Minerva anestesiologica
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Minerva anestesiologica · Sep 2015
Randomized Controlled TrialRandomized controlled pilot trial of the Rigid and Flexing Laryngoscope versus the fiber-optic bronchoscope for intubation of potentially difficult airway.
The flexible fiberoptic bronchoscope (FOB) is viewed as the gold standard device for awake intubation in the difficult airway. The newer rigid flexible laryngoscope (RIFL) was developed for similar indications. In this study we compare these two devices for management of potentially difficult airways after induction of general anesthesia. ⋯ The RIFL required significantly less time and fewer airway assist maneuvers for successful endotracheal intubation compared to FOB when used by experienced providers in patients with anticipated difficult airways.
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Minerva anestesiologica · Sep 2015
ReviewContinuous regional anesthesia and inflammation, a new target.
Inflammation can be defined as the host response when confronted with an aggression. The purpose of the inflammatory reaction is the defense of the host for re-establishing the baseline homeostasis of the organism. Compared to the neuroendocrine changes associated to the stress response to injury, the inflammatory reaction is the major determinant of patient's recovery in the perioperative period. ⋯ While experimental studies have shown that RA techniques modulate both local and systemic inflammatory reactions, in contrast, clinical findings are inconsistent as actual RA techniques fail to impact major patients' outcomes beyond immediate postoperative analgesia. The discrepancy between experimental findings and clinical observations asks questions and argues for a different view of perioperative inflammatory processes, in other words for an individualized management of the patients. Future developments of tools to quantify inflammatory and immune profile of patients might certainly lead to exciting findings and to major improvements in perioperative medicine.
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Perioperative hyperglycemia is associated with postoperative complications after major surgery. However, more than 50% of surgical procedures are performed in an ambulatory setting, where glucose is not routinely measured. The objectives of this study were to investigate the change in capillary glucose during ambulatory surgery, to identify patients at risk for perioperative increasing glucose and to evaluate whether hyperglycemia predisposes for complications after ambulatory surgery. ⋯ Minor ambulatory surgery is not associated with a clinically relevant increase in glucose. The very small glucose increase we observed could be attributed to the administration of dexamethasone for PONV prophylaxis. Hyperglycemia during ambulatory surgery is not associated with complications after discharge.
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Minerva anestesiologica · Sep 2015
Observational StudyChanged epidemiology of ICU acquired bloodstream infections over 12 years in an Italian teaching hospital.
We compared the etiology of 203 ICU-acquired laboratory confirmed bloodstream infections (LC-BSI) prospectively collected between January 2000-December 2007 (first period) with 83 LC-BSI recorded between January 2010-December 2012 (second period), after the diffusion in 2008 of K. pneumoniae expressing carbapenem-resistance due to K. pneumoniae carbapenemases production (KPC-CR-Kp). ⋯ ICU-acquired LC-BSI etiology shifted from Gram-positive to Gram-negative during the study period in our ICU. Also associated mortality decreased among the former, whereas it increased in the latter. Last MDR increased enormously among Enterobacteriaceae with the diffusion of KPC (75% of strains), adding significantly to associated mortality (RR 2.17; 1.16-4.05; P<0.01).