Minerva anestesiologica
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Minerva anestesiologica · Nov 2007
Review Meta AnalysisUltrasound guidance for locoregional anesthesia: a review.
Although regional anaesthesia has become safer, there are an increasing number of articles regarding complications of regional blocks. During the last few years, many authors have suggested the use of ultrasound to minimize the appearance of complications. This review was performed, through a Medline research, to evaluate articles concerning ultrasound and locoregional anaesthesia published until April 2005. ⋯ Ultrasound guidance is useful in facilitating peripheral and neuroaxial blocks and offers direct visualization of the target, adjacent structures, and local anesthetic spread. The advantages also include a decreased rate of complications and faster onset of blocks. Finally, ultrasound measurements can even result in suggestions to modify established block technique.
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Minerva anestesiologica · Nov 2007
ReviewFeasibility, limits and problems of clinical studies in Intensive Care Unit.
In critical care medicine there is still a paucity of evidence on how to manage most of the clinical problems commonly encountered in critically ill patients. Randomized controlled trials (RCTs) are the most powerful instruments to evaluate the efficacy of a therapeutic intervention and to generate evidence for clinical practice. Unfortunately, the design and conduct of RCTs in our field are particularly complicated, because of some intrinsic and structural problems (e.g. lack of reliable nosography, concomitant use of different therapies, problems in the definition of end-points besides mortality) that will be discussed in this review. ⋯ A particularly stimulating opportunity of development is represented also by the relationship of critical care to EBM. Because of the above problems, metanalyses could be less informative than in other areas of medicine, as they are based on few trials which are often contradictory and of unsatisfactory quality. Few suggestions are formulated which could help looking forwards.