Sufentanil-propofol vs remifentanil-propofol during total intravenous anesthesia for neurosurgery. A multicentre study.

BACKGROUND: In a randomised, prospective multi-centre study, we compared the intraoperative and postoperative effects of two opioids: sufentanil and remifentanil, in combination with propofol in two groups of patients undergoing neurosurgery. METHODS: After Local Ethics Committee approval and informed consent obtaining, 69 patients undergoing neurosurgery for supratentorial tumours, between 18 and 75 years of age were randomised to receive either sufentanil or remifentanil in combination with propofol. Intraoperative and postoperative haemodynamic variables, recovery times (time to eye opening and to extubation), the incidence of postoperative respiratory depression, pain, nausea and vomiting were also evaluated. The Short Orientation-Memory-Concentration Test was used to evaluate cognitive function at 15, 45 and 180 min after emergence from anesthesia. RESULTS: There were no significant differences between the groups in the duration of surgery and anesthesia, mean arterial pressure, heart rate, time to eye opening or extubation. The incidence of vomiting, respiratory depression and shivering was similar in both groups. Postoperative pain requiring supplemental analgesics was significantly lower in the sufentanil group (P<0.05). Although there were no significant differences between the groups in postoperative behavioural examinations by Rancho Los Amigos Test, patients anesthetised with sufentanil had significantly better Short Orientation-Memory-Concentration Test values at 15 and 180 min postoperatively (P<0.05). CONCLUSION. We conclude that remifentanil and sufentanil are suitable adjunct to propofol for total intravenous anesthesia (TIVA). Patients receiving sufentanil have reduced analgesic requirements and better cognitive function postoperatively than those who received remifentanil.

A simplified endoscopic third ventriculostomy under local anesthesia.

The aim of this study is the analysis of our experience with awake endoscopic third ventriculostomy (ETVS) in hydrocephalic patients. From September 1994 to December 2001, 24 neuroendoscopic procedures were performed under local anesthesia. Local infiltration was administered using a bupivacaine and lidocaine mixture. Analgesics were titrated to the effect. A free-hand technique with a flexible endoscope was adopted in 24 patients with primitive and secondary (neoplastic) hydrocephalus. ETVS was performed successfully in all cases. No procedure needed to be discontinued due to seizures, bleeding or agitation. Dural incision/coagulation and Fogarty dilatation proved to be the most painful maneuvers requiring, sometimes, supplemental analgesic administration. No intraoperative complications were observed; however, two asymptomatic trajectory hematomas were incidentally discovered two and three days after the operation, respectively. Awake ETVS is a valuable alternative procedure that can be adopted in adult cooperative patients, provided that the procedure is done in an essential and fast way with the free-hand technique, by means of a flexible endoscope, and with the assistance of an anesthesiologist.

[Epidemiological study of Chlamydia trachomatis infection in a sample of women requesting voluntary termination of pregnancy, treated with rokitamycin]. / Studio epidemiologico sull'infezione da Chlamydia trachomatis in un campione di donne che richiedono l'IVG trattate con rokitamicina.

BACKGROUND: Infection with Chlamydia trachomatis usually involves the cervix uteri, causing no symptoms, and may easily be unrecognised and untreated until troublesome symptoms arise, such as pelvic inflammatory disease, which can affect fertility and reproductive life. Therapies include the macrolide antibiotics, and in this class rokitamycin offers marked lipophilia, excellent intracellular penetration, and bactericidal activity at concentrations close to the MIC. The present study was therefore designed to establish the frequency of intracervical infection with Chlamydia trachomatis in women applying for termination of pregnancy, and to assess the efficacy and safety of this drug in this indication. METHODS: Women aged 18-40 years were admitted for termination of pregnancy, with a positive cervical swab for Chlamydia trachomatis. The study was conducted in accordance with the Declaration of Helsinki and amendments. Patients were given one oral tablet of 400 mg rokitamycin in the morning, and one in the evening, for two weeks. Treatment started ten days before the termination, within 48 h of taking the swab. Partners were to receive the same treatment. RESULTS: 292 women requiring termination of pregnancy, on average at the 9th week of pregnancy, were assessed. Of these, 24 (8.2%), mean (+/- SD) age 27.1 +/- 6.1 years, range 18-39, with a positive cervical swab for Chlamydia trachomatis, were treated with rokitamycin; 22 of their partners were treated too. Forty days after the start of treatment 22 patients (92%) gave negative results; these were all the cases whose partners had received treatment. No adverse events were reported and the acceptability of the treatment was considered good or excellent in 91% and fair in 9% of the cases. CONCLUSIONS: The findings confirm that rokitamycin is one of the most useful and effective macrolides for the treatment of infections caused by intracellular microorganisms; it is extremely well tolerated and has marked microbiological efficacy.

Case report acute respiratory failure after posterior cranial fossa surgery: report of two cases with unusual etiology.

Acute respiratory failure (ARF) occurred in two patients who had normal preoperative findings and intraoperative courses, early after posterior cranial fossa (PCF) surgery. In both instances, the postoperative pulmonary failure appeared to be due to an unknown pulmonary cancer, revealed by autopsy. The diagnosis of an asymptomatic pulmonary malignancy might be considered in the presence of ARF of unclear etiology in patients who undergo PCF surgery for removal of a brain tumor.

Autologous hemodonation in the corrective surgery of craniostenosis.

Homologous transfusions are mandatory in most surgical procedures for correcting craniofacial malformations in infancy. A program of preoperative and intraoperative auto-hemodonation was developed and carried out in eleven infants. Although homologous transfusion could have been avoided in only 7 patients, we think that further experiences and minor corrections of our program may improve these results.

[Autotransfusion technic in surgery of craniostenoses in children]. / Tecniche di autoemodonazione nella chirurgia delle craniostenosi in età infantile.

The extensive blood loss during the surgical correction of craniosynostosis in infancy needs usually homologous transfusion. The Authors report a program of preoperative and intraoperative hemodilution and their experience in six infants, the very first in pediatric neurosurgery. Prevention of homologous blood transfusion achieved in 4 out 6 cases can be considered a success that could be further improved introducing minor changes in our protocol.

Premedicación con diazepam, o droperidol, o con diazepam y droperidol por vía oral e inducción de la hipnosis con hidrato de cloral: estudio controlado en niños sometidos a tomografía axial, computarizada / Premedication with diazepam or droperidol or with diazepam and droperidol by oral way and induction of the hypnosis with hydrate of chloral: controlled study in children subjected to axial computarized tomography

120 niños, en edades comprendidas entre 0 y 48 meses, que debían ser sometidos a la T.A.C., fueron premedicados con diazepam, o droperidol o con diazepam + droperidol y dormidos con 25 mg./Kg.-1 de hidrato de cloral. Los resultados obtenidos demostraron que la asociación de droperidol 0,2 mg./kg.-1 + diazepam 0,2 mg./Kg-1 por vía oral potencia los efectos hipnóticos del hidrato de cloral, 30 minutos después de la ingestión de los fármacos de premedicación, en una mayor medida respecto a las mismas dosis de droperidol o diazepam, administrados singularmente. La anestesia obtenida se demostró segura en casi la totalidad de los pacientes y no alteró el curso normal del estudio neuroradiológico

Premedicación con diazepam, o droperidol, o con diazepam y droperidol por vía oral e inducción de la hipnosis con hidrato de cloral: estudio controlado en niños sometidos a tomografía axial, computarizada / Premedication with diazepam or droperidol or with diazepam and droperidol by oral way and induction of the hypnosis with hydrate of chloral: controlled study in children subjected to axial computarized tomography

120 niños, en edades comprendidas entre 0 y 48 meses, que debían ser sometidos a la T.A.C., fueron premedicados con diazepam, o droperidol o con diazepam + droperidol y dormidos con 25 mg./Kg.-1 de hidrato de cloral. Los resultados obtenidos demostraron que la asociación de droperidol 0,2 mg./kg.-1 + diazepam 0,2 mg./Kg-1 por vía oral potencia los efectos hipnóticos del hidrato de cloral, 30 minutos después de la ingestión de los fármacos de premedicación, en una mayor medida respecto a las mismas dosis de droperidol o diazepam, administrados singularmente. La anestesia obtenida se demostró segura en casi la totalidad de los pacientes y no alteró el curso normal del estudio neuroradiológico (AU)

Head injuries and their early management. An account of one year's experience.

We report 298 patients admitted to the Neurosurgical unit of the University of Padua during one calendar year. We divided the patients into two groups. "in coma" and "not in coma", and analyze their data records. The time between injury and admission to a neurosurgical centre is important for therapy as well as for transport. The necessity of an "Admission Chart" is emphasized.

Admission chart as a protocol for reception and first management of head injuries.

In order to gather fundamental information about the reanimative, diagnostic, and therapeutic measures concerning head-injured patients, we propose the introduction of an "Admission Chart". This Chart ought to accompany patients from the first contact with Accident-Emergency Medical Staff to arrival at a specialized Centre.