Minerva anestesiologica
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Minerva anestesiologica · Aug 2017
ReviewRecent anti-seizure medications in the intensive care unit.
Seizures and status epilepticus (SE), both clinical and subclinical, are frequent in critically ill patients. The list of available antiseizure medications (ASMs) is expanding and now includes older and widely used drugs as well as more recent medications with a better safety and pharmacokinetics profile. ⋯ Recent ASMs and could represent better treatment choices in critically ill patients than older ones but this needs to be confirmed in randomized controlled studies. In general, further studies are required to clarify the indications and optimal use of ASMs in the critical care setting.
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Minerva anestesiologica · Jul 2017
Meta AnalysisEffect of anesthesia methods on postoperative major adverse cardiac events and mortality after non-cardiac surgeries: a systematic review and meta-analysis.
Postoperative major adverse cardiac events (MACEs) are the main cause of postoperative mortality, and controversies exist regarding the effects of anesthesia methods on postoperative MACEs and mortality in high-risk cardiac patients after non-cardiac surgeries. ⋯ Sevoflurane anesthesia, or epidural combined with general anesthesia can provide short-term myocardial protective effect in high-risk cardiac patients undergoing intermediate- or high-risk non-cardiac surgeries.
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Minerva anestesiologica · Jul 2017
ReviewExtracorporeal CO2 removal (ECCO2R) in critically ill patients: a systematic review.
The use of extracorporeal CO2 removal (ECCO2R) is increasingly employed in critically ill patients. However, the clinical evidence supporting its efficacy remains currently poor. ⋯ In COPD patients, a significantly reduced need for endotracheal intubation was reported. However, the use of ECCO2R has not shown significant improvement on the outcome of critically ill patients in the reviewed studies. Therefore appropriately powered, randomized, controlled studies are urgently needed.
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Minerva anestesiologica · Jul 2017
ReviewExtracorporeal CO2 removal (ECCO2R) in critically ill patients: a systematic review.
The use of extracorporeal CO2 removal (ECCO2R) is increasingly employed in critically ill patients. However, the clinical evidence supporting its efficacy remains currently poor. ⋯ In COPD patients, a significantly reduced need for endotracheal intubation was reported. However, the use of ECCO2R has not shown significant improvement on the outcome of critically ill patients in the reviewed studies. Therefore appropriately powered, randomized, controlled studies are urgently needed.
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Minerva anestesiologica · Jul 2017
ReviewHalogenated volatile anesthetics in the intensive care unit: current knowledge on an upcoming practice.
The aim of this narrative review was to highlight key points of volatile anesthetics administration in the intensive care unit (ICU), including AnaConDa® and Mirus® devices characteristics and the reported findings on clinical outcomes in critically ill patients. Intravenous sedation in the ICU is associated with issues, such as over- and under-sedation. Halogenated compounds, which can be safely administered by inserting a device in any ICU ventilation circuit, have interesting pharmacodynamic and pharmacokinetic profiles for patients with multi-organ failure. ⋯ Apart from sedation, volatile anesthetics were therapeutic in case reports of status asthmaticus and epilepticus and data are cumulating for benefits in cases of acute respiratory distress syndrome. According to current literature, they should be withheld in cerebral injury. To summarize, the use of volatile anesthetics for sedation is yet only approved by German guidelines, but could spread due to its potential benefits.