Minerva anestesiologica
-
β-blockers are widely used to treat cardiovascular diseases and in the peri-operative period in selected patients. The main benefit in terms of morbidity and/or mortality of their use is believed to be linked to specific effects on myocardial oxygen supply/demand balance, to anti-arrhythmic effects and anti-inflammatory effects. Use of β-blockers in severe sepsis is still under debate and if any, their appropriate indications remain unclear. ⋯ However, many questions about effectiveness, safety and cardio-selectivity of the drugs and about the appropriate target population remain partially unanswered. Recently, esmolol, a short-time acting β1-adrenoceptor blocker titrated to decrease heart rate below 95 beats/min was shown to exert beneficial effects in a monocentric randomized clinical trial including selected septic patients. Further large multicenter randomized trials are required to confirm the potential benefit of such a therapy in patients with severe sepsis.
-
Minerva anestesiologica · Mar 2015
Editorial CommentEvery need is perfectly met if you do not measure it.
-
Minerva anestesiologica · Mar 2015
Comparative StudyComparison of three models for sepsis patient discrimination according to PIRO: predisposition, infection, response and organ dysfunction.
Sepsis remains one of the most challenging burdens of critically ill patients. But for interventional studies significant heterogeneity remains in classifying patients. PIRO (Predisposition, Response, Infection and Organ dysfunction) has been introduced as innovative option for improved patient characterization. Aim of this study was to evaluate precision to predict hospital mortality of three different proposed PIRO classification systems. ⋯ Proposed PIRO classifications demonstrated slight differences between models without prioritization of one approach and all seemed feasible for patient classification. Future PIRO-development is needed to straighten predisposition, infection, and especially the response category.
-
Minerva anestesiologica · Mar 2015
Observational StudyPrediction of haemodynamic reactivity during total intravenous anaesthesia for suspension laryngoscopy using Analgesia/Nociception Index (ANI): a prospective observational study.
The Analgesia/Nociception Index (ANI), a 0-100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anesthesia. The principal objective of this study was to evaluate the performance of ANI to predict hemodynamic reactivity during suspension laryngoscopy. The secondary objectives were to investigate the performances of ANI and bispectral index (BIS) to assess sedation and of BIS to predict hemodynamic reactivity during the procedure. ⋯ ANI exhibits good performance for the prediction of hemodynamic reactivity and BIS exhibits good performance for the assessment of sedation during suspension laryngoscopy with propofol/remifentanil total intravenous anesthesia.