Minerva anestesiologica
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Palliative sedation (PS), the medical act of decreasing a patient's awareness to relieve otherwise intractable suffering, is considered by some commentators to be controversial because of its consequences on residual survival and/or quality of life, and to be inappropriate for treating pure existential suffering. We will argue that PS must be always proportional, i.e. controlling refractory symptoms while keeping the loss of personal values (communication, affective relationships, care relationship) as low as possible, and that imminence of death is necessary too, from an ethical point of view, if a deep and continuous sedation (DCS) is proposed. ⋯ The use of progressive consent and advance care planning to share the decision with the patient and to involve the family in the decision process as much as the patient desires is another ethical aspect to be pursued. Producing, implementing and sustaining guidelines at the higher scientific and professional level promise to help in improving both clinical and ethical aspects of the practice of PS.
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Minerva anestesiologica · Dec 2017
Post-anoxic status epilepticus: which variable could modify prognosis? A single centre experience.
Status epilepticus (SE) is associated with high mortality in post-anoxic coma despite antiepileptic treatment. The aim of our study was to assess the percentage of awakening in a consecutive series of post-anoxic comatose patients with an EEG pattern consistent with SE and to verify any correlation with clinical, neurophysiological or pharmacological parameters. ⋯ In post-anoxic coma, SE does not always correlate with poor outcome. In patients with favorable patterns on multimodal prognostication approach, pharmacologic treatment, even aggressive, could be attempted.
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Minerva anestesiologica · Dec 2017
ReviewDexmedetomidine and general anesthesia: a narrative literature review of its major indications for use in adults undergoing non-cardiac surgery.
In Europe, dexmedetomidine has marketing approval only for sedation in intensive care units. However, its use during general anesthesia has been widely reported. The aim of this narrative review is to draw a picture of potential indications in anesthesia. ⋯ The properties of dexmedetomidine lead to its use for elective indications such as awake fiberoptic intubation and neurosurgical anesthesia. New topics are under debate. These subjects must be studied thoroughly because of their implication in the patients' surgical course. These advantages must be weighed against the major drawback of dexmedetomidine administration which is the potential for hemodynamic abnormalities.
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Minerva anestesiologica · Dec 2017
Randomized Controlled TrialThe impact of Dexmedetomidine or Xylocaine continuous infusion on opioid consumption and quality of recovery following laparoscopic sleeve gastrectomy: a randomized double blinded controlled study.
Postoperative pain control for morbidly obese patients represents a challenge because of their sensitivity towards opioid-induced respiratory depression. We elected both dexmedetomidine and xylocaine (lidocaine) continuous infusions as adjuvants because they lack respiratory depression side effect. ⋯ Continuous infusion of either dexmedetomidine or xylocaine reduces postoperative opioid consumption, pain and improve the quality of recovery following laparoscopic sleeve gastrectomy.
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Minerva anestesiologica · Dec 2017
Meta AnalysisRisk of spontaneous fungal peritonitis (SFP) in hospitalized cirrhotic patients with ascites: a systematic review of observational studies and meta-analysis.
Spontaneous fungal peritonitis (SFP) is an infection of ascitic fluid occurring in cirrhotic patients. SFP prevalence varies from 0% to 41% of patients with spontaneous peritonitis (SP) and a positive ascitic fluid culture. Cirrhotic patients with SFP who fail to show improvement with empirical antibiotic therapy, before the identification of the fungal pathogen, have high mortality (89.5-100%). Although the weight of the disease is so dramatic, more recent guidelines on infections in cirrhosis do not consider SFP management. The aim of this meta-analysis was to investigate the association between hospitalization (at least 48-72 hours after admission) and risk of SFP. ⋯ This meta-analysis suggests that hospitalization is related to a significant increase of SFP risk.