Luciano Frassanito

In vivo and in vitro effects of different anaesthetics on platelet function

Different effects of thiopental, propofol and sevoflurane on platelets have been reported. Patients undergoing thyroid surgery were anaesthetized with thiopental–fentanyl–sevoflurane (n = 11) or propofol–fentanyl–sevoflurane (n = 9). Platelet aggregation and thromboxane A2 generation were studied at baseline, and at the end of anaesthesia induction and surgery. Dose–response experiments were also performed in vitro with single agents. Thiopental–fentanyl–sevoflurane significantly reduced collagen‐induced aggregation by the end of induction, while ADP‐induced aggregation and thromboxane generation were unaffected. Propofol–fentanyl–sevoflurane had no effect on platelets. Thiopental dose‐dependently inhibited platelets in vitro, while fentanyl or propofol did not. In conclusion, thiopental reduces platelet function both ex vivo and in vitro and propofol might be considered haemostatically safer.

Peripheral blockade as treatment of arm ischaemia at birth

IntroductionLimbs ischaemia represents a rare event during the neonatal period. The present paper reports an unusual case of precocious arm ischemia that occurred immediately after birth and successfully treated with a peripheral nerve blockade.ConclusionsPeripheral nerve blockade resulted in an effective and safe therapeutic approach able to allow the salvaging of the limbs.

Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair

Background The transversus abdominis plane (TAP) block is a regional anesthesia technique that effectively reduces the pain intensity and use of analgesia in abdominal surgery. The aim of this study was to determine the utility of the ultrasound-guided TAP block in improving the efficacy of the ultrasound-guided ilioinguinal/iliohypogastric nerve (IIN/IHN) block for intraoperative anesthesia and postoperative pain control in day-case inguinal hernia repair (IHR). Methods We conducted a descriptive study of patients undergoing elective primary unilateral open IHR. Fifty-nine patients were divided into two groups according to the anesthetic technique used: ultrasound-guided TAP block plus ultrasound-guided IIN/IHN block (TAP group) vs. ultrasound-guided IIN/IHN block alone (IIN/IHN group). The outcome measures were the adequacy of anesthesia during surgery and postoperative analgesia. Results Four patients (12.5%) in the TAP group and 10 patients (37.0%) in the IIN/IHN group experienced inadequate anesthesia and needed systemic sedation (P < 0.05). No significant differences in additional local anesthetic volume were found between the two groups. Patients in the TAP group reported lower pain scores at the end of surgery (0.4 ± 0.8 vs. 2.1 ± 2.5, P < 0.01), at 2 hours after surgery (0.8 ± 1.3 vs. 3.0 ± 2.2, P < 0.01), at discharge (1.4 ± 1.2 vs. 4.3 ± 2.2, P < 0.01), and at 24 hours (1.5 ± 1.1 vs. 4.5 ± 2.3, P < 0.01). Conclusions The combination of the TAP and IIN/IHN blocks is associated with better intraoperative anesthesia and lower postoperative pain scores compared with the IIN/IHN block alone.

Hypobaric versus isobaric spinal levobupivacaine for total hip arthroplasty

BACKGROUND Spinal anesthesia (SA) in the lateral decubitus position is often used to perform total hip arthroplasty (THA). Hypobaric local anesthetic ensures enhanced and prolonged sensory and motor block in the involved side. The aim of this study was to compare the intraoperative anesthetic efficacy of hypobaric with isobaric levobupivacaine solutions for THA. METHODS Forty patients scheduled to elective THA were allocated into two groups: isobaric levobupivacaine group (IL group) and hypobaric levobupivacaine group (HL group). All the patients were placed with the operative side uppermost on the surgical table and spinal anesthesia was performed with 4 mL (12.5 mg) of selected solution. The evolution of sensory and block on nondependent (operative) and dependent sides were checked. RESULTS Regarding the nondependent side the onset times for maximal sensory block level in the in HL group was 17.8±1.1 minutes vs. 24.2±4.1 minutes in IL group. In HL group the onset time for motor block was 9.2±3.5 minutes vs. 15.6±5.4 minutes in IL group. The sensory regression time to L2 was significantly prolonged in HL group (192±30.3 minutes vs. 111±13.4 min). After surgery in HL group the residual motor block degree was 2.4±0.9 vs. 0.2±0.4 in IL group. CONCLUSIONS In patients undergoing THA under spinal anesthesia 12.5 mg of hypobaric levobupivacaine, compared with the same dose of isobaric levobupivacaine, allow shorter onset time for sensory block and delayed regression of sensory and motor block in the nondependent side.

Combined spinal-epidural anesthesia for urgent cesarean section in a parturient with a single ventricle: a case report

The number of women with major congenital heart defects reaching reproductive age is likely increasing. We herein describe the anesthetic management of a 33-year-old woman at 37 gestational weeks with a history of Glenn surgery who was undergoing an urgent cesarean section due to pathological cardiotocography. Combined spinal-epidural anesthesia was the most suitable technique for urgent cesarean section in our patient with a single ventricle and phasic flow in the pulmonary artery because it provided rapid-onset anesthesia with negligible hemodynamic effects.

Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report

Malaria is associated with high rates of morbidity and mortality worldwide, particularly in Africa, Southeast Asia and South America. Nonetheless, several cases of malaria have been reported in Western countries involving travelers from endemic areas, though very few involve pregnant women. In this article, we report a case of a young woman born in Sierra Leone who had been living in Italy for two years. She was admitted to our hospital with malaise; worsening of her condition led to Plasmodium falciparum infection diagnosis early during her hospital stay, as well as an urgent cesarean delivery. We briefly discuss the features of malaria in pregnancy, the difficulties associated with early diagnosis, and the possible fetal and maternal implications, and also consider how the disease may affect anesthetic management.

Anesthesia and Perioperative Care in MISS

The work of the anesthesiologist in MISS ranges widely, from mild to deep sedation and Monitored Anesthesia Care (MAC) to general anesthesia, in some cases with single-lung ventilation and/or invasive systemic blood pressure or central venous pressure monitoring. There is also great variability in surgical techniques, ranging from percutaneous or mini-open posterior approaches to laparo- or thoracoscopic anterior procedures. The choice of the anesthetic technique, drugs, and the appropriate treatment setting is made by considering both the planned surgical procedure and the patient’s preoperative conditions [1]. Especially in the elderly, coexisting diseases are frequent and chronic therapies can often interfere with anesthetics or increase the rate of some surgical or anesthesiological complications.