Minerva anestesiologica
-
Owing to their immune modulatory, anti-inflammatory, antioxidant, antithrombotic, and endothelial action, statins are widely used in the critical care setting in several disease scenarios. The present review focuses on the evidence supporting an even wider utilization of statins in intensive care practice for diverse indications. A search of the literature was carried out in PubMed, Cochrane and EMBASE databases up to January 2016. ⋯ References were also searched for other potentially useful articles. It was concluded that beneficial effects of statins are observed in cardiac surgery; however, no robust evidence supports their effectiveness in diverse critical care settings. The decision to discontinue statins in native users should be taken in consideration of particular clinical circumstances.
-
Minerva anestesiologica · May 2017
Randomized Controlled TrialReal-time ultrasound guided spinal anesthesia in patients with predicted difficult anatomy.
There are limited reports of lumbar neuraxial blocks using real-time US in patients with predicted difficulties. We compared the number of attempts to perform spinal anesthesia using real-time US guidance versus landmark technique in patients meeting predefined criteria for difficult spinal anesthesia. We also compared procedure time, block success, patient satisfaction and difficulty scores between groups. ⋯ This trial suggests that real-time US guidance for spinal anesthesia in challenging patients in comparison to the controlled group was completed in longer time, with lower needle insertion attempts, and higher patient satisfaction scores but without statistically significant differences.
-
Minerva anestesiologica · May 2017
European implementation of the "2014 ESC/ESA guideline on non-cardiac surgery: cardiovascular assessment and management".
Substandard implementation of a guideline is a major factor contributing to poor guideline adherence and has the potential to result in preventable patient harm. This study aims to quantify the uptake of the European guideline on non-cardiac surgery by European anesthetists. ⋯ Current implementation and knowledge of the guideline on non-cardiac surgery in Europe needs to be improved.
-
Severe obstructive sleep apnea (sOSA) and oxygen desaturations are both risk factors for postoperative complications. In some but not all patients, sOSA is associated with frequent oxygen desaturation episodes during sleep. The aim of this retrospective study was to identify the risk factors for exhibiting oxygen desaturation in patients with sOSA. ⋯ Less than 50% of patients with sOSA experience nocturnal oxygen desaturation. Obesity and daily benzodiazepine intake are independent risk factors for these patients to exhibit nocturnal oxygen desaturation. Benzodiazepine in obese patients with sOSA should, therefore, be used cautiously.
-
Minerva anestesiologica · May 2017
Palliative sedation: the position statement of the Italian National Committee for Bioethics (INCB).
In January 2016 the Italian National Bioethics Committee (NBC) published a position statement entitled Deep and continuous palliative sedation in the imminence of death, related to the use of sedation and analgesia for relief from pain and psychological distress in dying patients. In this statement the Committee points out the clinical and ethical appropriateness of palliative sedation as a therapeutic procedure. ⋯ At the same time, the position statement, once and for all, makes clear that palliative sedation cannot and must not be equated with the practice of euthanasia. Thus, this document should be known by health professionals caring for dying patients not only in palliative as well as in intensive care settings, but it should be also considered as a milestone aimed to encourage and ease a widespread implementation of this procedure in all health care settings.