[Evaluation of a protocol of health surveillance for the personnel exposed to inhalation anesthetics in a sample of 3 operating rooms]. / Valutazione di un protocollo di sorveglianza sanitaria per il personale esposto ad anestetici inalatori in tre sale operatorie campione.

OBJECTIVES: To verify the results of a health surveillance protocol for personnel exposed to inhalation anaesthetics. DESIGN: Yearly follow-up of operating room personnel. SETTING: Operating theatres of a university hospital; one "clean" room with waste anaesthetic scavengers, a second older room an thus "dirty", a third room with appropriate technical requirements, but with a considerable environmental emission of anaesthetics. PATIENTS OR PARTICIPANTS: Twenty-four technical surgical assistants and anaesthesiologists. INTERVENTION OR METHODS: Determination of the number of changes of air by means of concentration decay; determination of the baseline and final value of the environmental anaesthetics by infrared photoacoustic spectroscopy; analysis of the microclimate and inspection of the equipment. Determination of anaesthetics in the urine of personnel at the end of the work shift, using a gas-chromatograph with head space. Yearly medical check-up and blood tests. RESULTS: In the first year of observation we found values of nitrous oxide in one room and of isoflurane in all three rooms which exceeded the upper limit value. Acceptable values in all the rooms were detected during the second year. The values of anaesthetics found in urine samples reflected those measured in the rooms. Personnel reported subjective symptoms, but no blood alterations related to exposure were found. CONCLUSIONS: The application of the protocol has allow us to estimate the level of pollution and to suggest behavioral rules and technical precautions that have decreased the emission of anaesthetics in the environment. Blood tests are not a valid index of possible damage caused by exposure.

[Anesthesiology problems for implant and explant of left ventricular Novacor systems]. / Problematiche anestesiologiche per l'impianto e l'espianto di sistemi di assistenza ventricolare sinistra Novacor.

OBJECTIVES: To review experience with anaesthetic management in patients undergoing a left ventricular assist system (LVAS) Novacor implant as a bridge to cardiac transplantation. DESIGN: Retrospective clinical study. SETTING: Cardiothoracic operating room in a university hospital. PATIENTS: Nine, aged 37-62 years, suffering from 8 dilated and 1 postischemic cardiomyopathy at end stage heart failure. INTERVENTIONS OR METHODS: Under general anaesthesia and cardio-pulmonary bypass the LVAS pump is placed in the abdomen and connected to the left ventricle through an inflow cannula and to the aorta through an outflow cannula. The pump has an output of 5-7 l/min and works in synchronous counterpulsation with the left ventricle. RESULTS: The mean Novacor support has been 75.56 days (DS +/- 85.95). Five out of 9 patients have been transplanted, while 3 are still waiting at home. Pretransplant CI was on average 1.66 l/min/m2 (DS +/- 0.27) and REF 11.44% (DS +/- 5.29); after the Novacor implant CI was 3.44 (DS +/- 0.49) and REF 22.22% (DS +/- 4.49). CONCLUSIONS: A LVAS can bridge patients to heart transplantation while improving or preserving their health conditions. Some factors are to be taken into account for the anaesthesiological management of the implant/explant of a LVAS: the patients' poor clinical conditions; the knowledge of the components and functioning of the LVAS that conditions the choice of the anaesthesiological drugs and volemia; the unassisted right ventricle function that has to be pharmacologically supported; the bleeding problem because of the adherences during the explant surgery.

Management of anesthesia during dynamic cardiomyoplasty.

STUDY OBJECTIVE: To review experience with anesthetic management in ten patients undergoing dynamic cardiomyoplasty (CMPL), a new surgical technique that serves as an alternative to heart transplantation. DESIGN: Retrospective clinical study. SETTING: Cardiothoracic operating room at a university hospital. PATIENTS: Ten male functional New York Heart Association (NYHA) class III and IV patients, aged 39 to 60 years, awaiting heart transplantation, 7 of whom were diagnosed with dilated cardiomyopathy, 3 with postischemic cardiomyopathy. INTERVENTIONS: Under general anesthesia, the latissimus dorsi muscle was harvested and rotated into the chest through a window in the second rib. The muscle was then wrapped around the heart. Starting from the second postoperative week, the latissimus dorsi was stimulated to provide assistance to a failing heart. MEASUREMENTS AND MAIN RESULTS: The mean left ventricular ejection fraction (LVEF) of the 10 patients was 24.89% +/- 9.17% (range 10% to 37%). No intraoperative death occurred. Two patients died of multiple organ failure and an apparent arrhythmia on the 15th and 25th postoperative days, respectively. The rest of the patients regained good working capacity postoperatively, as evidenced by improvement in NYHA grade. Nevertheless, the LVEF improved in only one patient. No significant differences were evident between preoperative and postoperative blood values, hemodynamic data, or spirometry. CONCLUSIONS: Dynamic CMPL is a considerable challenge for the anesthesiologist because these patients have poor cardiac reserve preoperatively and do not benefit from the procedure in the first two postoperative weeks. To date, CMPL seems to be an important alternative to heart transplantation because experience has shown an improvement in the quality of life with low intraoperative and postoperative complications.

[Intravenous versus inhalation anesthetics in anesthesia for bone marrow harvest for transplantation]. / Anestetici endovenosi versus inalatori nell'anestesia per il prelievo di midollo osseo a scopo di trapianto.

It is well known that nitrous oxide and many volatile anaesthetic drugs possess a certain degree of myelodepressive activity. The authors' aim has been to evaluate the degree of proliferative activity after exposure to forane or propofol. Bone marrow samples have been cultured after general anaesthesia induced and maintained by the same agents; cultures have also been performed after samples exposure to forane and propofol. The results have not shown significative differences in the haemopoietic colonies growth of bone marrow harvested from patients underwent intravenous or inhalatory anaesthesia. In vitro study has shown a significative variation of the colonies growth at the forane higher concentration. Intravenous anaesthetic may be safer for bone marrow harvest for transplantation.

[Drepanocytosis in patients undergoing heart surgery. Anesthesiologic problems]. / Drepanocitosi in pazienti sottoposti a chirurgia cardiaca. Problematiche anestesiologiche.

The authors report their experience with the management of patients with sickle cell trait undergoing open heart surgery. They focus their attention mainly on those factors potentially able to precipitate episodes of sickling, i.e. hypoxia, hypothermia, vascular stasis and acidosis.

[Anesthesia and the chemotaxis of neutrophilic granulocytes in newborn infants]. / Anestesia e chemiotassi dei granulociti neutrofili nel neonato.

The authors investigated the modifications of neutrophil chemotaxis and cortisol plasma levels in the newborn delivered by cesarean section or vaginal delivery. Chemotaxis turned out to be higher in the group undergoing cesarean section, while cortisol was lower in this group. The increased activity of neutrophils can be explained with the lessened inhibitory effect of endogenous steroids and with the stimulating action of nitrous oxide.

[Anesthesiologic management for lower pulmonary lobectomy intervention in patients with heart transplant. A clinical case]. / Condotta anestesiologica per intervento di lobectomia polmonare inferiore in paziente cardiotrapiantato. Caso clinico.

The Authors describe the case of a patient who had undergone human allograft cardiac transplant seven months before inferior pulmonary lobectomy for neoplasia. The pulmonary neoplasia had been revealed by X-rays during the periodic check-up examinations. Because of the high risk of infection following corticosteroid and immunosuppressive therapy, sterile equipment for invasive monitoring and oro-tracheal intubation has been used. The denervated heart presents peculiar haemodynamic and pharmacological aspects that the anaesthetist must pay attention to in the conduction of a general anaesthesia; moreover, arrhythmias are common in the recently transplanted heart. Anaesthesia has been induced and maintained by an association propofol-fentanyl that showed a good cardiocirculatory stability; neither arrhythmias have happened, nor the need for drugs different from those of anaesthesia and resuscitation have occurred.

Effect of fentanyl-oxygen anesthesia during cardiac surgery on serum thyroid hormones.

Twenty-five euthyroid patients who underwent cardiac surgery with fentanyl-oxygen anesthesia were studied. The authors confirm that some thyroid hormones undoubtedly take part in a non-specific pool of reactions caused by surgical stress. For one or more days, all the patients had total triiodothyronine (TT3) and free triiodothyronine (FT3) levels clearly below the normal values, with a parallel increase in reverse triiodothyronine (rT3, biologically inactive). Changes in total (TT4) and free thyroxine (FT4), although significant, were smaller and hard to interpret. The most important changes occurred on the first postoperative day. Of seven patients who before the operation had a TT3 value below the lower normal limit, six had at discharge a mean TT3 level significantly above it. Serum TT3 concentrations could be a reliable prognostic index. High-dose fentanyl anesthesia probably does not affect thyroid hormone response to surgical stress. To date, the mechanisms which cause reduction of serum triiodothyronine have not been fully discovered and it is not known for certain whether this reduction is beneficial to the human organism.