Minerva anestesiologica
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Minerva anestesiologica · Mar 2011
Non-invasive ventilation outside of the Intensive Care Unit: an Italian survey.
Non-invasive ventilation (NIV) is increasingly utilized for patients with acute respiratory failure (ARF). The shortage of Intensive Care Unit (ICU) beds, a growing confidence with the technique, and the opportunity to treat ARF in a more responsive phase lead to the application of NIV outside of the ICU. The Study Group on Emergency of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) promoted a national survey to collect data on NIV use outside of the ICU. ⋯ In Italy, NIV is extensively applied in non-intensive wards, and its use is not free from criticalities and contradictions. Further prospective studies and possibly guidelines are needed.
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Minerva anestesiologica · Mar 2011
Randomized Controlled TrialStress doses of hydrocortisone reduce systemic inflammatory response in patients undergoing cardiac surgery without cardiopulmonary bypass.
Systemic inflammatory response occurs after cardiac surgery (CS) and leads to a worse outcome in many cases. Stress doses of hydrocortisone have been successfully used to reduce SIRS and to improve outcome of patients after CS with cardiopulmonary bypass grafting (on-pump CABG), but the effect of hydrocortisone on patients undergoing CS without cardiopulmonary bypass grafting (off-pump CABG) is unclear. Therefore, we evaluated the effect of stress doses of hydrocortisone in this group of patients. ⋯ We conclude that intravenous stress doses of hydrocortisone lead to a reduction of systemic inflammation and to a potential improvement in the early outcome of patients undergoing off-pump CABG.
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Minerva anestesiologica · Mar 2011
Randomized Controlled Trial Comparative StudyAuricular acupuncture for postoperative pain after gynecological surgery: a randomized controlled trail.
Acupuncture for postoperative pain remains controversial. Potential sources of bias are failures in patient-blinding and therapist-patient interactions. Our study investigates the effects of electrical auricular acupuncture (AA) on postoperative pain in patients undergoing laparoscopy with an emphasis on patient-blinding and the exclusion of therapist-patient interactions. ⋯ Our study shows no reduction in postoperative pain or an opioid sparing effect of auricular acupuncture in women undergoing laparoscopic procedures. Because we emphasized blinding of the patients and the exclusion of therapist-patient interactions, our study suggests that electrical auricular acupuncture has no effect on postoperative pain.
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Minerva anestesiologica · Mar 2011
ReviewBlood transfusion in trauma patients: unresolved questions.
Massive transfusion is an essential part of resuscitation efforts in acute trauma patients. The goal is to quickly correct trauma-induced coagulopathy and replace red blood cell (RBC) mass with the minimal number as well as the appropriate choice of blood components to minimize the possible adverse effects of transfusions. Early trauma induced coagulopathy (ETIC) is present in about 20% of patients upon hospital admission and predicts for decreased survival. ⋯ When creating an MTP, product wastage due to inappropriate activation and improper product storage should be considered and closely monitored. Another area of discussion regarding transfusion in trauma includes the potential association of prolonged storage of RBCs and adverse outcomes, which has yet to be confirmed. Significant progress has been made in the transfusion management of trauma patients, but further studies are required to optimize patient care and outcomes.
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Minerva anestesiologica · Mar 2011
Randomized Controlled Trial Comparative StudyInflammatory response in patients undergoing colorectal cancer surgery: the effect of two different anesthetic techniques.
Anesthesia during surgery often induces an inflammatory response. The aim of this study was to establish and compare differences in inflammatory response among colorectal cancer surgery patients receiving either total intravenous anesthesia (TIVA) with propofol and remifentanil or inhalational anesthesia (INHAL) with sevoflurane and fentanyl. ⋯ TIVA with propofol and remifentanil and INHAL with sevoflurane and fentanyl induced similar inflammatory responses during colorectal cancer surgery. We found that IL-17 cytokine levels were higher in patients anesthetized with sevoflurane and fentanyl.