Anaesthesia for shock wave therapy in musculoskeletal disorders: a preliminary report.

The potential for using external applied energy to rectify or ameliorate musculoskeletal disorders has been explored for decades. A shock wave is a pressure disturbance: tissue effect is cavitation, producing microtrauma or microfracture and haematoma formation, inducing, as to date is thought, increase in vascularization, increased soft callus and faster enchondral ossification. Anaesthesiological interest in this field is focused in non-union or delayed osseous union, joint stiffness or osteochondrosis and femoral head necrosis in adults. Actually, because of the pain associated with high energy extracorporeal shock wave therapy on bones, anaesthesia is necessary, but, since almost all patients have no complaint after treatment, there is no need of postoperative analgesia. Therefore, short duration anaesthetic techniques and agents should be preferred. Loco-regional anaesthesia or general anaesthesia are both suitable to the purpose. Fifty patients have been treated nowadays in our Institution with shock wave therapy needing anaesthesia. 18 patients (36%) received general anaesthesia. Since patient's stay in hospital was expected to be short, short duration agents have been used, avoiding those causing unpleasent side effects, first emesis. We used Propofol or Remifentanil by continuous infusion, titrated to maintain stable haemodynamics and an appropriate level of anaesthesia. The short duration of action of Propofol depends on its rapid elimination, whereas Remifentanil undergoes rapid biotransformation to minimally active metabolites. 32 patients (64%) received regional anaesthesia. We avoided long acting agents or high concentration drugs. Spinal blocks have been performed with 0.5% hyperbaric bupivacaine; brachial plexus blocks, sciatic-femoral blocks and an epidural block have been performed with 0.5-1% xylocaine or 1% mepivacaine. Shock Wave Therapy has been done during a 3-day hospital stay. With suitable anaesthesiological treatment and preparation, almost all patients could be treated as outpatients or with an overnight hospital stay.

[Anesthesia for laparoscopic cholecystectomy: the use of nitrous oxide in the anesthetic mixture]. / Anestesia per colecistectomia laparoscopica: utilizzo del protossido d'azoto nella miscela anestetica.

A study carried out on 44 patients undergoing laparoscopic cholecystectomy was started in order to evaluate if nitrous oxide is or not contraindicated. The patients were divided in two groups of 22 subjects receiving or not nitrous oxide in the anaesthetic mixture. All the patients received the same preanaesthetic medication (diazepam and atrophine), thiopental and fentanyl as induction drugs, vecuronium as muscle relaxant and isoflurane for maintenance of anaesthesia. Bowel distension, technical difficulty, incidence of postoperative nausea and vomiting were examined. Our conclusions were that nitrous oxide has no clinically deleterious effects during laparoscopic cholecystectomy.

[The use of subarachnoid bupivacaine analgesia in malignant hyperthermia-susceptible subjects. A clinical case report]. / Impiego dell'analgesia subaracnoidea con bupivacaina in soggetti suscettibili di ipertermia maligna. Descrizione di un caso clinico.

The authors report a case of malignant hyperthermia in susceptible woman undergoing safenectomy. Spinal anesthesia with bupivacaine was performed after dantrolene prophylaxis per os. No complications occurred during and after surgery. This case confirms the safety of local anesthetics and it suggests that anaesthesia should not be refused to caffeine halothane contracture test positive patients.

[Peridural anesthesia and adrenocortical function in man]. / Anestesia peridurale nell'uomo e funzione corticosurrenale.

A brief account of the stress action of anaesthetic drugs is followed by the description of an evaluation of plasma cortisol concentration in an enquiry into the effects of peridural anaesthesia with bupivacaine.

Lysine hydrochloride for the control of metabolic alkalosis: a clinical report.

Many physiopathological states can produce metabolic alkalosis that must be promptly corrected as soon as it is dangerous. In our study we report the effectiveness of lysine hydrochloride to correct this condition in patients. This drug lowers the pH, reduces the bicarbonate stores, and leads to normal blood gases.

Distribution of free amino acids in coma due to acute barbiturate poisoning in guinea pigs.

The cerebral protein and amino acid concentrations in guinea pigs coma due to barbiturate poisoning have been studies. Some significant alterations in systemic and central amino acid patterns have been found, giving rise to a hypothesis about the biochemical pathways involved in the coma. An attempt to correlate the amino acid changes and cerebral energetic 'need' is also reported.