Minerva anestesiologica
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Pediatric regional anesthesia (PRA) is widely practiced today; reassuring data from international literature show its safety and efficacy. However, for many years, PRA was considered an extravagant and ineffective technique by many detractors.
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Minerva anestesiologica · Mar 2009
Promoting epidural analgesia for labor: 2005-2007 diffusion in Lombardia, Italy.
Since January 2005 the Regional Government of Lombardia, a large Italian region with over 1/5 of all Italian births, allocated public funds for 3 consecutive years to help provide epidural analgesia (EA) for women in labor. The aim of the present study was to evaluate the trend of diffusion of EA in the triennium 2005-2007. ⋯ The continuous increase of EA for labor after regional financings suggests that the low rate of pain relief procedures in Lombardia was mainly due to economic and organizational issues, rather than to cultural and psychological factors.
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Innovation over the past 25 years in the field of the airway management has led to the proliferation of new and improved techniques and devices. It is important to emphasize that the definition of a failed airway must include the inability to maintain acceptable oxygenation and not only the evidence of unsuccessful laryngoscopy and impossible intubation. We must ask ourselves: is it always necessary to intubate? Is it necessary in all patients? Our answer is absolutely ''no." Patients' oxygenation is the absolute priority, where the choice of whether or not to intubate represents only a technical problem. ⋯ Furthermore, the applicability of associated techniques could represent an efficacious strategy to overcome the limitations of the single device by strengthening their capabilities and chances of successful airway management. To date there is no technique found to be effective in every case or that can solve all airway problems. It is not the latest device or the latest technique that can solve an airway management problem, but the operator's experience and skill with the device and technique that he knows best and uses daily.
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Minerva anestesiologica · Mar 2009
ReviewEvidence-based renal replacement therapy for acute kidney injury.
Acute kidney injury (AKI) with the subsequent need for renal replacement therapy (RRT) represents a persistent challenge, arising in 4-5% in critically-ill patients, and remains associated with a high mortality (60%) and morbidity. As AKI is an independent risk factor for poor prognosis, appropriate management of patients with AKI becomes of utmost importance. ⋯ However, the timing of the initiation, the modality, and the dose of RRT are still controversial and the subject of ongoing clinical trials. This review presents and discusses currently available data regarding the use of RRT in critically-ill patients with AKI.