Intraoperative epidural blockade prevents the increase in protein breakdown
after abdominal surgery.
Lattermann R, Schricker T, Wachter U, Goertz A, Georgieff M
Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
BACKGROUND: The aim of this study was to investigate the effect of epidural
blockade with bupivacaine, restricted to the intraoperative period, on protein
catabolism after major abdominal surgery. METHODS: Fourteen patients undergoing
cystoprostatectomy were randomly assigned to receive either general anaesthesia
with isoflurane (control group, n=7) or a combination of general anaesthesia
and epidural blockade with bupivacaine from segment T4 to S5 (epidural group,
n=7). Rates of urea (Ra urea) and glucose production (Ra glucose) were measured
three days before and three days after the operation using stable isotope
tracers ([15N2]urea, [6,6-2H2]glucose). Protein breakdown was calculated from
the urea production rate. Plasma concentrations of metabolic substrates (urea,
glucose, lactate, glycerol, amino acids) and hormones (insulin, glucagon,
cortisol, adrenaline, noradrenaline) were also determined. RESULTS: Protein
breakdown significantly increased after surgery in the control group (P<0.05),
while it remained unaltered in the epidural group (control; 66 (54-76), epidural;
43 (29-58) mg x kg(-1) x h(-1), P<0.05, median (range)). Glucose plasma
concentration and Ra glucose increased in both groups to a similar extent
(P<0.05). Plasma concentration of branched chain amino acids decreased
after epidural analgesia to a value significantly lower than in the control
group (P<0.05). Glutamine plasma concentration decreased in the control
group (P<0.05), but did not change in the epidural group. There were no
differences in plasma concentrations of insulin, cortisol and catecholamines
between the two groups. Glucagon plasma concentration in the epidural group
was significantly lower than in the control group (P<0.05). CONCLUSION:
Intraoperative epidural blockade inhibits the increase in protein breakdown
after abdominal surgery.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11683666, UI: 21540271
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Acta Anaesthesiol Scand 2001 Oct;45(9):1100-7
Nerve blocks in chronic pain therapy--are there any indications left?
Stanton-Hicks M
Division of Anesthesiology for Pain Management and Research, Cleveland Clinic
Foundation, Cleveland, Ohio 44195, USA.
Although diagnostic imaging is now highly developed, neural blockade provides
another opportunity to test for a source of pain that may frequently leave
no signature. Likewise, many neuropathic pains can not be tested by neurodiagnostic
methods. This paper makes a case for the continued use of regional anesthesia
to assist in the diagnosis and therapy of chronic pain. In particular, the
example of autonomic blocks and blocks of the axial spine are emphasized.
Nerve blocks require an understanding of the anatomy, physiology, pharmacology,
and the ability to interpret critically their results.
Publication Types:
Review
Review, tutorial
PMID: 11683660, UI: 21540265
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Acta Anaesthesiol Scand 2001 Sep;45(8):1055
Single injection paravertebral block.
Kurian J
Publication Types:
Letter
PMID: 11576067, UI: 21460061
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Acta Anaesthesiol Scand 2001 Sep;45(8):967-70
A comparison of 0.5% ropivacaine and 1% mepivacaine for sciatic nerve block
in the popliteal fossa.
Fernandez-Guisasola J, Andueza A, Burgos E, Plaza A, Porras MC, Reboto P,
Rivera JC, del Valle SG
Department of Anesthesiology and Critical Care, Anesthesia Unit, Fundacion
Hospital Alcorcon, Alcorcon, Madrid, Spain. jfguisasola@fhalcorcon.es
BACKGROUND: The purpose of this study was to compare anesthetic efficacy
and postoperative analgesia of 0.5% ropivacaine and 1% mepivacaine for sciatic
nerve block in the popliteal fossa (popliteal block). METHODS: A prospective,
double-blind study was carried out in 58 adult patients scheduled for outpatient
foot or ankle surgery. They were randomized to receive popliteal block with
40 ml of either 0.5% ropivacaine (group R) or 1% mepivacaine (group M). An
atraumatic, Teflon-coated needle connected to a neurostimulator was used to
make a single puncture using a posterior approach. The times to onset of sensory
and motor block, and the need for intraoperative sedation were recorded. Before
discharge, patients were asked to document the time to first analgesic use,
time to return of full sensation in the foot, and their evaluation of the
technique. RESULTS: Onset time (mean+/-standard deviation, 95% confidence
interval) of both sensory block (6.5+/-5.1 min, 4.47-8.49, in group R and
6.2+/-3.7 min, 4.83-7.69, in group M) and motor block (6.6+/-4.4 min, 4.81-8.23,
in group R and 7.9+/-4.1 min, 6.29-9.53, in group M) was similar in both groups.
Postoperative analgesia lasted longer in group R (15.2+/-5.1 h, 13.25-17.21)
than in group M (5.7+/-1.8 h, 5.01-6.41; P<0.001). Duration of sensory
block was longer in group R (20.7+/-6.2 h, 18.51-23.01) than in group M (6.5+/-1.7
h, 5.86-7.16; P<0.001). Acceptance of the anesthetic procedure was similar
in both groups. CONCLUSION: In this study we demonstrated that both 0.5% ropivacaine
and 1% mepivacaine for popliteal block produced rapid, effective and safe
anesthesia but postoperative analgesia was more long-lasting with ropivacaine.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11576047, UI: 21460041
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Acta Anaesthesiol Scand 2001 Sep;45(8):961-6
Comparison of lignocaine 2% with adrenaline, bupivacaine 0.5% with or without
hyaluronidase and a mixture of bupivacaine, lignocaine and hyaluronidase for
peribulbar block analgesia.
van den Berg AA, Montoya-Pelaez LF
Department of Anesthesia, King Khaled Eye Specialist Hospital, Riyadh, Kingdom
of Saudi Arabia.
PURPOSE: Each of the freely available local analgesic agents may be used,
alone or in combination, with or without hyaluronidase, epinephrine and sodium
bicarbonate for peribulbar block analgesia (PBA). A prospective audit of four
solutions was undertaken to rationalize choice of local analgesic agent for
PBA. METHODS: A randomized, prospective study on 200 middle-aged to elderly
patients undergoing cataract extraction was undertaken to compare the efficacy
of: (1) bupivacaine 0.5% (bup 0.5% plain); (2) bupivacaine 0.5% plus hyaluronidase
100 i.u. ml-1 (bup 0.5% hyalase); (3) lidocaine 2% plus epinephrine 1:200
000 (lido 2% epi); or (4) a mixture of lidocaine 2% and bupivacaine 0.5% (2:3
volume per volume mix) containing hyaluronidase 25 i.u. ml-1 (lido/bup/hyalase).
A standardized deep peribulbar block technique, akinesia scoring system (each
5 minx4), and supplemental protocol was followed. Onset of block and supplementation
rates to achieve akinesia were recorded by a blinded observer; the requirement
for augmentation with topical oxybuprocaine or subconjunctival lidocaine during
surgery and the time from first PBA injection to the completion of surgery
(the duration of surgical access) were also recorded. RESULTS: Groups (N=50)
were comparable. Akinesia scores were similar after each agent at 5 min, better
with lido 2% epi compared with bup 0.5% plain at 10 min (P<0.05), and better
with bup 0.5% hyalase, lido 2% epi, and lido/bup/hyalase, than with bup 0.5%
plain at 15 min (P<0.01, <0.01, <0.05, respectively) and at 20 min
(P<0.05, <0.05, <0.025, respectively). The supplementation rate at
5 min was least with lido 2% epi, greater with bup 0.5% plain (P<0.01)
and bup 0.5% hyalase (P<0.0005) and greatest with lido/bup/hyalase (P<0.0005),
but similar in each group at 10, 15 and 20 min. Overall, those given lido
2% epi required the least number of supplemental injections to achieve globe
akinesia. Mean supplemental injectate volumes, augmentation rates during surgery
and the durations of surgical access provided by each agent were similar.
CONCLUSION: All four agents provided adequate analgesia during cataract extraction
lasting approximately 95-100 min after PBA injection. Lido 2% epi demonstrated
most rapid onset and required least number of injections to establish block.
A hyaluronidase effect was evident only after 15 min in the bup 0.5% hyalase
and lido/bup/hyalase groups. Bup 0.5% plain was overall the least satisfactory,
and the greatest supplementation rate occurred with lido/bup/hyalase, suggesting
that either lido 2% epi or bup 0.5% hyalase are the most suitable of the agents
tested for this type of surgery.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11576046, UI: 21460040
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Anaesthesist 2001 Sep;50(9):721-34; quiz 735, 737
[Anesthesiologic management in laser surgical procedures in otorhinolaryngology].
Poliklinik fur Zahnerhaltung und Parodontologie, Klinikum der LMU Munchen,
Goethestrasse 70, 80336 Munchen. Matthias.Folwaczny@dent.med.uni-muenchen.de
PMID: 11593882, UI: 21478295
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Anaesthesist 2001 Sep;50(9):713-6
[Extra myocardial work with of reduction of O2 consumption: end of an illusion.
Reply to Habler O. et al. (2000). Acute normovolemic hemodilution (ANH). Effect
of ANH on the diastolic function of the left ventricle. Anaesthesist 49: 939-948].
[Article in German]
Zander R, von Bormann B
Publication Types:
Letter
PMID: 11593880, UI: 21478293
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Anaesthesist 2001 Sep;50(9):710-2
[Anesthesia for cesarean section and existing inoperable intracerebral angioma.
Remarks on the paper of M. Raber, Anaesthesist (2000) 49:907-908].
[Article in German]
Fries D, Innerhofer P, Schobersberger W
Publication Types:
Letter
PMID: 11593879, UI: 21478292
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Anaesthesist 2001 Sep;50(9):709
[Fulminant pulmonary embolism following cesarean section. Remarks on the
paper of U. Grundmann et al., Anaesthesist (2000) 49:1034-1037].
[Article in German]
Nordmeyer U
Publication Types:
Letter
PMID: 11593878, UI: 21478291
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Anaesthesist 2001 Sep;50(9):695-700
[German Anesthesia Congress 2001. Nurenburg, June 13-16, 2001].
[The effect of volume status of the right-left shunt in a patient with a
patent foramen ovale].
[Article in German]
Sgouropoulou SM, Papadopoulos GS, Arnaoutoglou EM, Xenakis TA, Katsouras
CS
Clinic of Anaesthesiology and Intensive Care, University Hospital of Ioannina,
Panepistimiou Avenue, 45110 Ioannina, Greece. thalassa2@otenet.gr
This is a description of the anaesthetic management of a patient with a flow
patent foramen ovale undergoing intramedullary nailing of the femur. In order
to detect the flow patent foramen ovale, we used transoesophageal echocardiography.
During the ventilation maneuver with positive airway pressure of 20 cmH2O,
a right-to-left interatrial shunt was observed. After the administration of
500 ml hydroxy-starch solution (6%) intravenously, detection of the right-to-left
shunt flow was no longer possible. This case report shows that the volume
status in a patient with a patent foramen ovale could influence the right
to left interatrial shunt during general anaesthesia.
PMID: 11593873, UI: 21478286
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Anaesthesist 2001 Sep;50(9):676-8
[Injection pain from propofol-MCT-LCT in children. A comparison with propofol-LCT].
[Article in German]
Larsen R, Beerhalter U, Erdkonig R, Larsen B
Klinik fur Anasthesiologie und Intensivmedizin, Universitatskliniken des
Saarlandes, Kirrbergerstrasse, 66421 Homburg/Saar. airlar@med-rz.uni-sb.de
OBJECTIVES: This prospective, randomised, double-blind study was designed
to compare the incidence and intensity of pain on injection of propofol formulated
in a mixture of medium- and long-chain triglycerides, Propofol-MCT/LCT 1%
(Propofol-Lipuro, B. Braun, Germany) with propofol in a commonly used emulsion
of long-chain triglycerides, Propofol-LCT 1% (Disoprivan, Zeneca) in children
undergoing elective surgical procedures. METHODS: After approval of the local
ethics committee 40 children, aged 7-14 years, were enrolled in the study.
Premedication was with 5-10 mg diazepam orally one hour before induction of
anesthesia. In the beginning 20% of the calculated dose of Propofol for induction
was injected into a separate venous cannula in a dorsal vein of the hand;
patients were observed for expressing pain spontaneously during injection
patients or were asked to describe the sensations after 10 s. Withdrawal of
the arm during injection was also noted. RESULTS: Significantly more children
reported pain on injection of propofol-LCT compared to Propofol-MCT/LCT (25%
vs, 10%) and significantly more children retracted their arm during injection
of propofol-LCT (40% vs. 10%). IMPLICATIONS: Propofol-MCT/LCT 1% (Propofol-Lipuro)
for induction of anesthesia produced significantly less pain on injection
and significantly less drawing back of the arm when compared to Propofol-LCT
(Disoprivan). Thus, with respect to pain on injection Propofol-MCT/LCT appears
to be superior to Propofol-LCT in children aged 7-14 years.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11593871, UI: 21478284
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Anaesthesist 2001 Sep;50(9):671-5
[Atkinson's retrobulbar anesthesia. A quality control study].
[Article in German]
Reber A, Odermatt TW, Ruttimann U, Schneider M
Departement Anasthesie, Kantonsspital, Universitat Basel, Schweiz. Adrian.Reber@unibas.ch
PURPOSE OF THE STUDY: Recognized local and systemic complications of retrobulbar
anaesthesia (RA) are well known. The purpose of this study was to determine
which clinical signs predict the success of the RA technique. METHODS: We
prospectively investigated 500 consecutive patients scheduled for elective
eye surgery for cataracts and for vitreoretinal procedures. Anaesthesia was
administered using the Atkinson RA technique while for preoperative quality
control, the following parameters were recorded: chemosis, eye motility, preservation
of vision, active eyelid movement, and burning caused by disinfection. For
analysis, a multidimensional model designed to be useful for forecasting results
of the anaesthetic outcome was used. The RA was labeled as a "success"
when no supplementary anaesthetics were required. "Partial success"
was defined as an incomplete RA with supplementary subconjunctival anaesthetic
requirement or an anaesthetic given in the form of eyedrops. In the case of
"RA failure", the RA had to be repeated. RESULTS: The success rate
for RA was higher for cataract operations than for glaucoma operations. The
success rate was not associated with the choice of the local anaesthetic,
the application of ocular, compression, or the anaesthetists and surgeons
who performed the RA. Burning caused by disinfectant, lid opening and temporal
eye motility were found not to be associated with a successful outcome. The
presence of chemosis had no influence on the success of anaesthesia. CONCLUSIONS:
The results of this study demonstrated that prognostic factors such as defined
existing clinical signs, are early predictors of the success of the Atkinson
RA.
Perioperative cardiac morbidity is one of the main challenges to the anaesthesiologist.
Because of demographic changes and the increased prevalence of coronary artery
disease (CAD) in elderly patients, the number of those at risk is increasing.
Special attention has to be paid to patients bearing an increased risk where
CAD has not been proven preoperatively because they represent the majority.
The use of the "Revised Cardiac Risk Index", which includes patient-related
as well as surgery-related risk, is recommended as its predictive value is
validated to be very high. Additional preoperative testing is indicated only
in those patients at intermediate risk where functional status is poor or
unclear. In those with clearly high risk, possibility and urgency of an intervention
related to their cardiac disease must be weighed against urgency and invasiveness
of planned non-cardiac surgery. Regarding prophylactic perioperative therapy,
only beta-blockers can be recommended on a sufficient basis of clinical data.
This treatment is of special value in patients with poor functional status
and those undergoing vascular surgery. Postoperative continuation of beta
blockade for five to seven days is essential to its success. The usefulness
of alpha-2-blockers is not equally well-proven so far. Prevention of perioperative
hypothermia can reduce cardiac risk. In addition, there is increasing evidence
that thoracic epidural anaesthesia decreases cardiovascular morbidity and
mortality.
Publication Types:
Review
Review, tutorial
PMID: 11593868, UI: 21478281
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Anaesthesist 2001 Sep;50(9):647-8
[Perioperative complications in cardiac risk patients. The power of anesthesia
to decide]?
[Article in German]
Zwissler B
Publication Types:
Editorial
PMID: 11593867, UI: 21478280
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Anesth Analg 2001 Nov;93(5):1327-31
Epinephrine does not prolong the analgesia of 20 mL ropivacaine 0.5% or
0.2% in a femoral three-in-one block.
Weber A, Fournier R, Van Gessel E, Riand N, Gamulin Z
Department of Anesthesiology, Pharmacology and Surgical Intensive Care, and
Clinic of Orthopedic Surgery, University Hospitals, Geneva, Switzerland. Anne.Weber@hcuge.ch
We tested the effect of epinephrine added to 20 mL ropivacaine 0.5% and 0.2%
on postoperative analgesia via a femoral catheter after total knee replacement.
Forty-one patients undergoing total knee replacement under combined peripheral
block/general anesthesia were randomly allocated to two groups. After insertion
of a femoral catheter, 21 patients in the Ropivacaine-Epinephrine (ROPI-EPI)
group received 20 mL ropivacaine 0.5% plus epinephrine 1:200,000, whereas
20 patients in the Ropivacaine group (ROPI) received 20 mL plain ropivacaine
0.5%. Thereafter, a sciatic block with 30 mL bupivacaine 0.5% plus epinephrine
1:200,000 was performed in all patients, followed by general anesthesia. After
surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% plus epinephrine
1:200,000 for Group ROPI-EPI and plain ropivacaine 0.2% for Group ROPI was
available via the femoral catheter (200 mL ropivacaine 0.2% +/- epinephrine,
bolus 20 mL, lockout 120 min). The patients were instructed to use PCA when
the knee pain score was >3 cm. The interval between the initial ropivacaine
injection and the first PCA injection determined the duration of 20 mL ropivacaine
0.5% +/- epinephrine, whereas the interval between the first and second PCA
injection determined the duration of 20 mL ropivacaine 0.2% +/- epinephrine.
The average duration of ropivacaine 0.5% was 657 +/- 345 min for the ROPI-EPI
group and 718 +/- 423 min for the ROPI group (NS), whereas for ropivacaine
0.2%, the average duration was 409 +/- 245 min for the ROPI-EPI group and
419 +/- 339 min for the ROPI group (not significant). We conclude that epinephrine
does not influence the duration of analgesia of the ropivacaine concentrations
investigated. IMPLICATIONS: We evaluated the effect of epinephrine on the
duration of analgesia of 20 mL ropivacaine 0.5% or 0.2% injected in femoral
three-in-one block for pain relief after total knee replacement. Our results
show that epinephrine does not alter the duration of analgesia of the two
solutions investigated.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11682424, UI: 21538419
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Anesth Analg 2001 Nov;93(5):1321-6
Preoperative epidural ketamine in combination with morphine does not have
a clinically relevant intra- and postoperative opioid-sparing effect.
Subramaniam B, Subramaniam K, Pawar DK, Sennaraj B
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston,
Massachusetts 021115, USA. chundhar_@hotmail.com
In this prospective, randomized, and double-blinded clinical trial, we evaluated
the efficacy of preincisional administration of epidural ketamine with morphine
compared with epidural morphine alone for postoperative pain relief after
major upper-abdominal surgery. We studied 50 ASA I and II patients undergoing
major upper-abdominal procedures. These patients were randomly allocated to
one of the two treatment groups: patients in Group 1 received epidural morphine
50 microg/kg, whereas those in Group 2 received epidural ketamine 1 mg/kg
combined with 50 microg/kg of morphine 30 min before incision. Intraoperative
analgesia was provided in addition, with IV morphine, and the requirement
was noted. A blinded observer using a visual analog scale for pain assessment
observed patients for 48 h after surgery. Additional doses of epidural morphine
were provided when the visual analog scale score was more than 4. Analgesic
requirements and side effects were compared between the two groups. There
were no differences between the two groups with respect to age, sex, weight,
or duration or type of the surgical procedures. The intraoperative morphine
requirement was significantly (P = 0.018) less in Group 2 patients (median,
6.8 mg; range, 3-15 mg) compared with patients in Group 1 (median, 8.3 mg;
range, 4.5-15 mg). The time for the first requirement of analgesia was significantly
(P = 0.021) longer (median, 17 h; range, 10-48 h) in Group 2 patients than
in Group 1 (median, 12 h; range, 4-36 h). The total number of supplemental
doses of epidural morphine required in the first 48 h after surgery was comparable
(P = 0.1977) in both groups. Sedation scores were similar in both groups.
One patient in Group 2 developed hallucinations after study drug administration.
None of the patients in either group developed respiratory depression. Other
side effects, such as pruritus, nausea, and vomiting, were also similar in
both groups. Although the addition of ketamine had synergistic analgesic effects
with morphine (reduced intraoperative morphine consumption and prolonged time
for first requirement of analgesia), there was no long- lasting preemptive
benefit seen with this combination (in terms of reduction in supplemental
analgesia) for patients undergoing major upper-abdominal procedures. IMPLICATIONS:
Ketamine added to epidural morphine given before surgery can decrease postoperative
pain by its preemptive effect, opioid potentiation, and prevention of acute
opioid tolerance. A single epidural bolus of 1 mg/kg of ketamine with morphine
given before major upper-abdominal surgery did not result in a clinically
relevant reduction in postoperative pain relief.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11682423, UI: 21538418
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Anesth Analg 2001 Nov;93(5):1304-6, table of contents
Subarachnoid block for a patient with progressive chronic inflammatory demyelinating
polyneuropathy.
Schabel JE
Department of Anesthesiology, State University of New York at Stony Brook,
Stony Brook, New York 11794-8480, USA.
IMPLICATIONS: We report a case of successful administration of a spinal anesthetic
to a patient with progressive chronic inflammatory demyelinating polyneuropathy
(CIDP). There have been no reports of regional anesthetic management of patients
with CIDP.
PMID: 11682419, UI: 21538414
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Anesth Analg 2001 Nov;93(5):1272-6
Scalp nerve blocks decrease the severity of pain after craniotomy.
Nguyen A, Girard F, Boudreault D, Fugere F, Ruel M, Moumdjian R, Bouthilier
A, Caron JL, Bojanowski MW, Girard DC
Department of Anesthesiology, CHUM, Hopital Notre-Dame, Montreal, Canada.
Up to 80% of patients report moderate to severe pain after craniotomy. In
this study, we assessed the efficacy of scalp block for decreasing postoperative
pain in brain surgery. Thirty patients scheduled for supratentorial craniotomy
were enrolled. They were randomly divided into two groups: Ropivacaine (scalp
block with 20 mL of ropivacaine 0.75%) and Saline (scalp block with 20 mL
of saline 0.9%). Anesthesia was standardized. The scalp block was performed
after skin closure and before awakening. Postoperative pain was assessed at
4, 8, 12, 16, 20, 24, and 48 h by using a 10-cm visual analog scale. Analgesia
was provided with sub- cutaneous codeine as requested by the patient. Average
visual analog scale scores were higher in the Saline group as compared with
Ropivacaine (3.7 +/- 2.4 vs 2.0 +/- 1.6; P = 0.036). The total dose of codeine
did not differ, nor did the duration of time before the first dose of codeine
was required in the Ropivacaine (571 +/- 765 min) versus Saline (319 +/- 409
min; P = 0.17) group. In conclusion, we found that postoperative scalp block
decreases the severity of pain after craniotomy and that this effect is long
lasting, possibly through a preemptive mechanism. IMPLICATIONS: Up to 80%
of patients report moderate to severe pain after craniotomy. This randomized
double-blinded study demonstrated that ropivacaine scalp block decreases the
severity of pain after supratentorial craniotomy.
PMID: 11682413, UI: 21538408
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Anesth Analg 2001 Nov;93(5):1165-9
Sevoflurane titration using bispectral index decreases postoperative vomiting
in phase II recovery after ambulatory surgery.
Nelskyla KA, Yli-Hankala AM, Puro PH, Korttila KT
Department of Anaesthesia and Intensive Care, Women's Hospital, University
of Helsinki, Helsinki, Finland. kaisa.nelskyla@hus.fi
We tested the hypothesis that titration of sevoflurane using bispectral index
(BIS) of the electroencephalogram decreases postoperative nausea and vomiting
and improves recovery after outpatient gynecologic laparoscopy. After propofol
induction, anesthesia was maintained in all patients with sevoflurane in 65%
nitrous oxide and oxygen. In the BIS-Titrated group (n = 32), sevoflurane
was titrated to maintain the BIS between 50 and 60 during surgery. In the
Control group (n = 30), sevoflurane was adjusted to keep hemodynamic variables
within 25% of control values. The severity of pain, postoperative nausea and
vomiting, and recovery variables were recorded. In the Control group, 30%
of the patients had BIS <40 during surgery (versus 0 in the BIS-Titrated
group). Orientation and ability to drink were achieved earlier in the BIS
group (P < 0.05). At 30 min after cessation of nitrous oxide, patients
in the BIS group performed better in the psychomotor recovery test (P <
0.01). In Phase II recovery room, these patients had significantly less vomiting
than the patients in the Control group (16% versus 40% of the patients, respectively,
P < 0.05). No differences were found in times to achieve home readiness.
IMPLICATIONS: In patients undergoing outpatient gynecologic laparoscopy, the
monitoring of bispectral index decreases vomiting in Phase II recovery room,
but it has no effect on the time to achieve home readiness.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11682388, UI: 21538383
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Anesth Analg 2001 Nov;93(5):1156-61
Caudal epidural block: a review of test dosing and recognition of systemic
injection in children.
Tobias JD
Departments of Child Health and Anesthesiology, The Division of Pediatric
Critical Care/Pediatric Anesthesiology, The University of Missouri, Columbia,
Missouri 65212, USA. Tobiasj@health.missouri.edu
Publication Types:
Review
Review, tutorial
PMID: 11682386, UI: 21538381
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Anesth Analg 2001 Nov;93(5):1091-2
Not only towards enhanced preoperative comfort.
Lindahl SG
Publication Types:
Comment
Editorial
PMID: 11682373, UI: 21538368
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Anesthesiology 2001 Nov;95(5):1285-7
Paraplegia immediately following removal of a cerebrospinal fluid drainage
catheter in a patient after thoracoabdominal aortic aneurysm surgery.
Heller LB, Chaney MA
Department of Anesthesia and Critical Care, University of Chicago, Illinois
60637, USA.
PMID: 11685001, UI: 21540555
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Anesthesiology 2001 Nov;95(5):1151-9
Bispectral index monitoring during sedation with sevoflurane, midazolam,
and propofol.
Ibrahim AE, Taraday JK, Kharasch ED
Department of Anesthesiology, University of Washington, Seattle, 98195, USA.
BACKGROUND: Bispectral Index (BIS) has been used to measure sedation depth.
Ideally, to guide anesthetic management, range of BIS scores at different
sedation levels should not overlap, and BIS should be independent of drug
used. This study assessed ability of BIS to predict sedation depth between
sevoflurane, propofol, and midazolam. Quality of recovery was also compared.
METHODS: Patients undergoing surgery with local or regional anesthesia and
sedation were randomized to sevoflurane (n = 23), midazolam (n = 21), or propofol
(n = 22). Sedation was titrated to Observers's Assessment of Alertness-Sedation
score of 3 (responds slowly to voice). BIS and Observers's Assessment of Alertness-Sedation
were measured every 5 min. BIS prediction probability (PK) was compared between
drugs. Recovery was assessed by BIS and Digit Symbol Substitution and memory
tests. RESULTS: Bispectral Index of responders to voice was significantly
different from nonresponders (86 +/- 10 vs. 74 +/- 14, mean +/- SD; P <
0.001) However, wide variability and overlap in BIS were observed (25th-75th
percentile, responders vs. non-responders: 79-96 vs. 65-83). BIS of responders
was different for sevoflurane versus propofol and midazolam. BIS was a better
predictor of propofol sedation than sevoflurane or midazolam (PK = 0.87 +/-
0.11, 0.76 +/- 0.01, and 0.69 +/- 0.02, respectively; P < 0.05). At 10
min after the procedure, 76, 48, and 24% of sevoflurane, propofol, midazolam
patients, respectively, returned to baseline Digit Symbol Substitution scores
(P < 0.05). Excitement-disinhibition occurred in 70, 36, and 5% of sevoflurane,
propofol, and midazolam patients, respectively (P < 0.05). CONCLUSION:
Individual BIS scores demonstrate significant variability, making it difficult
to predict sedation depth. The relation between BIS and sedation depth may
not be independent of anesthetic agent. Quality of recovery was similar between
drugs, but excitement occurred frequently with sevoflurane.
Publication Types:
Clinical trial
Multicenter study
Randomized controlled trial
PMID: 11684984, UI: 21540538
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Br Dent J 2001 Aug 11;191(3):119
Competency in sedation.
Girdler NM
Newcastle Dental School & Hospital. n.m.girdler@ncl.ac.uk
Conscious sedation has become an integral part of the undergraduate dental
curriculum. The attributes of the competent graduate in sedation are defined
and all providers of sedation education should be aiming towards this standard.
It is important that students receive appropriate theoretical and practical
training which must include hands-on clinical experience in sedation techniques.
PMID: 11523881, UI: 21414733
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Br J Anaesth 2001 May;86(5):735-6
Lobectomy for cavitating lung abscess.
Karzai W, Klein U
Publication Types:
Letter
PMID: 11575357, UI: 21459199
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Br J Anaesth 2001 May;86(5):674-7
Double-blind comparison of ropivacaine 7.5 mg ml(-1) with bupivacaine 5
mg ml(-1) for sciatic nerve block.
Connolly C, Coventry DM, Wildsmith JA
Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee,
UK.
Two groups of 12 patients had a sciatic nerve block performed with 20 ml
of either ropivacaine 7.5 mg ml(-1) or bupivacaine 5 mg ml(-1). There was
no statistically significant difference in the mean time to onset of complete
anaesthesia of the foot or to first request for post-operative analgesia.
The quality of the block was the same in each group. Although there was no
statistically significant difference in the mean time to peak plasma concentrations
the mean peak concentration of ropivacaine was significantly higher than that
of bupivacaine. There were no signs of systemic local anaesthetic toxicity
in any patient in either group.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11575344, UI: 21459186
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Br J Anaesth 2001 May;86(5):669-73
Autologous blood transfusion in total knee replacement surgery.
Thomas D, Wareham K, Cohen D, Hutchings H
Morriston Hospital, Swansea NHS Trust, UK.
We compared allogeneic blood usage for two groups of patients undergoing
total knee replacement surgery (TKR). Patients were randomized to receive
either their post-operative wound drainage as an autotransfusion (n=115) after
processing or to have this wound drainage discarded (n=116). Allogeneic blood
was transfused in patients of either group whose haemoglobin fell below 9
g dl(-1). Only 7% of patients in the autotransfusion group required an allogeneic
transfusion compared with 28% in the control group (P<0.001). There was
no hospital mortality and only 3% mortality from all causes at the study completion,
which spanned 6 months to 3 yr. There was a higher incidence of infection
requiring intervention in the allogeneic group (P<0.036). Total patient
costs were Pound Sterling 113 greater in the autotransfusion group. We conclude
that in this type of surgery post-operative cell salvage is a safe and effective
method for reducing allogeneic blood use.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11575343, UI: 21459185
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Br J Anaesth 2001 May;86(5):633-8
Peri-operative risk factors for acute lung injury after elective oesophagectomy.
Tandon S, Batchelor A, Bullock R, Gascoigne A, Griffin M, Hayes N, Hing
J, Shaw I, Warnell I, Baudouin SV
Department of Anaesthesia and Intensive Care Medicine, Newcastle upon Tyne
NHS Trust, UK.
Acute lung injury after oesophagectomy is well recognized but the risk factors
associated with its development are poorly defined. We analysed retrospectively
the effect of a number of pre-, peri- and post-operative risk factors on the
development of lung injury in 168 patients after elective oesophagectomy performed
at a single centre. The acute respiratory distress syndrome (ARDS) developed
in 14.5% of patients and acute lung injury in 23.8%. Mortality in patients
developing ARDS was 50% compared with 3.5% in the remainder. Features associated
with the development of ARDS included a low pre-operative body mass index,
a history of cigarette smoking, the experience of the surgeon, the duration
of both the operation and of one-lung ventilation, and the occurrence of a
post-operative anastomotic leak. Peri-operative cardiorespiratory instability
(measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements
and the need for inotropic support) was also associated with ARDS. Acute lung
injury after elective oesophagectomy is associated with intraoperative cardiorespiratory
instability.
Publication Types:
Multicenter study
PMID: 11575337, UI: 21459179
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Can J Anaesth 2001 Oct;48(9):935-6
Identification of the thoracic epidural space by the running infusion drip
technique.
Baraka A
Publication Types:
Letter
PMID: 11606359, UI: 21518356
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Can J Anaesth 2001 Oct;48(9):919-23
Use of the fibreoptic stylet scope (Styletscope) reduces the hemodynamic
response to intubation in normotensive and hypertensive patients.
Kimura A, Yamakage M, Chen X, Kamada Y, Namiki A
Department of Anesthesiology, Sapporo Medical University School of Medicine,
Sapporo, Hokkaido, Japan.
PURPOSE: To compare hemodynamic changes after tracheal intubation when using
a new fibreoptic stylet scope (Styletscope) and a conventional laryngoscope
in normotensive and hypertensive patients. METHODS: Normotensive (N; n=30)
and hypertensive (H; n=30) patients undergoing general anesthesia participated
in this study. Each group was divided into two groups. In one group, patients
were intubated by using a stylet scope with a laryngoscope as an adjuvant
(S; n=15 each), while patients in the other group were intubated using a laryngoscope
by the usual technique (L; n=15 each). The time necessary for intubation,
hemodynamic changes, and adverse effects were recorded. RESULTS: Patients
in the normotensive groups (SN and LN groups) showed significant increases
in both systolic and diastolic blood pressures from before induction to one
minute after intubation; however, blood pressures in the SN group were significantly
lower than those in the LN group. Both systolic and diastolic blood pressures
increased after intubation in the LH group, but not in the SH group. Heart
rates in all four groups showed significant increases, and there were no differences
between heart rates in the stylet scope and laryngoscope groups or between
the normotensive and hypertensive groups. The number of patients who complained
of sore throat was greater in the laryngoscope groups. CONCLUSIONS: Tracheal
intubation with a stylet scope can attenuate hemodynamic changes and reduce
the incidence of sore throat in comparison with the conventional laryngoscope
technique in both normotensive and hypertensive patients.
PMID: 11606351, UI: 21518348
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Can J Anaesth 2001 Jun;48(6):526-8
[Patient's perspectives with regard to anesthesia services].
[Article in French]
Baillard C, Lamberto JF, Martinez C, Le Toumelin P, Fournier JL, Cupa M,
Samama CM
Departement d'anesthesie, Hjpital Avicenne, Bobigny, France. christophe.baillard@avc.ap-hop-paris.fr
PURPOSE: Whereas patients most often select their surgeon, they don't usually
select their anesthesiologist. Further, anesthesia frequently involves different
physicians at different stages perioperatively. This inability to choose and
the multiplicity of interveners may reduce patient satisfaction. Our study
examined patients' willingness to choose their anesthesiologist for the operation,
as well as their opinion on the way anesthesia is practiced presently. CLINICAL
FEATURES: Nine hundred and twelve patients (mean age 51 +/- 16 yr, 58% moles)
were requested, immediately after the preoperative visit, to choose their
anesthesiologist for the operation. The request was formuled by a nurse, in
the absence of the anesthesiologist, in order to avoid a courteous response.
After surgery, prior to leaving the hospital, patients were invited to give
their opinion on the anesthesia core received and to name the anesthesiologist(s)
and surgeon involved. RESULTS: Women chose an anesthesiologist more frequently
than men, but only 34% of patients overall elected to do so. Eighty percent
of patients were cared for by an anesthesiologist other than the one seen
at the preoperative visit. Four percent of patients regretted the change.
Patients recalled the surgeon's name more frequently (60%) than the attending
anesthesiologist's (4%). CONCLUSION: In France, the preoperative visit is
required by law and must precede the operation by at least 48 hr. Despite
this preoperative interview, patients were unwilling to choose the anesthesiologist
responsible for surgery, did not object to multiple interveners and seldom
remembered their anesthesiologist's name. Efforts to improve the image of
the profession are required.
PMID: 11450682, UI: 21337345
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Can J Anaesth 2001 Jun;48(6):613-4
Convulsions after the administration of high dose ropivacaine following
an interscalenic block.
Ekatodramis G, Borgeat A
Publication Types:
Letter
PMID: 11444462, UI: 21337363
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Can J Anaesth 2001 Jun;48(6):592-9
Lightwand intubation using the Trachlight: a brief review of current knowledge.
Agro F, Hung OR, Cataldo R, Carassiti M, Gherardi S
Department of Anaesthesia, University School of Medicine, Rome, Italy. f.agro@unicampus.it
PURPOSE: About 1% to 3% of laryngoscopic intubations can be difficult or
impossible. Light-guided intubation has been proven to be an effective, safe,
and simple technique. This article reviews current knowledge about the newer
version lightwand: the Trachlight (TL). SOURCE: To determine its clinical
utility and limitations, we reviewed the current literature (book and journal
articles) on the TL since its introduction in 1995. PRINCIPAL FINDINGS: TL
has been shown to be useful both in oral and nasal intubation for patients
with difficult airways. It may also be useful in "emergency" situations
or when direct laryngoscopy or fiberoptic endoscopy is not effective, such
as with patients who have copious secretions or blood in the oropharynx. TL
can also be used for tracheal intubation in conjunction with other devices
(laryngeal mask airway -LMA-, intubating LMA, direct laryngoscopy). However,
TL should be avoided in patients with tumours, infections, trauma or foreign
bodies in the upper airway. CONCLUSIONS: Based on the clinical reports available,
the TL has proven to be a useful option for tracheal intubation. In addition,
the device can also be used together with other intubating devices, such as
the intubating LMA and the laryngoscope, to improve intubating success rates.
A clear understanding of the principle of transillumination of the TL, and
an appreciation of its indications, contraindications, and limitations, will
improve the effectiveness of the device as well as reducing the likelihood
of complications. Finally, regular practice with the TL with routine surgical
patients requiring tracheal intubation will further improve intubation success
rates.
Publication Types:
Review
Review, tutorial
PMID: 11444456, UI: 21337357
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Can J Anaesth 2001 Jun;48(6):545-50
Pain after laparoscopic cholecystectomy: the effect and timing of incisional
and intraperitoneal bupivacaine.
Lee IO, Kim SH, Kong MH, Lee MK, Kim NS, Choi YS, Lim SH
Department of Anesthesia, College of Medicine, Korea University Guro Hospital,
Seoul.
PURPOSE: To examine the combined preemptive effects of somatovisceral blockade
during laparoscopic cholecystectomy (LC). METHODS: One hundred fifty-seven
patients under general anesthesia receiving local infiltration and/or topical
peritoneal local anesthesia were studied. Patients were randomized to receive
a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal
(40 mL with 1:200,000 epinephrine) administration of each. Group A received
preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine
immediately after the pneumoperitoneum. Group B received periportal and intraperitoneal
bupivacaine at the end of the operation. Group C (preoperative) and Group
D (postoperative) received only periportal bupivacaine and Group E (preoperative)
and Group F (post-operative) received only intraperitoneal bupivacaine. The
control group received no treatment. Pain and nausea were recorded at one,
two, three, six, nine, 12, 24, 36, and 48 hr postoperatively. RESULTS: Throughout
the postoperative 48 hr, incisional somatic pain dominated over other pain
localizations in the control group (P <0.05). The incisional pain of groups
A, B, C and D was significantly lower than that of the control group in the
first and second hours. The incisional pain of groups A and C was significantly
lower than that of the control group in the first three hours. CONCLUSION:
Incisional pain dominated during the first two post-operative days after LC.
Preoperative somato-visceral or somatic local anesthesia reduced incisional
pain during the first three post-operative hours. A combination of somato-visceral
local anesthetic treatment did not reduce intraabdominal pain, shoulder pain
or nausea more than somatic treatment alone. Preoperative incisional infiltration
of local anesthetics is recommended.
Publication Types:
Clinical trial
PMID: 11444448, UI: 21337349
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Can J Anaesth 2001 Jun;48(6):522-5
Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary,
perivascular brachial plexus block.
Erlacher W, Schuschnig C, Koinig H, Marhofer P, Melischek M, Mayer N, Kapral
S
Department of Anaesthesia and Intensive Care, Hospital Lainz, Vienna, Austria.
Wolfgang.Erlacher@univie.ac.at
PURPOSE: To evaluate the effects of clonidine on three local anesthetics
(mepivacaine 1%, ropivacaine 0.75% and bupivacaine 0.5%) with comparable potency
and almost the same concentration-response relationship. METHODS: One hundred
and twenty trauma-patients were randomly allocated into six groups. In the
control-groups (Mo/Ro/Bo) brachial plexus was performed using 40 mL of local
anesthetic plus 1 mL of NaCL 0.9%. In the clonidine-groups (Mc/Rc/Bc) brachial
plexus was performed using each 40 mL of drug plus 1 mL (0.150 mg) of clonidine.
Onset-time and the duration of the sensory block were recorded. Data are expressed
as mean +/- SD. RESULTS: According to the average sensory block determined
by a visual analog scale in the median, ulnar and radial nerve distributions
and ranging from 100 (no sensory blockade) to 0 (complete sensory blockade),
both mepi-groups showed a rapid onset (at 10 min: -Mo 20 +/- 15/Mc 19 +/-
14; at 30 min: -Mo 3 +/- 4/Mc 5 +/- 4). The ropi-and bupi- groups both had
a longer onset time (at 10 min: -Ro 23 +/- 19/Rc 25 +/- 22/Bo 24 +/- 15; at
30 min -Ro 10 +/- 6/ Rc 11 +/- 6 /Bo 12 +/- 4). The onset time in group-Bc
was significantly prolonged (at 10 min: -45 +/- 21; at 30 min: -20 +/- 6).
Duration of motor blockade was prolonged by clonidine only in the mepivacaine
and bupivacaine groups; (in minutes: Mo 212 +/- 47 -Mc 468 +/- 62; Ro 702
+/- 52 -Rc 712 +/- 82; Bo 728 +/- 36 -Bc 972 +/- 72). CONCLUSION: The present
study shows that the addition of clonidine has a different impact on each
of the three local anesthetics investigated in terms of onset and duration
of block.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11444444, UI: 21337344
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Can J Anaesth 2001 Jun;48(6):519-21
CSE for labour: the debate goes on ..
Gunka VB, Douglas MJ
Publication Types:
Comment
Editorial
PMID: 11444443, UI: 21337343
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Chest 2001 Oct;120(4):1152-6
Spirometry in surgery for anterior mediastinal masses.
Hnatiuk OW, Corcoran PC, Sierra A
Pulmonary and Critical Care Medicine Service, Department of Medicine, Walter
Reed Army Medical Center, Washington, DC 20307-5001, USA. oleh.hnatiuk@na.amedd.army.mil
STUDY OBJECTIVES: To identify the impact of upright and supine spirometry
(USS) on the choice of anesthesia and outcomes in patients undergoing surgery
for anterior mediastinal masses (AMMs). DESIGN: Retrospective cohort study.
SETTING: A referral, tertiary-care, military medical center. PATIENTS: We
reviewed the records of all patients who underwent surgery for AMMs between
June 1994 and December 2000 at Walter Reed Army Medical Center. Patients aged
> or = 18 years who had "anterior mediastinal mass" listed as
the preoperative diagnosis, which had been confirmed by a preoperative CT
scan, and who had available preoperative spirometry data were included in
our analysis. In cases in which surgery was performed more than once on the
same individual, only data from the first operation were evaluated. MEASUREMENTS:
Patient demographics, the results of pulmonary function testing, perioperative
complications, type of anesthesia, type of surgery, and pathology were used
in the evaluation. RESULTS: Thirty-seven patients (median age, 31 years; age
range, 19 to 86 years) were included in the final analysis. There were 24
men and 13 women in this group. The mean (+/- SD) seated FVC and FEV(1) values
for the group were 4.02 +/- 0.75 L (90.7 +/- 13.3% predicted) and 3.22 +/-
0.56 L 89.6 +/- 14.2% predicted. Twelve patients (32.4%) had USS ordered,
and 10 patients (27.0%) had USS performed. USS was ordered significantly more
frequently in younger and symptomatic patients (p = 0.022 and p = 0.005, respectively).
Spirometry suggestive of possible upper airway obstruction was found in four
patients. However, general anesthesia was used in all four patients without
complications. Only two patients suffered perioperative complications. One
of these patients had normal USS values but underwent surgery under local
anesthesia nonetheless. CONCLUSIONS: The recommendation to perform USS prior
to surgery on AMMs is based on anecdotal data. Our study found that the incidence
of perioperative complications in surgery for AMMs is low. We also found that
USS is not ordered in all patients preoperatively and that the results do
not always alter the anesthetic technique when abnormal. One patient who experienced
a perioperative complication had normal USS values. Larger studies are necessary
to further evaluate the utility of USS in surgery for AMMs.
PMID: 11591553, UI: 21475393
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Eur J Anaesthesiol 2001 Nov;18(11):706-12
Colour Doppler imaging of the interspinous and epidural space.
Grau T, Leipold RW, Horter J, Martin E, Motsch J
University of Heidelberg, Department of Anaesthesiology, Im Neuenheimer Feld
110, D-69120 Heidelberg, Germany. thomas_grau@med.uni-heidelberg.de
BACKGROUND AND OBJECTIVE: In recent studies, ultrasonic diagnostic imaging
has proved useful in the screening of the trajectory of the epidural needle.
With regard to possible side-effects of spinal and epidural anaesthesia caused
by vessel injury, we aimed to evaluate the usability of Colour Doppler imaging
for the depiction of interspinous vessels in prepuncture examination. METHODS:
Ultrasonic examination of the L3/4 interspace area was performed in 20 volunteers.
Using a 4-MHz and a 7-MHz probe with B-mode and Colour Doppler imaging, respectively,
we compared four settings for the quality of vessel depiction in the puncture
area. Overall resolution was evaluated according to the distinction of landmarks.
Vascular structures were identified by pulsation (B-mode) or blood flow (Doppler).
RESULTS: Colour Doppler imaging of the L3/4 interspace was unachievable using
the 7-MHz transducer. Vessel detection was possible in 50% of the B-mode images
and in all of the 4-MHz Doppler images. Vessels were perceptible from a diameter
of 0.5 mm. Veins were the predominantly visible structures. Overall vessel
visibility was best using 4-MHz Colour Doppler. CONCLUSIONS: Prepuncture Doppler
imaging can provide the epiduralist with information regarding the position
of vessels in the needle trajectory. This might help to reduce complications
in regional anaesthesia.
Publication Types:
Evaluation studies
PMID: 11580776, UI: 21464610
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Eur J Anaesthesiol 2001 Oct;18(10):632-52
Malignant hyperthermia.
Wappler F
Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Martinistr.
52, D-20246 Hamburg, Germany.
Malignant hyperthermia is an autosomal-dominant inherited disorder of the
skeletal muscle cell characterized by a hypermetabolic response to all commonly
used inhalational anaesthetics and depolarizing muscle relaxants. The clinical
syndrome includes muscle rigidity, hypercapnia, tachycardia and myoglobinuria
as result of increased carbon dioxide production, oxygen consumption and muscle
membrane breakdown. In human beings and animals susceptible to malignant hyperthermia,
it is generally accepted that an increase in the level of myoplasmic free
calcium is the cause of the syndrome. Various hypotheses have been proposed
to account for the increase of intracellular calcium levels, e.g. a defect
in the calcium release channel of the sarcoplasmic reticulum (ryanodine receptor),
an abnormality of the excitation-contraction coupling mechanisms, or alterations
in second messenger systems of skeletal muscles. This review gives an overview
of the main features of this disease and recent advances in research including
pathophysiology, treatment, diagnosis and genetics as well as association
with other disorders.
TUTTO
IL MATERIALE CONTENUTO IN QUESTO SITO E' STATO REPERITO IN RETE. GLI AUTORI
NON SI ASSUMONO RESPONSABILITA' PER
DANNI A TERZI DERIVATI DA USO IMPROPRIO O ILLEGALE DELLE INFORMAZIONI
RIPORTATE O DA ERRORI RELATIVI AL LORO CONTENUTO.
