The efficacy of the psoas compartment block versus the intrathecal combination of morphine, fentanyl and bupivacaine for postoperative analgesia after primary hip arthroplasty: a randomized single-blinded study.

Purpose: Intrathecal morphine and psoas compartment block represent two accepted techniques to provide postoperative analgesia after hip arthroplasty. We designed a prospective, randomized, single-blinded study to compare these two techniques.

Methods: Forty patients scheduled for primary hip arthroplasty under general anesthesia were randomized to receive either an intrathecal administration of 0.

Ropivacaine induced acute neurotoxicity after epidural injection.

Ropivacaine is an amide-type long acting local anaesthetic. According to experimental and human data, its toxicity for Central Nervous System (CNS) and Cardiovascular System (CVS) is considered lower than toxicity related to bupivacaine, the now-a-days accepted golden standard for long acting local anaesthetics. Nevertheless, reports about this kind of accidents are fairly numerous.

Midazolam as an anti-emetic.

Benzodiazepines have been involved during the years in the prevention and treatment of Post-Operative Nausea and Vomiting (PONV). Midazolam, a short acting benzodiazepine widely used as a premedicant before surgery, for induction of anaesthesia, and for conscious sedation, has been particularly studied, sometimes with conflicting results. This paper will discuss the possible mechanisms of action of midazolam in PONV management and its fields of application (adults and children undergoing surgery, treatment of persistent postoperative emesis), as far as potentialities of other non-traditional anti-emetics, maybe ready to get out the arena of case reports, and the need of further studies on postoperative anti-emetics in their efficacy in treating established PONV.

[Anaesthesia for shock wave therapy in orthopaedics].

Shock wave therapy (orthotripsy) is a non-invasive method to treat or ameliorate many musculoskeletal disorders. When higher energies are applied on bones pain is associated with treatment, and anaesthesia is necessary, but there is no need of analgesia after shock wave application. Patients usually receive treatments during a short hospital stay: therefore, short duration drugs and techniques should be preferred, avoiding those causing unpleasant postanaesthetic sequelae.

A runny nose: an unexpected ferromagnetic foreign body in an unexpected place.

A case report about a small child scheduled to undergo brain Magnetic Resonance (MR) imaging first and Computed Tomography (CT) scan next in the same session for coeliachia and possible associate malformative diseases is described. Only by chance the MR procedure has not been carried out, and the CT scan scout view revealed unexpectedly a metallic paper clip deeply embedded in a nasal fossa. The potential of unwelcome side effects and effective safety degree of MR imaging are discussed.

A new method of orotracheal intubation in mice.

A new method of orotracheal intubation in mice is described. After intraperitoneal induction of anaesthesia, 36 male animals, belonging to common laboratory strains, have been intubated with the aid of a straight, small bore arthroscope, connected to a video-camera. After the insertion of a guide wire of appropriate size across the vocal cords, a polyethylene (PE) cannula has been introduced over it as an endotracheal tube.

An update on Intravenous Regional Anaesthesia of the arm.

Intravenous Regional Anaesthesia (IVRA) has been first described in 1908 by the german surgeon August KG Bier. Although the technique was easy to perform and effective in giving surgical anaesthesia, the newer plexus block techniques largely replaced in a short time the "Bier block", because of time limitations of IVRA and safety considerations. Throughout the years modifications in procedure and new pharmacologic adjuvants have been shown to prevent toxic reactions to anaesthetics and mitigate limitations of IVRA.

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.

Intra-articular analgesia following arthroscopic surgery of the shoulder.

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.

Wake-up test during major spinal surgery under remifentanil balanced anaesthesia.

Damage to spinal cord and subsequent neurological deficit is a recognised complication of major spinal surgery. It may be produced by a number of causes, not last excessive stretching when surgical instrumentation is positioned; it is easy to understand that early intraoperative warning of potential damage is highly desiderable. Wake-up test is a simple, safe and reliable method of recognition of such a complication, allowing rapid neurological recovery by reduction of spinal distraction.

Detection of arrhythmogenic cellular magnesium depletion in hip surgery patients.

The use of high-dose magnesium infusions in critically ill and surgical patients is increasing. This practice is associated with considerable risk of toxicity, as no reliable criteria are currently available to detect significant intracellular magnesium depletion. We have evaluated, before and after surgery, 33 elderly patients with hip fracture, by 24-h Holter ECG monitoring, Doppler echocardiography and serum chemistry; lymphocyte magnesium was measured using atomic absorption spectrophotometry.

Cost effective prophylaxys of postoperative nausea and vomiting by anesthetic premedication.

Postoperative emesis is a common daily problem in anesthetic practice. Authors report their experience about prevention of PONV (postoperative nausea and vomiting) with the association of different drugs in premedication, and suggest Promethazine as an effective and inexpensive medication to prevent PONV in orthopedic surgery.

[Transitory swelling of a parotid gland following general anesthesia. Description of a case].

An acute transient swelling of the parotid glands is recorded after general anaesthesia in orthopaedic surgery. The first differential diagnosis is bacterial parotitis; other causes of gland enlargement are viral infections, lymphoma, leukemia, sarcoidosis, Sjogren's syndrome, malnutrition cirrhosis, vomiting, and poor oral hygiene. Excluding the above mentioned conditions, the most probably factors involved in our case are drugs used for anaesthesia, congestion of the venous drainage of the gland because of parasympathetic stimula during tracheal intubation and head positioning during surgery.

Intubating conditions with propofol under muscle relaxation with vecuronium bromide. A time-related comparison with thiopental.

In the present study a comparison has been made between intubating condition obtainable after anesthesia induction with Thiopental or Propofol, using Vecuronium Bromide to achieve muscle relaxation. Data were collected about hemodynamic parameters, vocal cords position, coughing or bucking, and involuntary movements. Three-hundred patients, males and females, ASA classes I and II, not premedicated, were included in the study; they all had to undergo surgery requiring tracheal intubation.

Intravenous premedication with atropine and postanesthetic delirium. Report of two cases.

The authors report two cases of postanesthetic delirium in patients receiving intravenous atropine sulphate before surgery. In the first case the diagnosis of atropinic syndrome has been suggested by a cause effect relationship; in the second case the diagnosis has been supported by the prompt resolution after intravenous physostigmine salycilate administration. Since such syndrome was never observed in patients receiving atropine sulphate as i.

[An unusual cause of obstruction of the anesthesia circuit ].

The authors report an unusual accident, uneventful for the patient, due to the mobilization of a foreign body (a piece of tape) inside the anaesthesia circuit, following Emergency Oxygen administration. The accident dynamics and the safety of anaesthesia equipment are discussed.

Traumatic hernias of diaphragm following thoracoabdominal trauma.

A series of 14 cases of traumatic hernias of the diaphragm following major thoraco-abdominal traumas is reported. The problems concerned with the diagnosis treatment and anaesthesia and resuscitation are discussed.