Minerva anestesiologica
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Minerva anestesiologica · Jun 2012
Randomized Controlled Trial Comparative StudyIntercomparison of three recruitment maneuvers in acute respiratory distress syndrome: the role of Body Mass Index.
The aim of this paper was to investigate the effectiveness of three different recruitment maneuvers (RMs) on respiratory and hemodynamic indexes, in patients with acute respiratory distress syndrome (ARDS), and determine the impact of patients' body mass index (BMI) on RMs efficacy. ⋯ In our cohort, recruitment by two sustained inflations resulted in a more persistent improvement of oxygenation as compared with recruitment by pressure controlled ventilation or consecutive sighs with the same airway pressure. BMI seems to have an impact on RMs effectiveness, most probably by altering the effective transpulmonary pressure. More studies are required to elucidate this observation.
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Minerva anestesiologica · Jun 2012
ReviewEarly interventions in severe sepsis and septic shock: a review of the evidence one decade later.
The outcomes of acute myocardial infarction, trauma, and stroke have improved by implementing processes that provide early diagnosis and aggressive interventions at the most proximal point of disease presentation. A common feature in these conditions is the implementation of early intervention strategies. One decade ago, a similar approach to sepsis began when a prospective randomized trial compared early goal-directed therapy (EGDT) to standard care using specific criteria for the early identification of high risk patients with infection. ⋯ Since the EGDT study was published a decade ago, significant emphasis worldwide has been placed on a comprehensive approach to the first 6 hours of sepsis management which is commonly referred to as the resuscitation bundle (RB). The RB consists of early diagnosis, risk stratification using lactate levels, hemodynamic response after a fluid challenge, antibiotics, source control and hemodynamic optimization or EGDT. This review will examine one decade of evidence for the components of the RB examining its impact on systemic inflammation, the progression of organ failure, health care resource consumption and mortality in severe sepsis and septic shock.
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Minerva anestesiologica · Jun 2012
Meta AnalysisThe efficacy of NMDA receptor antagonists for preventing remifentanil-induced increase in postoperative pain and analgesic requirement: a meta-analysis.
Meta-analysis was performed to evaluate the preventive effects of N-methyl-D-aspartate (NMDA) receptor antagonists on remifentanil-induced increase in postoperative pain and analgesic requirement in patients. ⋯ These data do not support the use of NMDA receptor antagonists, ketamine and magnesium sulfate to prevent the development of remifentanil-induced postoperative hyperalgesia and tolerance.
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Critically ill cirrhotic patients are characterized by unique and complicated clinical scenarios related to some characteristic and clear-cut pathophysiological features of their chronic end-stage liver disease that challenge Intensive Care Unit (ICU) physicians with several management problems. This class of patients may require admission to the ICU because of decompensation of their pre-existing liver disease or due to medical problems independent of cirrhosis as pneumonia, trauma or surgery. ⋯ Despite some improvement that was recently reported, patients with decompensated cirrhosis pose to ICU physicians several and, sometimes, dramatic dilemmas in terms of therapeutic strategies and efficacy of the treatments also due to the lack of large specific studies on this particular class of patients. This review will focus on kidney, cardiopulmonary and cerebral complications of severe cirrhosis as well as those related to portal hypertension and their management.
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Minerva anestesiologica · Jun 2012
Randomized Controlled TrialInfluence of a prolonged lateral position on induction of spinal anesthesia for cesarean delivery: a randomized controlled trial.
Maternal hypotension occurs commonly during cesarean delivery under spinal anesthesia. We evaluated whether hypotension due to aortocaval compression could be prevented by maintaining a lateral position after an intrathecal injection. ⋯ During spinal anesthesia for elective cesarean delivery, maintaining the lateral position for 6 min after an intrathecal injection of hyperbaric bupivacaine resulted in a more gradual and higher cephalad sensory block, without an increase in the incidence of maternal hypotension.