Minerva anestesiologica
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Minerva anestesiologica · Feb 2017
ReviewBurnout syndrome and wellbeing in anaesthesiologists: the importance of emotion regulation strategies.
Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. ⋯ New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.
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Minerva anestesiologica · Feb 2017
Meta AnalysisAnalgesia-Nociception monitoring for opioid guidance: meta-analysis of randomized clinical trials.
The adequate suppression of nociception is, besides induction of unconsciousness and immobility, the main objective during anesthesia. Analgesics, most commonly opioids, are usually titrated by established clinical surrogates of nociception. Recently, monitoring techniques became available to evaluate analgesia/nociception during anesthesia and provide better measures then clinical evaluation alone. They are primarily derived from autonomic response on physiologic standard measures. ⋯ Monitoring analgesia/nociception is often reliant on regular physiologic conditions, like sinus rhythm. Opioid guidance dependent on analgesia/nociception monitoring during anesthesia may have beneficial and clinically relevant effects, however the number of currently available randomized controlled studies is low and conclusions are hampered by heterogeneity. More studies with focussed clinical endpoints are therefore needed.
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Minerva anestesiologica · Jan 2017
Meta AnalysisEfficacy of the prophylactic administration of tramadol against postoperative shivering: a meta-analysis of randomized controlled trials.
Postoperative shivering (POS) is a common complication that occurs after regional and general anesthesia. Thus far, numerous studies have reported on the effectiveness of tramadol in preventing or treating POS. Here, we performed a meta-analysis to assess the efficacy of tramadol in the prevention of POS. ⋯ This meta-analysis revealed that prophylactic tramadol effectively prevents POS and reduces rescue medication use without significant adverse effects.
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Minerva anestesiologica · Jan 2017
ReviewAcute kidney injury in liver transplant candidates: a position paper on behalf of the LIVER INTENSIVE CARE GROUP of EUROPE.
Acute kidney injury is associated with high mortality in the perioperative period of liver transplantation. The aim of this position paper was to provide an up-to-date overview with special emphases on diagnosis, risk factors, and treatment. ⋯ Perioperative liver transplant risk factors for acute kidney injury are difficult to control. Therefore, the focus should be on intra-operative hemodynamics and nephrotoxic drugs avoidance. Prospective randomized trials are needed to show the beneficial effect of early replacement therapy. In this context, the new biomarkers would be helpful in identifying kidney injury earlier.