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Pizzi B, Petrucci E, Marinangeli F. Emergency Cricothyrotomy in a Harsh Environment: A Case Report of Complete Airway Obstruction Following a Lightning Strike. A A Pract 2023; 17:e01688. [PMID: 37335890 PMCID: PMC10977055 DOI: 10.1213/xaa.0000000000001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 06/21/2023]
Abstract
A lightning strike is an extreme event with the highest mortality rate among electrical injuries. Death from a lightning strike is caused by either cardiac arrest or respiratory arrest. It is rare for upper airway damage to occur, but in these cases, airway control is recommended. If transoral intubation is unsuccessful, an emergency cricothyrotomy should be considered. Our case report describes an emergency cricothyroidotomy performed in a harsh environment on a mountain 2300 m above sea level on a patient with extensive burns of his supraglottic structures, after being directly hit by a lightning strike.
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Affiliation(s)
- Barbara Pizzi
- From the Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, L’Aquila, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, L’Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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Petrucci E, Cofini V, Pizzi B, Sollecchia G, Cascella M, Stefano N, Vittori A, Marinangeli F. Health Status Perception and Psychological Sequelae in Buried Victims: An Observational Study on Survivors of the Earthquake in Amatrice (Italy), Three Years Later. Prehosp Disaster Med 2023; 38:193-198. [PMID: 36803525 DOI: 10.1017/s1049023x23000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The extrication from rubble is particularly critical for the survival of the victims of an earthquake. Early repeated infusion of sedative agents (SAs) in the acute trauma phase may interfere with neural processes leading to posttraumatic stress disorder (PTSD). STUDY OBJECTIVE This study aimed to analyze the psychological status reported by the buried victims of the earthquake in Amatrice (August 24, 2016; Italy) by considering type of the SAs administered during the extrication maneuvers. METHODS This was an observational study on data from 51 patients directly rescued under the rubble during the earthquake in Amatrice. During extrication maneuvers, a moderate sedation was administered by titrating ketamine (0.3-0.5mg/kg) or morphine (0.1-0.15mg/kg) with respect to the Richmond Agitation and Sedation Scale (RASS; between -2 and -3) in buried victims.Three years following the rescue, the survivors were interviewed on their perceived health status and stress using a questionnaire which consisted of 17 items: the standard four-item set of healthy days core questions (CDC HRQOL-4); the 12-item General Health Questionnaire (GHQ-12); and in addition, survivors were asked if they had a diagnosis for anxiety, depression, or for PTSD. RESULTS The study analyzed data from the complete clinical documentation of 51 survivors; 30 were males and 21 females, with an average age of 52 years. Twenty-six (26) subjects were treated with ketamine, while 25 were treated with morphine, during the extrication procedures. Concerning the quality-of-life analysis, only 10 survivors out of 51 perceived their health status as good; the others reported psychological disorders. The GHQ-12 scores showed that all survivors had psychological distress with a mean total score of 22.2 (SD = 3.5). Eighteen (18) victims declared to have had a diagnosis of generalized anxiety (35%), while 29 were treated for depression (57%) and PTSD (57%) by a specialist. With regards to the perceived distress level and the anxiety disorder, this analysis showed significant associations with SAs used during extrication, with a better performance for ketamine than for morphine. CONCLUSION These findings suggest investigating whether early sedation with ketamine directly in the disaster setting may promote the prophylaxis and reduce the risk of developing trauma-related disorders (TRDs) on the buried victims of major natural disasters in future studies.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Giacomo Sollecchia
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy
| | - Necozione Stefano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Petrucci E, Cofini V, Pizzi B, Cascella M, Marrocco G, Ceccaroni G, Necozione S, Vittori A, Marinangeli F. Pain in critically ill COVID-19 patients: An Italian retrospective study. Open Med (Wars) 2022; 17:1803-1810. [PMID: 36447524 PMCID: PMC9673487 DOI: 10.1515/med-2022-0600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 08/26/2023] Open
Abstract
We retrospectively analyzed the data from patients admitted to the intensive care unit (ICU) of the Hospital of L'Aquila during the first and second waves of pandemic to identify pain related to COVID-19. Pain was evaluated by using the Numerical Rating Scale, and the assessment for neuropathic disturbances of pain was performed with von Frey's hair and Lindblom tests. Pain increased significantly during hospitalization (from 48% at hospital admission to 94.3% at ICU discharge). Female patients were affected by somatic pain in 32.8% of the cases and by somatic pain and pain with neuropathic features (NFs) in 23.5% of the cases, during the ICU stay. Somatic pain and pain with NFs affected more frequently patients with cardiological and respiratory comorbidities. Patients treated with continuous positive airway pressure via helmet had a higher frequency of somatic pain and pain with neuropathic disturbances (84 and 74%, respectively). The frequency of somatic pain and pain with neuropathic disturbances was lower in patients sedated with propofol combined with ketamine. Females have been associated with a higher risk of somatic pain and pain with NFs. Patients with cardiological and respiratory comorbidities undergoing noninvasive ventilation had higher levels of pain. As conclusion, ketamine may reduce the promotion or the worsening of pain in COVID-19 patients.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100, L’Aquila, Italy
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100, L’Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, 67051, Avezzano, L’Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, 80131, Naples, Italy
| | - Gioele Marrocco
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
| | - Gianmaria Ceccaroni
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100, L’Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
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Petrucci E, Cofini V, Pizzi B, Cascella M, Sollima L, Calvisi G, Gentili L, Marrocco G, Vittori A, Necozione S, Marinangeli F. Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies. Minerva Anestesiol 2022; 88:918-927. [PMID: 36367410 DOI: 10.23736/s0375-9393.22.16434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Non-invasive ventilation may alter the morphology and histology of the upper airway mucosa. This study aimed to investigate the alterations of hypopharynx and oropharynx mucosa, identified during oro-tracheal intubation procedure via video-assisted laryngoscopy, in severe acute respiratory syndrome Coronavirus 2 related, treated by non-invasive ventilation via full-face mask or helmet. METHODS Data of patients affected by Coronavirus 2 admitted to COVID Hospital of L'Aquila (Italy), presenting hypopharynx and oropharynx morphology alterations, requiring oro-tracheal intubation for invasive ventilation and initially treated with non-invasive ventilation were included in the study. The study aimed to investigate the upper airway mucosa alterations using oropharyngeal and hypopharyngeal images and biopsies taken during video-assisted-laryngoscopy. Data from the hypopharynx and oropharynx morphology and histology alterations between non-invasive ventilation via a full-face mask or helmet used during hospitalization were compared. RESULTS From 220 data recorded, 60 patients were included in the study and classified into non-invasive ventilation full-face mask group (30/60) and via helmet group. Comparing data between groups, significant differences were found with respect to hyperemia (77% vs. 20%), laryngeal bleeding ulcerations (87% vs. 13%), and vocal cord edema with >50% narrowing of the tracheal lumen (73% vs. 7%), respectively. The histology examination revealed fibrin-necrotic exudate with extensive necrotic degenerative changes in the sample tissue of the groups. There were not any differences in the duration time of non-invasive ventilation, time from hospitalization and the start of ventilation between groups. CONCLUSIONS The data from this research suggested that there were differences in airway mucosa damages among patients treated with a full-face mask or helmet. Further studies should be planned to understand which non-invasive ventilation support may mitigate upper airway mucosa damages when oro-tracheal intubation is requested for invasive respiratory support.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy -
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Naples, Italy
| | - Laura Sollima
- Department of Anatomopathology, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Giuseppe Calvisi
- Department of Anatomopathology, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Luca Gentili
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gioele Marrocco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Bambino Gesù IRCCS Children Hospital, Rome, Italy
| | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Ciccozzi A, Pizzi B, Vittori A, Piroli A, Marrocco G, Della Vecchia F, Cascella M, Petrucci E, Marinangeli F. The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature. Children (Basel) 2022; 9:children9101438. [PMID: 36291372 PMCID: PMC9600107 DOI: 10.3390/children9101438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 06/01/2023]
Abstract
The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. This article reports an overview of the anesthetic management of non-cooperative patients between 6 and 14 years old. The pathologies most frequently responsible for psycho-physical disorders can be summarized into three groups: (1) collaboration difficulties (autism spectrum disorders, intellectual impairment, phobia); (2) motor dysfunction (cerebral palsy, epilepsy, other brain pathologies, neuromuscular disorders), and (3) craniofacial anomalies (Down syndrome, other genetic syndromes). Anesthesia can be performed safely and successfully due to careful management of all specific problems of these patients, such as a difficult preoperative evaluation (medical history, physical examination, blood sampling, evaluation of vital parameters and predictive indices of difficult airway) and the inapplicability of a "standard" perioperative path (timing and length of the hospitalization, anesthetic premedication, postoperative management). It is necessary to ensure a dedicated perioperative process that is safe, comfortable, tailored to specific needs, and as less traumatic as possible. At the same time, all necessary precautions must be taken to minimize possible complications.
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Affiliation(s)
- Alessandra Ciccozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, 67051 L’Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
| | - Alba Piroli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Gioele Marrocco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Federica Della Vecchia
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Petrucci E, Marinangeli F, Pizzi B, Sciorio F, Marrocco G, Innamorato MA, Cascella M, Vittori A. A Modified Approach for Ultrasound-Guided Thoracic Paravertebral Block via Thoracic Intervertebral Foramen in an Adolescent Patient: A Case Report. J Clin Med 2022; 11:jcm11092646. [PMID: 35566772 PMCID: PMC9105263 DOI: 10.3390/jcm11092646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
This case report describes a modified approach for a thoracic paravertebral block by performing a bilateral ultrasound-assisted injection of 12 mL of 0.5% levobupivacaine near the thoracic intervertebral foramen, combined with general anesthesia, in a patient who underwent emergent laparotomy for small intestinal volvulus. Two continuous catheter sets were used for a bilateral continuous block with levobupivacaine 0.25% at a rate of 5–8 mL/h. No complications during the execution of the block were recorded. No supplemental opioids were administered and the patient was hemodynamically stable, requiring no pharmacological cardiovascular support during surgery. At the end of the surgical procedure, the patient received a continuous flow of 0.2% levobupivacaine as postoperative analgesia, at a basal flow of 4 mL/h per each side, a bolus of 4 mL, and a lockout time of 60 min was used. The postoperative pain on the Numeric Rating Scale was 2 at rest and it was 4 in motion, without neurological or respiratory sequelae due to block in the first 72 h after surgery.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, Via Vetoio 48, 67100 L’Aquila, Italy
- Correspondence:
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, Coppito, 67100 L’Aquila, Italy; (F.M.); (F.S.); (G.M.)
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, 67051 L’Aquila, Italy;
| | - Francesco Sciorio
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, Coppito, 67100 L’Aquila, Italy; (F.M.); (F.S.); (G.M.)
| | - Gioele Marrocco
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi 1, Coppito, 67100 L’Aquila, Italy; (F.M.); (F.S.); (G.M.)
| | - Massimo Antonio Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Viale Vincenzo Randi 5, 48121 Ravenna, Italy;
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, Via Mariano Semmola 53, 80131 Naples, Italy;
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy;
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Petrucci E, Pizzi B, Marinangeli F. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia: a model of clinical worsening prediction is it possible? Minerva Anestesiol 2021; 87:1389-1390. [PMID: 34337924 DOI: 10.23736/s0375-9393.21.15908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy -
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Corino C, Prost M, Pizzi B, Rossi R. Dietary Plant Extracts Improve the Antioxidant Reserves in Weaned Piglets. Antioxidants (Basel) 2021; 10:702. [PMID: 33946752 PMCID: PMC8145250 DOI: 10.3390/antiox10050702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Reducing the use of antibiotics in livestock in order to contain antibiotic resistance and studying natural substance additives are key to sustainability. Among the various biological activities of plant extracts, antioxidant activity plays an important role. The present study assesses the total antioxidant activity and antioxidant reserves using the Kit Radicaux Libres test (KRL™ Kirial International, Couternon, France). One hundred and sixty piglets (Topics × Tempo) weaned at 28 days of age were divided into four dietary treatment groups that were fed a commercial diet (the control group, C); 500 mg/kg Boswellia extract (BOS); 200 and 50 mg/kg Uncaria and Tanacetum extracts (UT) respectively; and 225 mg/kg of an antioxidant plant extract mixture (AOX). The blood antioxidant activity of the piglets was measured using the KRL test and the reserves were analyzed on whole blood samples after hydrolysis with glucosidase, sulfatase and glucuronidase. No significant differences were observed in growth performance. The delta KRL values of the whole blood showed a significantly higher total antioxidant status of the piglets from the BOS and AOX groups than the UT and C groups (+30.7 BOS; +27.7 AOX vs. +17.81 UT +13.30 C; p = 0.002) between 18 and 28 days post-weaning. The delta KRL values of red blood cells (RBCs) showed a significantly higher total antioxidant status of the piglets from the AOX groups than the UT and BOS groups (+22.2 AOX; vs. +9.90 UT +9.4 BOS; p = 0.016) between the two sampling times. Reserves of UT and AOX were higher than C and BOS for all enzymes, glucosides, sulphates, and glucuronides. The biological KRL test proved to be an extremely sensitive tool to evaluate the piglets' antioxidant status. Determining the antioxidant reserve also provides a better understanding of the real antioxidant status of pigs.
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Affiliation(s)
- Carlo Corino
- Department of Veterinary Medicine, Università degli Studi di Milano, Via Dell’Università 6, 26900 Lodi, Italy;
| | | | | | - Raffaella Rossi
- Department of Veterinary Medicine, Università degli Studi di Milano, Via Dell’Università 6, 26900 Lodi, Italy;
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Petrucci E, Cofini V, Pizzi B, Coletta R, Blasetti AG, Necozione S, Fusco P, Marinangeli F. Intermediate Cervical Plexus Block in the Management of Persistent Postoperative Pain Post Carotid Endarterectomy: A Prospective, Randomized, Controlled, Clinical Trial. Pain Physician 2020; 23:237-244. [PMID: 32517389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The mechanisms of persistent postoperative pain (PPP) with neuropathic features after carotid endarterectomy (CEA) are multifaceted and are incompletely understood. OBJECTIVES The aim of this research was to assess whether the ultrasound-guided (USG) intermediate cervical plexus block (ICPB) could provide better control of PPP and neuropathic disturbances (NPDs) after CEA than the USG superficial cervical plexus block (SCPB). STUDY DESIGN Prospective, randomized, controlled, clinical trial. SETTING This clinical trial was conducted at the SS Filippo and Nicola Academic Hospital of Avezzano (L'Aquila, Italy). METHODS Patients who were scheduled for primary CEA were chosen. In the experimental group, the USG-ICPB was performed unilaterally, at the level of the third cervical vertebra. The needle was inserted into the deep lamina of the deep fascia of the neck, between the posterior border of the middle scalene muscle and the anterior border of the posterior scalene muscle. Three milliliters saline solution was injected into the opening of the deep lamina, and 20 mL 0.375% levobupivacaine was injected. In the control group, the anesthetic target was located at the inferior border of the sternocleidomastoid muscle at the level of the third cervical vertebra. The needle was superficially inserted below the skin, and 2 to 3 mL saline solution was injected into the opening of the superficial lamina of the deep fascia of the neck. A total of 20 mL 0.375% isobaric levobupivacaine was subsequently injected.The primary outcome measure was the proportion of patients with PPP on movement and at rest 3 months after surgery. The secondary outcome measures were NPD assessment scores using the von Frey hair test and the Lindblom test, opioid and pregabalin consumption. Adverse effects were also recorded. RESULTS A total of 98 consecutive patients were enrolled and randomized to receive either a USG-SCPB (control group, n = 49) or a USG-ICPB (experimental group, n = 49). The sensory blockade was longer in the experimental group. Three months after surgery, the proportions of patients with PPP on movement were significantly different between the experimental and control groups (33%, 95% confidence intervals [CI], 20%-47% vs. 71%, 95% CI, 57%-83%; P < 0.001), whereas there were no differences in the proportions of patients with pain at rest between groups (31%, 95% CI, 18%-45% vs. 49%, 95% CI, 34%-64%; P = 0.063). The proportions of patients with NPDs were not different between the groups, whereas the sizes of the areas of interest (cm2) were significantly different. LIMITATIONS A limitation of this study is that we assessed NPDs for only 3 months using the von Frey hair test and the Lindblom test without additional instrumental techniques. Additionally, there are many risk factors for NPDs after CEA. For this reason, another limitation of this research is that we neglected to consider the relationship between the choice of anesthetic block and the presence of these risk factors. CONCLUSIONS The USG-ICPB provided long-lasting analgesia during the postoperative period and might mitigate the development of NPDs, thereby decreasing the analgesic drug requirement. KEY WORDS Carotid endarterectomy, intermediate cervical plexus block, myofascial planes of neck, neuropathic disturbances, persistent postoperative pain, superficial cervical plexus blocks, ultrasound guidance, vascular disease.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Italy
| | - Vincenza Cofini
- Department of life health & environmental sciences, University of L'Aquila
| | - Barbara Pizzi
- SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, Italy
| | - Rosaria Coletta
- SS Filippo and Nicola Academic Hospital of Avezzano, Avezzano, Italy
| | | | - Stefano Necozione
- Department of life health & environmental sciences, University of L'Aquila
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Italy
| | - Franco Marinangeli
- Department of life health & environmental sciences, University of L'Aquila
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Petrucci E, Cofini V, Pizzi B, Di Carlo S, Necozione S, Fusco P, Marinangeli F. Ultrasound-guidance for intraosseous access could improve resuscitation maneuvers. A retrospective data report on Italian earthquake victims. Minerva Anestesiol 2019; 86:357-358. [PMID: 31818088 DOI: 10.23736/s0375-9393.19.14072-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital, L'Aquila, Italy -
| | - Vincenza Cofini
- Biostatistics and Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS . Filippo and Nicola Hospital of Avezzano, L'Aquila, Italy
| | - Stefano Di Carlo
- Department of Anesthesia, Resuscitation, Intensive and Pain Care, Gabriele D'Annunzio University, Chieti, Italy
| | - Stefano Necozione
- Biostatistics and Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital, L'Aquila, Italy
| | - Franco Marinangeli
- Unit of Anesthesia, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Petrucci E, Pizzi B, Scimia P, Conti G, Di Carlo S, Santini A, Fusco P. Wireless and Low-Weight Technologies: Advanced Medical Assistance During a Cave Rescue: A Case Report. Wilderness Environ Med 2018; 29:248-251. [PMID: 29804622 DOI: 10.1016/j.wem.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 11/17/2022]
Abstract
Trauma care in cave rescue is a unique situation that requires an advanced and organized approach with medical and technical assistance because of the extreme environmental conditions and logistical factors. In caving accidents, the most common injuries involve lower limbs. We describe an advanced medical rescue performed by the Italian Corpo Nazionale del Soccorso Alpino e Speleologico, in which extended focused assessment with sonography for trauma and an ultrasound-guided adductor canal block were performed on a patient with a knee distortion directly in the cave. The rescue team inside the cave shared data on patient monitoring and the ultrasound scanning in real time with rescuers at the entrance, using a video conference powered by the new Ermes system. The use of handheld, battery-powered, low-weight, multiparametric monitors, ultrasound machines, and digital data transmission systems could ensure complete medical assistance in harsh environmental conditions such as those found in a cave.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anaesthesia and Intensive Care Unit, SS Filippo e Nicola Academic Hospital of Avezzano, L'Aquila, Italy.
| | - Barbara Pizzi
- Department of Anaesthesia and Intensive Care Unit, SS Filippo e Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Paolo Scimia
- Department of Anaesthesia, Analgesia and Perioperative Medicine, ASST of Cremona, Cremona, Italy
| | - Giuseppe Conti
- Italian Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS), Milan, Italy
| | - Stefano Di Carlo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Santini
- Italian Corpo Nazionale Soccorso Alpino e Speleologico (CNSAS), Milan, Italy
| | - Pierfrancesco Fusco
- Department of Anaesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
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Moretti R, Scarrone S, Pizzi B, Bonato V, Vivaldi N. Coupled plasma filtration-adsorption in Weil's syndrome: case report. Minerva Anestesiol 2011; 77:846-849. [PMID: 21494219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Weil's syndrome is a form of leptospirosis characterized by jaundice, renal failure and hemorrhagic diathesis. Its pathogenesis is related with the invasiveness of leptospires and with the subsequent systemic inflammatory response. Coupled plasma filtration-adsorption (CPFA) is a modality of extracorporeal blood purification in which plasma is separated from the whole blood and directed into a sorbent cartridge. Due to the ability of the sorbent agent to remove cytokines, CPFA has been proposed as an adjuvant treatment in septic shock. We report the case of a 27-year-old man with Weil's syndrome who was admitted to ICU with hypotension and anuria refractory to fluid therapy, ARDS, and hepatic involvement. The man needed intubation, mechanical ventilation and vasopressor infusion. CPFA was started early after the onset of shock. Five courses of CPFA were performed. Each course lasted for 10 h with 14 h interval. Weaning from vasopressors was achieved during the second course of CPFA (day 2 after admission). Weaning from ventilation was achieved on day 6. Interestingly, diuresis started during the first course of CPFA, with a creatinine clearance of 63 ml/min on day 8 and a normalization of the ratio urinary to plasma osmolality on day 28. The patient was discharged on day 11 and 28 from the Intensive Care Unit and hospital respectively.
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Affiliation(s)
- R Moretti
- Department of Anesthesia and Critical Care, S.S. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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Abstract
The rapid diagnosis of intracranial hypertension is urgently needed for therapeutic reasons in various clinical settings. This can rarely be achieved without invasive procedures such as intracranial pressure (ICP) monitoring or neuroimaging. The optic nerve is surrounded by cerebrospinal fluid (CSF) and dura mater, which forms the optic nerve sheath (ONS). Because of the connection with the intracranial subarachnoid space, ONS diameter (ONSD) is influenced by CSF pressure variations. Bedside ultrasonographic measurement of ONSD has been proposed as a non-invasive and reliable means to detect raised ICP in neurocritically ill patients. In several studies, it proves to have a good correlation with the direct measurement of ICP and a low interobserver variability. However, no general consensus exists over the upper normal ONSD limit. We performed a review of the literature on the use of the ultrasonography of the optic nerve in the evaluation of patients with suspected intracranial hypertension. The aim of this review is to describe the technique and to assess the validity of this diagnostic method.
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Affiliation(s)
- R Moretti
- Department of Anesthesia and Critical Care, Ospedale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Moretti R, Moretti F, Pizzi B. Reply. Acta Anaesthesiol Scand 2011. [DOI: 10.1111/j.1399-6576.2011.02476.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND The objective of our study is to assess the reliability of the distensibility of the inferior vena cava (dIVC), as measured by ultrasound, as an indicator of fluid responsiveness in patients with subarachnoid hemorrhage. METHODS We enrolled 29 adult patients requiring advanced hemodynamic monitoring, sedation, and mechanical ventilation. Inferior vena cava diameter was measured during a single mechanical breath. The dIVC was calculated as (the diameter of the inferior vena cava on inspiration-the diameter on expiration)/the diameter on expiration. All the hemodynamic parameters were collected at baseline and after a fluid challenge (7 ml/kg) with 6% hydroxyethyl starch. A 15% increase of cardiac index was the standard criterion used to differentiate patients with and without a response to fluid therapy. RESULTS Apart from stroke volume variation (SVV) and dIVC, which were significantly higher in fluid responders (17 patients), the other baseline characteristics did not differ significantly between groups (responders versus non-responders). Significant changes in hemodynamic parameters after volume load were observed only in fluid responders. The area under the ROC curve was 0.779 (95% confidence interval 0.587-0.911) for SVV and 0.902 (95% confidence interval 0.733-0.979, P = NS) for dIVC. Central venous pressure was a less reliable indicator of fluid responsiveness than dIVC. A dIVC value of >16% yielded the most favorable balance of test characteristics, with 70.59% sensitivity and 100% specificity. There was a trend toward a lower incidence of delayed ischemic lesions in fluid responders (11.7 vs. 25%, P = NS). CONCLUSION dIVC proved to be a reliable predictor of fluid responsiveness in ICU patients with subarachnoid hemorrhage.
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Affiliation(s)
- Riccardo Moretti
- Department of Anesthesia and Critical Care, Ospedale SS Antonio e Biagio e Cesare Arrigo, via Venezia n 16, 15100, Alessandria, Italy.
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Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 2009; 11:406-10. [PMID: 19636971 DOI: 10.1007/s12028-009-9250-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The aim of our study is to confirm the reliability of optic nerve ultrasound as a method to detect intracranial hypertension in patients with spontaneous intracranial hemorrhage, to assess the reproducibility of the measurement of the optic nerve sheath diameter (ONSD), and to verify that ONSD changes concurrently with intracranial pressure (ICP) variations. METHODS Sixty-three adult patients with subarachnoid hemorrhage (n = 34) or primary intracerebral hemorrhage (n = 29) requiring sedation and invasive ICP monitoring were enrolled in a 10-bed multivalent ICU. ONSD was measured 3 mm behind the globe through a 7.5-MHz ultrasound probe. Mean binocular ONSD was used for statistical analysis. ICP values were registered simultaneously to ultrasonography. Twenty-eight ONSDs were measured consecutively by two different observers, and interobserver differences were calculated. Twelve coupled measurements were taken before and within 1 min after cerebrospinal fluid (CSF) drainage to control elevated ICP. RESULTS Ninety-four ONSD measurements were analyzed. 5.2 mm proved to be the optimal ONSD cut-off point to predict raised ICP (>20 mmHg) with 93.1% sensitivity (95% CI: 77.2-99%) and 73.85% specificity (95% CI: 61.5-84%). ONSD-ICP correlation coefficient was 0.7042 (95% CI for r = 0.5850-0.7936). The median interobserver ONSD difference was 0.25 mm. CSF drainage to control elevated ICP caused a rapid and significant reduction of ONSD (from 5.89 ± 0.61 to 5 ± 0.33 mm, P < 0.01). CONCLUSION Our investigation confirms the reliability of optic nerve ultrasound as a non-invasive method to detect elevated ICP in intracranial hemorrhage patients. ONSD measurements proved to have a good reproducibility. ONSD changes almost concurrently with CSF pressure variations.
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Affiliation(s)
- Riccardo Moretti
- Department of Anesthesia and Critical Care, Ospedale SS Antonio e Biagio e Cesare Arrigo, via Venezia 16, 15100 Alessandria, Italy.
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Moretti R, Pizzi B, Colizza MT, Carta G. Symptom management in a patient with end-stage ovarian cancer: case report. EUR J GYNAECOL ONCOL 2007; 28:325-7. [PMID: 17713106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Bowel obstruction is a common complication in patients with far advanced abdominal or pelvic cancer. In patients with recurrent or advanced disease, where options for curative treatment have been exhausted, palliation of symptoms with minimal additional morbidity is the aim of therapy. Owing to the difficulties inherent in conducting perspective randomized trials, clinicians face a significant challenge in managing terminally ill obstructed patients. We evaluated the case of a woman with ovarian cancer. Clinically, the objective of the study was to focus attention on the most up-to-date evidence concerning the treatment of malignant bowel obstruction.
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Affiliation(s)
- R Moretti
- Intensive Care Unit, Hospital of Avezzano, Italy
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