintenance of anaesthesia has been by balanced anaesthesia with continuous remifentanil infusion, ventilating patients with sevoflurane in oxygen and air. Patients were randomized into two homogenous groups. Into the control group has been varied sevoflurane inspiratory concentration on the ground of BIS value (from 0.3% to 3%), while into remifentanil group remifentanil infusion has been varied (from 0.25 to 2 mg/kg/min) to maintain medium pressure values which don't stray more than 25% from basal values, on the ground of BIS values. On pre-established times of operation, respiratory mechanics and blood gases were examined. RESULTS: As it was to expect, sevoflurane concentration variations resulted very high in control group compared to remifentanil group. Awakening time, extubation, orientation and transfer to PACU (postanaesthesia care unit) resulted significantly lower than remifentanil group. CONCLUSIONS: Concluding, remifentanil infusion, BIS-titrated, facilitates awakening times from balanced anaesthesia with Sevoflurane in obese patients, submitted to laparoscopic cholecystectomy.

Adult↗
PubMed2001

Airway management with the Combitube during anaesthesia and in an emergency.

The oesophageal-tracheal Combitube (Kendall-Sheridan Catheter Corp., Argyle, NY) is a device designed for difficult airways and emergency intubation. The manufacturer recommends that the Combitube size 37F SA be used in patients with a height of between 122 and 152 cm. The aim of this study was to evaluate whether ventilation is effective and reliable in anaesthetized patients taller than 152 cm using the size 37F SA in the oesophageal position. We also evaluated whether airway protection is adequate and whether direct intubation of the trachea with the Combitube inserted in the oesophagus is possible. We studied 15 adult patients undergoing routine general anaesthesia and 20 patients who required emergency intubation following trauma. They were between 150 and 180 cm in height. Under direct vision, a size 37F SA Combitube was inserted into the oesophagus of all the patients undergoing routine general anaesthesia (control group). Blind insertion was performed in the emergency patients (emergency group). The pharyngeal balloon was inflated with a volume titrated to air leak and cuff pressures were measured. During surgery, a laryngoscope was inserted into the pharynx with the pharyngeal balloon deflated and the laryngoscopic view was evaluated using the Cormack-Lehane scale. Ventilation was effective and reliable in all 35 patients who were between 150 and 180 cm in height. In addition, a direct relationship between the pharyngeal balloon volume and patient height was established (P<0.05), using linear regression models. The laryngoscopic view of the glottis was adequate to allow direct tracheal intubation in patients in the control group, so that the Combitube size 37F SA may be used in patients from 122 to 185 cm in height. The trachea could be directly intubated with the Combitube in the oesophageal position in patients with normal airways and in patients involved in trauma. In all patients in the emergency group, blind insertion of the Combitube resulted in the device being placed in the oesophagus. The airway protection appears to be adequate.

Adult↗
PubMed2001

Volatile anesthesia in bariatric surgery.

BACKGROUND: Obesity causes anesthesiologists a broad variety of perioperative theoretical and practical problems. The aim of this study was to compare two protocols of anesthesia employing Isoflurane and Sevoflurane and evaluate the cardiorespiratory parameters, postoperative recovery and analgesia. METHODS: 90 patients underwent biliopancreatic diversion. 60 patients (group A) received Isoflurane and 30 patients (group B) were anesthetized with Sevoflurane. Intraoperative monitoring consisted of EKG, invasive arterial pressure, SpO2, EtCO2, Etanest, Spirometry, urinary output and TOF. Cardiorespiratory parameters and end tidal expiratory concentrations of volatile agents were collected during specific phases of surgery: 1) before induction of anesthesia, 2) after intubation, 3) after skin incision, 4) after positioning of costal retractors, 5) in the reverse Trendelenburg position, 6) end of surgery. During the postoperative period the Aldrete test was carried out to evaluate the recovery from anesthesia. VAS was administered for 6 hours after the end of surgery to set the quality of analgesia. RESULTS: No statistically significant differences in cardiorespiratory parameters were found between the two groups. Extubation time was significantly less in the Sevoflurane Group than in the Isoflurane (15 +/- 7 min vs 24 +/- 5 min, p < 0.05). The Sevoflurane Group showed an Aldrete score significantly higher than the Isoflurane (8.8 +/- 0.3 vs 8.1 +/- 0.4, p < 0.05). VAS values did not show statistical differences. CONCLUSION: The introduction of Sevoflurane, a volatile agent with rapid pharmacokinetic properties, seems to offer an interesting application in these patients.

Adult↗
PubMed2001

Bispectral index monitoring in sevoflurane and remifentanil anesthesia. Analysis of drugs management and immediate recovery.

BACKGROUND: Recent studies have suggested that electroencephalogram bispectral index (BIS) monitoring can improve recovery after anaesthesia and save money by shortening patients postoperative stay. The aim of the study is to evaluate the management of drugs and to measure immediate recovery after anaesthesia with or without BIS monitoring. METHODS: We studied 90 patients undergoing abdominal surgery randomly allocated to one of two groups of 45 each with or without BIS monitoring. Standard monitoring (EKG, arterial oxygen saturation and non-invasive blood pressure) was applied. All groups were monitored with BIS, using electrodes (Zipprep, Aspect Medical Systems) applied to the forehead. In the group 2 the BIS value was blinded to the anaesthesiologist. The BIS value was displayed using Spacelabs Medical BIS Ultraview Monitor. After obtaining baseline values for the BIS index (group 1) and haemodynamic data (all groups) anaesthesia was induced with a bolus dose of remifentanil and TPS, and vecuronium. The anaesthesia was maintained with Remifentanil and Sevoflurane. At standard times BIS, haemodynamic and respiratory parameters were recorded. Recovery times were measured by a study coordinator. Drug consumption was calculated. RESULTS: In group 1 the consumption of Sevoflurane decreased by 40 % while the consumption of remifentanil decreased by 10 % as compared to group 2. The use of vecuronium did not change in the 2 groups. In group 1 the time elapsed from cessation of anaesthetics to orientation decreased significantly. The difference was 5 min, from 11 to 6 min. CONCLUSIONS: BIS monitoring decrease both sevoflurane and remifentanil consumption, when compared to anaesthesia without BIS, with an immediate recovery after sevoflurane and remifentanil anaesthesia.

Adult↗
PubMed2001

Effects of sevoflurane versus propofol on QT interval.

BACKGROUND: Prolongation of the QT interval is an alteration of the electrocardiogram (ECG) that may result in a potentially dangerous polymorphic ventricular tachycardia known as torsade de pointes. Michaloudis et al. investigated the effect of isoflurane and halothane on the QT interval in premedicated and non premedicated children, and in premedicated adults. Isoflurane significantly prolonged the QTc interval, in contrast to halothane, which shortened the QTc interval. The aim of the study was to evaluate the effect of sevoflurane on the QT interval in patients undergoing non-cardiac surgery. METHODS: One hundred and eighty patients classified as ASA physical status I-III were enrolled and 102 were excluded. Patients had been scheduled for elective non cardiac surgery. Exclusions criteria were: cardiovascular impairment or chronic obstructive lung disease, medication affecting QT interval, and an abnormal prolongation of the QTc interval (440 ms). The patients were then randomly allocated to one of two groups, one receiving sevoflurane anesthesia and the other receiving propofol anesthesia. In all patients, a 12 lead ECG was recorded before surgery, after intubation, after extubation. The investigators reading the ECG were blinded to the type of induction and anesthesia used. The following variables were recorded or calculated: heart rate, P-R interval, QRS interval, QT interval, QTc interval according to Bazett's formula, systolic, diastolic and mean blood pressure. RESULTS: The sevoflurane significantly prolongs the QT and the QTc interval, whereas the induction and total intravenous anesthesia with propofol significantly shortens the QT but not the QTc interval. CONCLUSIONS: The amount the sevoflurane-associated QT prolongation may possibly be of clinical significance in some patients presenting long QT syndrome, hypokalemia, or in presence of other agents or factors that lengthen QT.

Adult↗
PubMed2000

The effects of the reverse trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery.

Anesthesia adversely affects respiratory function, particularly in morbidly obese patients. Although many studies have been performed to determine the optimal ventilatory settings in these patients, this question has not been answered. The aim of this study was to evaluate the effect of reverse Trendelenburg position (RTP) on gas exchange and respiratory mechanics in 15 obese patients undergoing biliopancreatic diversion. A standardized anesthetic regimen was used and patients were examined at standard times: 1) after tracheal intubation, 2) after laparotomy, 3) after positioning of subcostal retractors, 4) with retractors in RTP. The measurements of respiratory mechanics were repeated for a wide range of tidal volumes by using the technique of rapid occlusion during constant flow inflation. We noted a wide alveolar-arterial oxygen difference [P(A-a)O(2)] in all patients, particularly during Phase 3. When the patients were placed in RTP, P(A-a)O(2) showed a significant improvement and a return toward baseline values. As for mechanics, total respiratory system compliance was significantly higher in RTP than in the other phases. In conclusion, our data suggest that RTP is an appropriate intraoperative posture for obese subjects because it causes minimal arterial blood pressure changes and improves oxygenation.

Adult↗
PubMed1999

Haemodynamic changes detected during open prostatectomy and transurethral resection for benign prostatic hyperplasia.

To detect possible intraoperative haemodynamic differences, 60 patients undergoing transurethral (n = 18) or open prostatectomy (n = 42) for benign prostatic hyperplasia were evaluated. The same type of general anaesthesia was used in the two groups. Data, including temperature and cardiac output, were collected at five standard times during the procedures. No significant differences were found between the two groups. However, in all patients, irrespective of the operation, significant decreases in cardiac output and increases in systemic resistance occurred during surgery. Body temperature showed a mild, insignificant decrease, which may play a role in determining the mild haemodynamic derangement observed in all patients. Our patients subjected to open prostatectomy and transurethral resection presented the same kind of haemodynamic derangement, with no significant differences. Therefore it seems unlikely that the kind of surgery could play a relevant role in the late mortality rate of these patients.

Aged↗
PubMed1998

Maintenance and recovery characteristics of sevoflurane anaesthesia in adult patients. A multicenter, randomized comparison with isoflurane.

BACKGROUND: The goal of the present multicenter, prospective, randomized clinical investigation was to compare the clinical efficacy and safety of sevoflurane and isoflurane during maintenance of and recovery from general anaesthesia in adult patients. METHODS: With the approval of the Ethical Committee and the patient informed consent, 143 ASA physical status I-II patients, aged 18-65 years, were randomized in order to receive either isoflurane (n = 71) or sevoflurane (n = 72) as the main general anaesthetic. After an oral diazepam (0.1-0.2 mg kg-1) and atropine (0.007-0.01 mg kg-1) premedication and a standardized intravenous induction, general anaesthesia was maintained by adjusting the end-tidal concentrations of the inhalational agent for the maintainance of cardiovascular stability. At the end of surgery the anaesthetic vapours were discontinued, and the neuromuscular block was reversed; the following times were recorded: time of eyes opening, time of command response and suitability for discharge from the recovery area. The occurrence of any untoward event was also recorded. Preoperatively and 24 hr after surgery, blood was collected in order to assess renal an hepatic functions. RESULTS: No differences in demography, duration of surgery, exposure to the inhalational agent and haemodynamic effects were observed between the two groups. Patients receiving sevoflurane showed shorter times for the achievement of extubation (median: 9 min versus 13 min, p = 0.002), eyes opening (median: 10 min versus 13 min, p = 0.002), command response (11 min versus 15 min, p = 0.002) and suitability for discharge from recovery room (median: 19 min versus 22 min, p < 0.05) than those receiving isofluorane. No intra- and intergroup differences were observed in pre- and post-operative laboratory testing of renal and hepatic function. DISCUSSION: We conclude that sevoflurane, when compared to isoflurane, provides a similarly safe maintenance but allows for a more rapid emergence from general anaesthesia.

Adolescent↗
PubMed1995

Paroxystic hypertension in a long-term hemodialyzed patient. Successful adrenalectomy for a dopamine-producing pheochromocytoma.

Pheochromocytoma (Pheo) is an uncommon neoplasm producing blood pressure troubles and it may be undiagnosed in chronic dialyzed patients in whom hypertension is a common finding. The symptoms in Pheo syndrome depends on the prevalent catecholamine released, the most common being epinephrine (E) and norepinephrine (NE). Recently, a particular clinical picture has been described for dopamine (DA)-producing Pheos, in whom a normo-hypotensive status is more often observed. The authors report a case of mainly dopamine-producing Pheo in a long-term dialyzed patient, successfully treated with adrenalectomy. The main steps in diagnosis and preoperative management are described and debated also in view of the particular background produced by the end-stage renal failure. The common imaging techniques adopted for adrenal medullary neoplasms (US, CT, MIBG scintiscan) confirmed to be decisive for diagnosis; HPLC assay of plasma catecholamines is the only biochemical test available in these patients although its significance is questionable due to the poor knowledge of catecholamine metabolism in chronic renal failure. The clinical findings observed in this case seem in disagreement with those already reported in DA producing Pheos. Pheo in hemodialyzed patients is a rare event and it may be hidden by other more common causes of hypertension. However, more awareness from the medical staff allows to diagnose the neoplasm correctly by the currently available methods and to plan a safe surgical therapy also in high-risk patients.

Adrenal Gland Neoplasms↗
PubMed1994

Anesthetic management of pheochromocytoma in a long term hemodialysed patient.

The anesthetic management of a hemodialyzed patient with a dopamine producing pheochromocytoma is described. A 56-years old man underwent surgical procedure the day after hemodialysis. Prior to intervention adrenal cortex hormones were normal as well as other endocrine variables (T3-T4-TSH-cortisol-ACTH-parathyroid hormone); epinephrine and norepinephrine, were in a normal range while dopamine was elevated (185 pg/ml). Preoperatively the patient was alpha-blocked with oral phenoxybenzamine (20 mg/day). A balanced anesthesia was performed (isoflurane and fentanyl). Plasma catecholamines were determined. During the induction of anesthesia and before tracheal intubation phentolamine and labetalol were injected till 3.4 mg and 50 mg total dose respectively. During surgical manipulation a nitroglycerin infusion was started (1.5 gamma/kg/min) and after tumor resection dopamine was given till 15 gamma/kg/min. Hormonal values increased in presence of unchanged hemodynamic parameters, likely due to alpha and/or beta blockade. In this case report our problem was especially fluid replacement after tumor resection, because of renal failure. On the basis of CVP and PCWP values, fluid treatment and dopamine infusion allowed to achieve an adequate preload. A sufficient level of analgesia and an efficient alpha blockade may assure hemodynamic stability also in a so compromised patient status.

Adrenal Gland Neoplasms↗
PubMed1991

[Serologic study on the prevalence of HIV, HBV infection and on the false positive reaction of VDRL at a prison].

Prisoners are considered to be a high risk population for HIV and HBV infection. Aim of this study was to determine the prevalence of HIV, HBV infection and of the VDRL false positivity by performing screening tests in 496 prisoners of Monza in 1987. About a third of prisoners was HIV infected (with a high prevalence in drug addicts) and about a half had a contact with HBV virus. We observed a very common association between HIV and HBV infections. About ten per cent of HIV infected presented a false positivity for VDRL while one per cent of not infected did. Our data show that in Italian prison HIV and HBV infections are spreadly diffused. False positivity for VDRL may be due not only to drug addiction but also to the immunological variations connected with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Possibility of prenatal ultrasonic diagnosis of growth defects in fetal long bones. Report of a case].

Recent advances in echographic diagnosis and its application during the first three months of pregnancy provide a direct method for assessment in both normal and pathological pregnancies. Given their frequency, the study was focused on the congenital structural anomalies of fetal limbs. The possibility of the repetition of these malformations in the same patient is very high, ranging from 2-25%. It is therefore extremely important to use echographic monitoring during pregnancy in order to observe and measure with great precision the lengths of the limbs and individual bones in fetuses at risk at an early stage of their development.

Adult↗