Minerva anestesiologica
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Minerva anestesiologica · Nov 2015
Comparative Study Clinical TrialNavigator® and SmartPilot® View are helpful in guiding anesthesia and reducing anesthetic drug dosing.
The recently introduced Navigator® (GE Healthcare, Helsinki, Finland) and SmartPilot® View (Dräger Medical, Lübeck, Germany) show the concentrations and predicted effects of combined anesthetic drugs, and should facilitate more precisely their titration. Our aim was to evaluate if Navigator® or SmartPilot® View guided anesthesia was associated with a good quality of analgesia, depth of hypnosis and may reduce anesthetic requirements. ⋯ Navigator® and SmartPilot® View may be of clinical use in monitoring adequacy of anesthesia. Both displays can optimize the administration and monitoring of anesthetic drugs during general anesthesia and may reduce the consumption of volatile anesthetic agents.
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Minerva anestesiologica · Nov 2015
ReviewComplications of immunosuppressive agents therapy in transplant patients.
Solid organ transplantation remains the gold standard for the treatment of end-stage organ dysfunction and saves thousands of lives. Besides the progress of surgery, advances in understanding transplant physiology, immunology and the development of immunosuppressive drugs lead to improved short- and long-term survival. ⋯ Approximately one third of organ recipients require hospital readmission after transplantation because of a multitude of clinical problems related to immunosuppressive therapy. We review the current knowledge on typical complications associated with immunosuppressants with emphasis on the intensivist's perspective.
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Minerva anestesiologica · Nov 2015
ReviewPeriprocedural management of antithrombotic therapy and open issues in cancer patients.
Perioperative management of patients who are receiving anticoagulant or antiplatelet drugs and require surgical or invasive procedure is a dilemma for clinicians. The discontinuation exposes the patient to an exceedingly high risk of thromboembolism while there is an exceedingly high bleeding risk if antithrombotic therapy is continued, strictly related to the type of surgery. This complex management is based on the assessment of thromboembolic and bleeding risk. In this review we analyze the strategies to optimize the perioperative use of antithrombotic drugs with special attention to new oral anticoagulant drugs, also in cancer patients.
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Minerva anestesiologica · Nov 2015
Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients.
Labile iron is important in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin control iron metabolism and are upregulated during renal stress. However, higher levels of urinary NGAL are associated with AKI severity whereas higher urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in intensive care unit (ICU) patients. ⋯ The NGAL/hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.