Minerva anestesiologica
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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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Minerva anestesiologica · Sep 2015
Review Meta Analysis Comparative StudyColloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. a systematic review and meta-analysis.
The incidence of hypotension associated to spinal anesthesia in elective cesarean section is high. To determine the effects of colloids and crystalloids in the incidence of hypotension induced by spinal anesthesia in elective cesarean section, an attempt was made to define which type of fluid and what total volume should be administered. Following the PRISMA methodology a systematic review and meta-analysis were carried out. ⋯ A significative decrease of incidence of hypotension associated to spinal anesthesia was observed with the use of colloids compared to crystalloids (RR [95% CI] 0.70 [0.53-0.92], P=0.01). However, there was no difference between crystalloid and colloid in the risk of intraoperative nausea and vomiting (RR [95% CI] 0.75 [0.41-1.38]; P=0.33). This meta-analysis shows colloid administration to significantly reduce the incidence of hypotension associated to spinal anesthesia in elective cesarean section compared with of crystalloid use.
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Minerva anestesiologica · Sep 2015
Review Meta Analysis Comparative StudyColloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. a systematic review and meta-analysis.
The incidence of hypotension associated to spinal anesthesia in elective cesarean section is high. To determine the effects of colloids and crystalloids in the incidence of hypotension induced by spinal anesthesia in elective cesarean section, an attempt was made to define which type of fluid and what total volume should be administered. Following the PRISMA methodology a systematic review and meta-analysis were carried out. ⋯ A significative decrease of incidence of hypotension associated to spinal anesthesia was observed with the use of colloids compared to crystalloids (RR [95% CI] 0.70 [0.53-0.92], P=0.01). However, there was no difference between crystalloid and colloid in the risk of intraoperative nausea and vomiting (RR [95% CI] 0.75 [0.41-1.38]; P=0.33). This meta-analysis shows colloid administration to significantly reduce the incidence of hypotension associated to spinal anesthesia in elective cesarean section compared with of crystalloid use.
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Minerva anestesiologica · Sep 2015
ReviewBlood glucose amplitude variability in critically ill patients.
While the discussion on the optimal blood glucose (BG) level target in critically ill patients is on-going, attention shifts towards other aspects of the BG signal, such as hypoglycemia and blood glucose amplitude variability (BGAV). A large number of observational and mostly retrospective studies have demonstrated an association between increased BGAV and worse outcomes. ⋯ In this review article, intuitive concept of "variability" will be clarified, and possible metrics to quantify BGAV are discussed. Whether it is feasible to actively minimize BGAV in order to improve the outcome of critically ill patients, is questionable.
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Insights into the pathogenesis of lung deformation injury inspired a benchmark clinical trial, which demonstrated that reducing tidal volumes compared to previous norms was associated with improved patient survival in acute respiratory distress syndrome (ARDS). Since many critically ill patients without ARDS possess ventilator associated lung injury (VALI) risk factors, there is no need to expose them to tidal volumes that are larger than would be needed to achieve acceptable blood gas tensions. ⋯ We will review studies in the medical and surgical literature that have addressed "lung protective ventilation" in patients without ARDS and summarize them with a focus on tidal volume, positive end expiratory pressure and oxygen supplementation settings. In addition, we will briefly discuss under what circumstance one might consider deviating from a conventional approach.