Minerva anestesiologica
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Minerva anestesiologica · Jun 2013
Review Meta AnalysisIntrathecal magnesium as analgesic adjuvant for spinal anesthesia: a meta-analysis of randomized trials.
Intrathecal magnesium extends analgesic duration of spinal opioids.
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Minerva anestesiologica · Jun 2013
ReviewDo we need to use sugammadex at the end of a general anesthesia to reverse the action of neuromuscular bloking agents? Position Paper on Sugammadex use.
Sugammadex, the first selective relaxant-binding agent indicated to reverse the neuromuscular blockade induced during general anesthesia, was recently introduced into clinical practice. In the present report, the following issues pertinent to the use of sugammadex in anesthesia practice are discussed: the intraoperative use of NMBAs and the incidence of postoperative residual curarization (PORC); the efficacy and safety of rocuronium plus sugammadex compared to succinylcholine for rapid sequence induction; the availability of sugammadex in hospitals; and, finally, some relevant legal medical aspects. Sugammadex is considerably more expensive than neostigmine, but its use can be advocated based on its safety and efficacy profile as a reversal agent of steroidal neuro muscular blocking agents (NMBAs), and as a mean to prevent PORC. ⋯ In the case of rapid sequence intubation (RSI), rocuronium (1.2 mg/kg) administration followed by sugammadex represents a better choice in terms of efficacy and safety than succinylcholine. If a new drug is proven to be safer and more efficient than the one it is replacing, hospitals should consider the new drug and make it available, at least for selected patients or in situations at risk of severe complications. It is reasonable to hypothesize that, when discussing informed consent for elective procedures, patients and families may want to know if the admitting facilities have the superior agent available, and that the absence of such agent could create concerns and complains.
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Minerva anestesiologica · Jun 2013
Randomized Controlled Trial Comparative StudyAcupuncture versus valproic acid in the prophylaxis of migraine without aura: a prospective controlled study.
The pharmacologic treatment of migraine still remains below the expectations. The aim of this study is to compare the effectiveness of traditional acupuncture and valproic acid in migraine prophylaxis. ⋯ Our data show a lower pain intensity and lower Rizatriptan intake at six-months follow-up with no adverse events in acupuncture patients compared to those treated with valproic acid.
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Minerva anestesiologica · Jun 2013
ReviewTracheal intubation of patients in non-standard positions requires training.
In extreme emergency situations, patients may need to undergo endotracheal intubation, while in a non-supine position. This manuscript offers several options to the anesthesiologist to cope with tracheal intubations in non-standard positions. The authors stress that there is a need for adequate training in an anaesthesia skills lab, whereby classic direct laryngoscopy and indirect videolaryngoscopy should be practiced on manikins, before our trainees actually practice anesthesia on patients in operating theatres. This manuscript is also a plea for developing an algorithm for emergency airway management in the non-supine position.