Minerva anestesiologica
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Recently, many trials have been published to validate different techniques in peripheral regional anesthesia, but it is important to understand why and when we have to choose a specific technique and which advantages are offered by each of them. We performed a review of the clinical trials from the last three years (January 2007-September 2009), finding 644 articles on this topic. Even if many clinical trials underline a better efficacy of ultrasound (US) rather than peripheral nerve stimulators (PNSs), it could be important to confirm these results with trials having larger sample sizes and to compare US to percutaneous electric guidance (PEG) and/or sequential electrical nerve stimulation (SENS) techniques rather than peripheral nerve stimulation. Finally, even if it is well recognized that peripheral regional anesthesia is a safe technique, it is important to underline how the "new" techniques can guarantee a further improvement in the safety and effectiveness of regional anesthesia.
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Awareness during anesthesia has been the subject of much research and commentary in recent years. In this article, we review the recent publications in the area of anesthesia awareness and attempt to answer the question: Is awareness a problem without solutions? The incidence of awareness has been reported in benchmark studies to be about 0.1%, but two recent studies in Spain and China have reported incidences of awareness of 1% and 0.4%, respectively. ⋯ The best current evidence from one randomized trial suggests that bispectral index monitoring identifies the presence and reduces the incidence of awareness in high-risk patients. More trials are needed and two large ongoing trials are exploring the value of monitoring end-tidal gas concentrations and maintaining adequate age-adjusted values during surgery as an alternative method to prevent awareness.
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Minerva anestesiologica · Aug 2010
Comparative StudyComparison of the serial surveillance with quantitative and non-quantitative tracheal aspirate in predicting ventilator-associated pneumonia etiology in patients receiving antibiotic therapy.
The aim of this study was to investigate the value of serial quantitative (QC) and non-quantitative (NQC) endotracheal aspirate (ETA) surveillance cultures in predicting the causative pathogen of ventilator associated pneumonia (VAP) in patients receiving antibiotic therapy and the factors associated with their predictive value. This was a prospective observational cohort study carried out in the Intensive Care Unit of a tertiary hospital. ⋯ These results suggest that surveillance with NQ-ETA is better than the Q-ETA in predicting the development and causative pathogen of VAP in patients who have already been receiving antibiotic therapy.
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Minerva anestesiologica · Aug 2010
The practice of therapeutic mild hypothermia in cardiac arrest survivors in the Czech republic.
The proper performance of therapeutic mild hypothermia (TH) in cardiac arrest survivors is a prerequisite for achieving the best possible outcome. We analyzed the recent technical issues of in-hospital TH practices in the Czech Republic. ⋯ The survey revealed the recent practice of TH management of cardiac arrest survivors in the Czech republic. The modes of TH practice were different in many aspects, and unifying the basic components is advisable.