Minerva anestesiologica
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Minerva anestesiologica · Apr 2014
ReviewThe last truth for beta-blockers in non-cardiac surgery is still missing!
The perioperative use of beta-blockers (BBs) with the aim of decreasing perioperative adverse cardiac events has been strongly supported, especially after the publication of two small trial (McSPI and DECREASE I) that showed major benefits. However, some later trials did not confirm these benefits. The POISE trial, with 8351 patients, showed reduced primary outcomes (cardiac death, non-fatal myocardial infarction, non-fatal cardiac arrest) at the expense of significant harm, increasing all-cause and sepsis-related deaths, and doubling the incidence of stroke. ⋯ In this review the most recent available evidence, the changes in the guidelines and the criticism on POISE results are discussed together with reasons why recent meta-analyses may not have greater certainty. This is explained by the huge numeric influence of the POISE trial and the heterogeneity in the design of the trials on perioperative BBs. Thus all the evidence available must now be taken into consideration to develop more appropriate guidelines to minimise the risks and enhance the benefits of perioperative beta-blockade.
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Minerva anestesiologica · Apr 2014
Review Practice GuidelinePreoperative evaluation in infants and children: recommendations of the italian Society of pediatric and neonatal anesthesia and intensive care (sarnepi).
The preoperative assessment involves the process of evaluating the patient's clinical condition, which is intended to define the physical status classification, eligibility for anesthesia and the risks associated with it, thus providing elements to select the most appropriate and individualized anesthetic plan. The aim of this recommendation was provide a framework reference for the preoperative evaluation assessment of pediatric patients undergoing elective surgery or diagnostic/therapeutic procedures. ⋯ Preoperative evaluation is mandatory before any diagnostic or therapeutic procedure that requires the use of anesthesia or sedation. The systematic prescription of complementary tests in children should be abandoned, and replaced by a selective and rational prescription, based on the patient history and clinical examination performed during the preoperative evaluation.
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Fungal infections including Candida peritonitis (CP) are being observed with increasing frequency in the ICU. We summarize current knowledge on epidemiology, risk factors, diagnostic tests and treatment options in the previously immunocompetent patient suffering from CP. ⋯ Besides skilled surgical management, the decision for empirical antifungal treatment in any patient with suspected CP has to be based on the exact knowledge regarding origin, type of peritonitis, severity of disease, knowledge of patient specific risk factors and previous exposure to antibiotics or azole antifungals.