[The Bengmark tube in surgical practice and in the critically ill patient]. / Il sondino di Bengmark nella pratica chirurgica e nel paziente critico.

Enteral nutrition (EN) is increasingly used to minimize the rate of septic complications related to bacterial translocation, due to its effectiveness and low cost. Bengmark's self-propelling auto-positioning feeding tube (SPT) absorbs and uses gut motility for rapid transport to the upper small intestine, thereby allowing uninterrupted EN both in surgical and critically ill patients. We report on our experience with 175 SPTs applied over the period from December 1996 to February 2000, and analyse the safety, compliance, and indications of SPT in surgical and ICU practice. Open study: feasibility of insertion, time and rate of placement, compliance and complications related to the tube or to EN were studied. SPTs were successfully placed in 40 patients before liver resection, in 32 patients before extensive maxillo-facial surgery MFS and prior to colon resections in 10 cases. SPTs were also applied in 56 patients with acute vascular neurological diseases, 22 in pancreatic diseases and in another 15 critically ill patients. 92.5% of SPT's crossed the pylorus, while only 7.5% stopped in the stomach and 3.4% in the duodenum; 89.14% reached the first jejunal loop. The tip of the tube reached its final position within a mean period of 5.2 hours, 8% instantly and all within 24 hours. Enteral nutrition was started immediately after introduction of the tube into the stomach. The compliance was excellent, even in maxillo-facial surgery patients: only 2/76 patients (2.6%) showed poor compliance. There were no cases of aspiration pneumonia or other complications related to SPT. Polymeric nutrition was usually supplied at a starting flow rate of 45 ml/hour and rapidly increasing over the following 48 h. Eleven patients experienced diarrhoea and 6 abdominal distension, leading to a temporary reduction of the EN flow rate. Clogging of the SPT occurred in 13 patients: 7/13 were cleansed with pancreatic enzymes, but 6 had to be replaced. SPT is ideal for intensive EN and is characterised by minimal complications and excellent patient compliance.

[Hemodynamic and metabolic impairment during hepatectomy: effect of continuous dobutamine infusion]. / Alterazioni emodinamiche e metaboliche in corso di intervento di emiepatectomia: effetto dell'infusione continua di dobutamina.

Following surgical liver resection haemodynamic and metabolic impairment, potentially responsible for post-operative hepatic failure may occur. In this prospective, randomized study such impairments and the effect on them of continuous peri-operative infusion of dobutamine were examined. Twelve patients, scheduled for hepatectomy, were divided in two groups: Group I was treated with an infusion of dobutamine 6 micrograms/kg/min from 10 minutes before the induction of anaesthesia till the fifth postoperative hour; Group II was considered as the control group. The main haemodynamic parameters, gastric pHi and serum lactate level were examined. No significant differences were detected in heart rate, parameters of pressure and SvO2. In both groups, during portal clamp, SVR increased while Cl and DO2 decreased with respect to basal and the other intra- and postoperative values. Gastric pHi decreased in both groups after portal clamp. These alterations were significantly lower in the group treated with dobutamine when compared with the control group. Serum lactate level increased in both groups. This increase was lower in Group I. Differences between groups were not statistically significant. In conclusion, during hepatectomy important haemodynamic and metabolic impairments occur. Dobutamine, by reducing such impairments, can be usefully employed in this kind of surgery.

[Peridural administration of low-dose morphine on demand following major abdominal surgery]. / Somministrazione peridurale di morfina in basse dosi a domanda nel postoperatorio della chirurgia addominale maggiore.

The present report deals with 20 patients undergoing major abdominal surgery, in whom a postoperative antalgic regimen has been administered on demand by means of morphine via lumbar peridural catheter. We injected 3 mg as the first dose after surgery and subsequent 2 mg doses when required. In each patient we controlled regularly for 72 hours the following: respiratory function, antalgic effects and side effects. We concluded that this technique is fit to obtain good analgesia with rare and mild side-effects.

[Psychologic implications in loco-regional anesthesia]. / Implicazioni psicologiche in anestesia loco-regionale.

A patients, who undergoes surgery, bears so stressful an emotional charge that his personality layout and life conflicts may emerge. When a patient is scheduled for loco-regional anaesthesia, the above mentioned issues should be taken into account to get a proper relation between the patient and the anaesthetist both in the pre- and intraoperative period. The following survey deals with psychological dynamics which compel the patient to ask for or reject a loco-regional anaesthetic procedure. Suggestions are also provided in order to manage adequately the anxiety and the hidden fears of the patient.

[Surgical treatment of isthmic coarctation of the aorta by left subclavian artery post-isthmic aortic by-pass]. / Trattamento chirurgico della coartazione istmica dell'aorta mediante by-pass tra arteria succlavia sinistra e aorta post-istmica.

Between May 1978 and July 1981 at the Department of Cardiovascular Surgery, Padua University Medical School in Verona, 10 patients with coarctation of the aorta underwent surgical treatment with a by-pass between the left subclavian artery and the descending aorta. A synthetic fibre graft was employed. The patient's age varied between 20 and 46 years and all were hypertensive: 160-220 mmHg systolic, 90-110 diastolic pressure. No hospital deaths occurred. Blood pressure decreased significantly in all patients as well as their electrocardiographic signs of left ventricular hypertrophy.