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1.
Facts Views Vis Obgyn ; 16(3): 295-300, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39357860

RESUMO

Background: Despite discouragement from many scientific societies, routine preoperative testing remains a common practice. Minor gynaecological surgery, being widely performed in everyday practice, represents an opportunity for implementing cost-reduction policies by avoiding unnecessary diagnostic assessments. Objectives: To assess whether performing routine preoperative blood tests affects postoperative complications and cost-effectiveness in patients undergoing minor gynaecological surgery. Materials and Methods: An interim subgroup analysis of a retrospective study conducted by Fondazione Policlinico Gemelli (Rome) and Azienda Sanitaria Universitaria Friuli Centrale (Udine) was performed. Patients who underwent surgery under general anaesthesia were included. The studied population was divided based on the preoperative work up. Clinical data, surgical features and complications were collected. Main Outcome Measures: Intraoperative and postoperative complications, healthcare expenditure in two groups. Results: Subgroup analysis included 1191 patients in Centre A (Rome) who underwent routine complete preoperative tests and 500 patients in Centre B (Udine), who underwent exams only if indicated. Population characteristics were similar in two groups. Postoperative complications were observed in 1.2% and 1.4% of cases in Group A and Group B, respectively (p=0.70). Severe complications occurred in 0.3% of cases in Group A and 0.4% in Group B. Group B showed a cost saving of approximately 70 Euros per procedure (p < 0.001). Conclusions: Preliminary data indicate that routine perioperative assessment did not reduce complication rates, hospital readmissions or surgical reinterventions. Given the high number of procedures, performing specific preoperative tests only when indicated may result in significant cost reduction. What is new?: This study selectively highlights the potential benefits to overall public health expenditure that could be achieved through stricter adherence to guidelines on preoperative assessment in minor gynaecological surgery.

2.
Eur Rev Med Pharmacol Sci ; 26(17): 6208-6214, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36111921

RESUMO

OBJECTIVE: The term THRIVE refers to the delivery of 100% heated and humidified oxygen via a nasal cannula to maintain viable gas exchange during prolonged apnea. There are no reports of its application for Operative Hysteroscopy (OH) under general anesthesia (GA). The aim of the study is to investigate the success rate of THRIVE as unique airway management technique in this setting. The results will support the development of a randomized controlled trial (RCT) to demonstrate the non-inferiority of THRIVE compared to traditional techniques. PATIENTS AND METHODS: Twenty consecutive ASA I-II women presenting for OH were enrolled. Standard anesthesia, as well as transcutaneous carbon dioxide (tcCO2) monitoring, was performed. After preoxygenation with 30 L∙min-1, GA was induced with propofol and fentanyl, then oxygen flow was increased to 70 L∙min-1 and anesthesia maintained with propofol infusion. The primary outcome was success rate of THRIVE defined as SpO2 > 94%, tcCO2 < 60 mmHg and no need for rescue airway intervention. RESULTS: Mean age was 47 ± 12 years. Mean duration of the procedure was 25 ± 9 minutes, and the success rate of the technique was 100%. Median SpO2 during the procedure was 100 (IQR 99-100) %. Mean maximum tcCO2 level was 51 ± 7 mmHg while mean tcCO2 level during the procedure was 45 ± 7 mmHg. At the end of the procedure, mean tcCO2 was 44 ± 5 mmHg. CONCLUSIONS: THRIVE allowed adequate gas exchange during OH under GA, without additional rescue airway interventions. The application of THRIVE in this setting may allow minimal airway manipulation and optimal comfort for the patient with low failure rate. We calculated the sample size for the planned non-inferiority RCT investigating the effectiveness of THRIVE versus laryngeal mask ventilation in OH: 82 is the minimal number of patients per group to test a non-inferiority limit of 10%.


Assuntos
Insuflação , Propofol , Adulto , Manuseio das Vias Aéreas , Anestesia Geral , Dióxido de Carbono , Estudos de Coortes , Estudos de Viabilidade , Feminino , Fentanila , Humanos , Histeroscopia , Pessoa de Meia-Idade , Gravidez
3.
Eur Rev Med Pharmacol Sci ; 5(4): 143-6, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-12067083

RESUMO

Shoulder surgery is very often followed by severe postoperative pain. Loco-regional anaesthesia has greatly contributed as a solution of this problem. Nevertheless most of surgery is still performed under general anaesthesia. In this case many different methods have been proposed in order to mitigate postoperative pain. Intra-articular administration of local anaesthetics after shoulder surgery is not yet in routinely clinical practice. In this study efficacy of intra-articular administration of Ropivacaine versus Bupivacaine has been evaluated. Analysis of results showed both drugs to share the same effectiveness within four hours postoperatively. In subsequent period (6-24 hours) Ropivacaine demonstrated to provide a statistically significant better postoperative pain relief. Furthermore Ropivacaine group patients needed postoperative analgesics to a lesser extent than Bupivacaine group. The long-losting satisfactory level of analgesia, particularly with Ropivacaine, could recommend the use of intra-articular analgesia even for day-hospital or one-day surgery procedures.


Assuntos
Amidas/administração & dosagem , Amidas/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Artroscopia , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Ombro/cirurgia , Adulto , Idoso , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ropivacaina
4.
Eur Rev Med Pharmacol Sci ; 6(6): 133-8, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12776807

RESUMO

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.


Assuntos
Anestesia Geral , Doenças Musculoesqueléticas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Necrose da Cabeça do Fêmur/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Osteocondrite/terapia
5.
Pediatr Neurosurg ; 33(2): 83-8, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11070434

RESUMO

Few studies on analgesia with remifentanil (Rf) in children are available, and there are no data on the use of this drug in pediatric neurosurgery. Rf is a new mu-receptor opioid agonist, acting through the activation of pain inhibitory mechanisms. We conducted a prospective trial on the analgesic effects of Rf in 20 children less than 1 year of age undergoing a neurosurgical procedure for craniosynostosis repair. Rf was administered at doses of 0.25 microgram/kg/min, by continuous infusion, 1 h after admission to the pediatric intensive care unit (PICU). The treatment was prolonged for 12 h after the operation. The postoperative pain was evaluated in our PICU, comparing the changing of behavioral (AFS and CHEOPS score) and hemodynamic (heart rate, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, O(2) and CO(2) partial pressure) parameters, before and after treatment with Rf. This drug showed a satisfactory pain control in all the children treated. No significant side effects were noticed, except for one episode of urinary retention. In conclusion, Rf appears to be safe and effective for the treatment of acute pain in the very young child submitted to craniosynostosis repair.


Assuntos
Analgésicos Opioides/uso terapêutico , Craniossinostoses/cirurgia , Procedimentos Neurocirúrgicos/métodos , Dor Pós-Operatória/tratamento farmacológico , Piperidinas/uso terapêutico , Fatores Etários , Analgésicos Opioides/administração & dosagem , Encéfalo/irrigação sanguínea , Circulação Cerebrovascular , Esquema de Medicação , Feminino , Humanos , Lactente , Pressão Intracraniana/fisiologia , Masculino , Medição da Dor , Dor Pós-Operatória/diagnóstico , Piperidinas/administração & dosagem , Remifentanil , Resultado do Tratamento
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