Minerva anestesiologica
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Minerva anestesiologica · Nov 2011
Review Meta AnalysisPediatric delirium in the pediatric intensive care unit: a systematic review and an update on key issues and research questions.
There was a dearth in awareness and knowledge regarding pediatric delirium (PD) at the pediatric intensive care unit (PICU). The aim of this study is to highlight the most recent and up-to-date findings of current literature -by means of a systematic review (SR) method-, and to present the key issues and research questions. ⋯ There still is a dearth of literature on PD, with also a variable level of evidence (1b - 5), especially in relation to critical illness. To be able to further clarify PD in the PICU, additional research questions are provided for future research.
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Minerva anestesiologica · Nov 2011
Review Comparative StudyCoxibs: is there a benefit when compared to traditional non-selective NSAIDs in postoperative pain management?
A multi-modal approach for the management of postoperative pain has become increasingly popular. Strategies to avoid the use of opioids and thus any opioid analgesic related side-effect is an important part of the expansion of ambulatory surgery. Combining long acting local anesthesia in the wound area and non-opioid analgesics are today a basic concept in management of day care, short stay patients. ⋯ The less pronounced effect on platelet function and subsequent lower risk for impaired hemeostasis makes them, in theory, a preferred option to the non-selective traditional NSAIDs. The benefit versus risk for a more generalized use of Coxibs must, however, be based on a thorough evaluation of the overall benefits and risks for the use of NSAIDs and a further evaluation on whether the specific therapeutic features of the Coxibs provide benefits outweighing their increased cost. This review aims at providing a background and an overview of the benefits versus risks for the use of Coxibs as part of a multimodal postoperative pain management.
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Minerva anestesiologica · Nov 2011
Comparative StudyPharmacokinetics of free ertapenem in critically ill septic patients: intermittent versus continuous infusion.
The aim of this paper was to compare the pharmacokinetic and pharmacodynamic (PK/PD) parameters of continuous (CI) and intermittent infusion (ITI) of ertapenem into critically ill patients with severe abdominal infections. ⋯ Ertapenem exhibited satisfactory PK/PD parameters and achieved serum-free concentrations 100% of the time, above even the high MIC of extracellular pathogens normally encountered during severe abdominal infections. CI administration resulted in equally effective PK/PD parameters as ITI in normal weight, good renal-function patients.
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Minerva anestesiologica · Nov 2011
Case ReportsSuccessful application of helmet non-invasive ventilation in a parturient with acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is an important cause of morbidity and mortality during pregnancy. The case of a twin pregnant woman in her 28th week who developed infection-related ARDS, undergoing a cesarean section for premature membrane rupture is described. It was performed epidural anaesthesia and helmet non-invasive ventilation (NIV) during the postoperative period. The combination of epidural anesthesia with NIV helped to restore physiological gas-exchange and to prevent common complications associated with a more invasive approach.
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Minerva anestesiologica · Nov 2011
The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest.
Currently there are few tools available for clinicians to predict outcomes in cardiac arrest survivors. Our objective was to determine if the combination of simple clinical parameters (initial blood lactate and vasopressor use) can predict outcome in post-cardiac arrest patients. ⋯ The combination of two clinical parameters, vasopressor need and lactic acid levels, is an accurate severity of illness classification system and can predict mortality in patients following out-of-hospital cardiac arrest. Prospective validation of these variables in post-cardiac arrest is needed.