Effective nasotracheal intubation using a modified transillumination technique

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Ozone therapy can be considered as an integrative therapy in oncology? [abstract]

BACKGROUND: Our group in Policlinic Umberto I - University Hospital of Sapienza Rome - has decided to further investigate if Ozone therapy can be of support in oncology. In literature it has been reported that ozone applications in oncology or in cancer cells is associated with: high efficiency in preventing chemotherapy complications (nausea, vomiting, opportunistic infections, asthenia) as well as confining or restricting the expansion of tumours.(1-5) PURPOSE: The aim of our study in to evaluate and eventually confirm the validity of ozone treatments in order to consider such procedures as a possible and concrete support therapy for oncology patients undertaking chemotherapy. A statistical significance and clinical evaluation of our work would finally give a scientifically validation, still missing, to officially consider ozone therapy as one of the many possible integrative therapy in oncology. DESIGN: It is a pilot study designed and approved by the Ethical Committee of the University of Rome, La Sapienza (March 2017) to evaluate quality of life and reduction of side effects of adjuvant chemotherapy in 20 breast cancer patients. METHODS: The selected patients will be treated with systemic ozone treatment: Ozonated autohemotherapy will be performed according to the following method: 200 ml venous blood will be exposed an equal amount of O2 /O3 (200 ml) The ozone concentration will be gradually increased as follows: 20-30-40 mcrg/mL with a specific schedule until each patient will receive 15 applications overall. The sessions will be scheduled according to a specific timetable during the administration of adjuvant chemotherapy by means of Epirubicin and Cyclophsphamide (EC) every 3 weeks for 4 cycles followed by Paclitaxel for 12 consecutive weeks. Ozone therapy will not be applied on days of chemotherapy in order to avoid interaction between chemotherapeutics and ozonides. Biochemical blood analysis and stress oxidative blood test will be used as parameters for activity of antioxidant defence system. Quality of life will be evaluated with Fact G Test. It is the first study to have been evaluated and approved by an official university ethical committee and we will be glad to publish our result as soon as possible. On this behalf it would be great if any other centre could be interested in cooperating with us so to transform this pilot study into a multicentre study with larger numbers and therefore, with a greater impact on the international community. Our aim is to give cancer patients a better life quality in general and especially help them overcome all the side effects during the chemotherapy. This could open a new scenario in the alternative complementary treatments in oncology

Dedicated endotracheal tube for percutaneous tracheostomy

Background and objective Percutaneous dilational tracheostomy (PDT) is an accepted method in intensive care patients. In our neurosurgical ICU, we routinely perform PDT. We have performed 130 PDT procedures and have often observed previously reported difficulties/complications: dislocation of the endotracheal tube (ETT); frequent puncture of the ETT cuff; difficult visualization of the entire procedure because the ETT is often in the way; and risk of damaging the posterior tracheal wall due to needle puncture or rotating dilator. We believe that the rate of complications is directly related to the ability and experience of the anaesthetist carrying out the PDT. Because our hospital is a university teaching centre, PDT is often carried out by residents who are not experienced with the technique. In order to guarantee the patient's safety and to optimize the learning curve, we propose, in such circumstances, the use of a modified standard ETT. Method We developed a prototype tube for percutaneous tracheostomy procedures modifying a commercially available ETT. The idea was to create a protection shield for the tracheal wall, greater stability of the ETT in the tracheaand improved vision during the whole procedure. We tested the effectiveness of the prototype on a manikin model. Conclusion The dedicated ETT eliminates puncturing of the ETT, rupture of the cuff and difficult direct vision. We report an optimal stability of the tube during the whole procedure and improvement in the efficacy and safety of the procedure. When residents attempt PDF for the first time, we believe that it would be safer and more practical to perform such a technique with the dedicated ETT. Eur J Anaesthesiol 26:936-939 (C) 2009 European Society of Anaesthesiology

Severe Repeated Hypotension Occurred after Rocuronium Administrations in a Morbidly Obese Patient: A Case Report

Rocuronium has the most rapid onset of action among the nondepolarizing neuromuscular blocking drugs; doses of 0.6-0.9 mg/ Kg guarantee a complete block in about 60-90 seconds and good or excellent intubating conditions in 60 seconds [1,2].Its pharmacokinetics and pharmacodynamics can be influenced by different factors as age, inhaled anesthetics, hepatic and renal insufficiency, hypothermia, gender and obesity [3-8].Rocuronium has been shown to cause less histamine release and cardiovascular instability than benzylisoquinolinum neuromuscular blocking agents such as atracurium and mivacurium [9], however it can act as an antigen: in our clinical experience three acute reactions occurred after its administration in the same patient.</p

Intrathecal Versus Intravenous Morphine in Minimally Invasive Posterior Lumbar Fusion: A Blinded Randomized Comparative Prospective Study

STUDY DESIGN: A blinded, randomized, comparative prospective study. OBJECTIVE: The aim of this study was to compare the use of intrathecal morphine to endovenous morphine on postoperative pain after posterior lumbar surgery. SUMMARY OF BACKGROUND DATA: Intrathecal morphine can provide significant safe analgesia for at least 12 hours and up to 24 hours in patients undergoing major surgery. Its dosages have been decreasing in the last 30 years, but currently, the optimal dose remains unknown. As of today, there are no studies comparing the efficacy and the side effects of this technique with intravenous morphine administration after minimally invasive lumbar fusion surgery. METHODS: We randomized and compared two groups of 25 patients, who were given either 100 μg intrathecal (ITM group) or 5 ± 2 mg intravenous morphine delivered intravenously for 24 hours at 2 mL/h (IVM group) after minimally invasive posterior lumbar fusion. VAS score at 0, 6, 12, 24 hours, mobilization out of bed at 6 hours, hospitalization duration and complications as lower limbs paresthesia, urinary retention at 6 and 12 hours, nausea, vomit, itch, and constipation were evaluated. RESULTS: Data showed a lower VAS score, a reduction of constipation, lower limbs paresthesia, or urinary retention at 12 hours in ITM rather than in the IVM group. None suffered of vomit, itch, or nausea in both groups. Urinary retention was observed more frequently in ITM group at 6 hours. Patients of ITM group were mobilized out bed earlier than those from IVM group. CONCLUSION: A low dosage of intrathecal morphine is safe and effective after minimally invasive lumbar fusion surgery. The reduction of pain in the study group permitted a shorter hospitalization and earlier mobilization out of bed, augmenting patients' comfort. LEVEL OF EVIDENCE: 2

Metabolic and Clinical Effects of the Supplementation of a Functional Mixture of Amino Acids in Cerebral Hemorrhage

Oral supplementation of a specific mixture of essential and non-essential amino acids has been shown to modulate hypercatabolism in patients with chronic heart failure, leading to improved clinical outcome. The aim of this study was to test whether such effects could be replicated in an acute clinical model of hypercatabolism. After approval by the Ethics Committee, patients with acute brain hemorrhage admitted to the Neurosurgical ICU were randomly assigned to receive enterally for 14 days 20% of their estimated nitrogen requirements as a standard protein supplement (control group; n = 9) or as a functional amino acid mixture (Aminotrofic(A (R)), Errekappa Euroterapici; study group; n = 10). Metabolic and clinical outcome measures were monitored. In the study group, insulin sensitivity and total lymphocyte count appeared to improve when compared with control patients. Less positive blood cultures were found in the study group against control patients (4 vs. 7, respectively; P = 0.05). Also, mortality in the study group was reduced than in control patients (60 vs. 77%; P = n.s.). Supplementation with specific amino acids in critically ill patients may modulate metabolic response and improve clinical outcome