Minerva anestesiologica
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Minerva anestesiologica · May 2016
Review Meta AnalysisIntravenous immunoglobulin in septic shock: review of the mechanisms of action and meta-analysis of the clinical effectiveness.
Sepsis is characterized by a complex immune response. In this study we aimed to provide a review of the mechanisms of action of immunoglobulin (Ig) related to sepsis and an updated meta-analysis of the clinical effectiveness of the Ig use in septic patients. ⋯ Our study showed that the use of intravenous Ig therapy in adult septic patients may have a rationale and seems to be associated with a reduced mortality. Anyway, the treatment effect generally tended to be smaller or less consistent if considering only those studies that were deemed adequate on each indicator. So, the available evidence is not clearly sufficient to support the widespread use of Ig in the treatment of sepsis.
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Automated anesthesia which may offer to the physician time to control hemodynamic and to supervise neurological outcome and which may offer to the patient safety and quality was until recently consider as a holy grail. But this field of research is now increasing in every component of general anesthesia (hypnosis, nociception, neuromuscular blockade) and literature describes some successful algorithms - single or multi closed-loop controller. ⋯ Literature contains many randomized trials comparing manual and automated anesthesia and shows feasibility and safety of this system. Automation could quickly concern other aspects of anesthesia as fluid management and this review proposes an overview of closed-loop systems in anesthesia.
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Minerva anestesiologica · Apr 2016
ReviewAnother failed attempt of neuroprotection: Progesterone for moderate and severe traumatic brain injury.
Two large phase-III prospective, multicenter, controlled, double-blind, randomized clinical trials (the PROTECT III study; the SYNAPSE study) evaluated the effectiveness of an early administration of progesterone in patients with moderate to severe traumatic brain injury (TBI). In the PROTECT III Trial, patients were included if the admission Glasgow Coma Scale (GCS) was within 4-12, whereas the SYNAPSE Trial only included patients with GCS 4-8. The total dose of progesterone was nearly similar in both studies and drug administration was initiated early after injury (within 4 hours for a total of 96 hours in PROTECT; within 8 hours for 120 hours in SYNAPSE). ⋯ In PROTECT, the proportion of patients with favourable outcome was similar between groups (51% for progesterone vs. 56% for placebo; RR 3.03 [95% CI 1.96-4.66]); in SYNAPSE, no difference in GOS between the progesterone and placebo group was found (OR 0.96 [95% CI 0.77-1.18]). There was no difference in 6-month mortality or any of the other secondary outcomes between groups in the two trials. These studies demonstrated that early progesterone administration did not provide any benefit on the neurological recovery of TBI patients.
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Minerva anestesiologica · Apr 2016
Review Meta AnalysisEffectiveness of benzodiazepine premedication on recovery in day-case surgery; a systematic review with meta-analysis.
Benzodiazepines are frequently used as a premedication. In day-case surgery, anesthetists are reluctant to administer benzodiazepines preoperatively for reasons of delayed recovery. However, premedication with benzodiazepines might be beneficial regarding postoperative somatic symptoms/complaints (i.e. time to recovery and postoperative side effects) and psychological phenomena. ⋯ For a firm conclusion regarding psychological phenomena, more research is needed. Anaesthetists should take into account this new evidence when they apply their premedication regime in day-case surgery.
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Minerva anestesiologica · Apr 2016
Review Meta AnalysisEffectiveness of benzodiazepine premedication on recovery in day-case surgery; a systematic review with meta-analysis.
Benzodiazepines are frequently used as a premedication. In day-case surgery, anesthetists are reluctant to administer benzodiazepines preoperatively for reasons of delayed recovery. However, premedication with benzodiazepines might be beneficial regarding postoperative somatic symptoms/complaints (i.e. time to recovery and postoperative side effects) and psychological phenomena. ⋯ For a firm conclusion regarding psychological phenomena, more research is needed. Anaesthetists should take into account this new evidence when they apply their premedication regime in day-case surgery.