Minerva anestesiologica
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Minerva anestesiologica · Aug 2018
ReviewFluid resuscitation during early sepsis: a need for individualization.
The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called "early goal-directed therapy" (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. ⋯ Dynamic variables of fluid responsiveness are now recommended to be used after an initial fluid infusion of a fixed volume (30 mL/kg) during the first three hours of resuscitation. However, this approach is also questionable due to the lack of individualization at the early and crucial phase of resuscitation. In this review, we propose a more personalized approach for the early and later phases of fluid resuscitation during sepsis.
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Minerva anestesiologica · Aug 2018
ReviewDo patients require "escorts" or "carers" for discharge following day surgery and office-based anesthesia? Both sides of the debate explored.
Over the past few years, there has been a rapid rise in office-based procedures, out of hospital and day surgery procedures, particularly as an effort to combat the escalating costs of hospital-based services. Coincident with this burgeoning demand for office-based anesthesia, is the accompanying increased risk of anesthesia and sedation-related complications. ⋯ A challenge for office-based settings, is the expectation of having an "escort" available to assume responsibility for the patient at time of discharge from the post anesthesia care setting. Challenges in securing an escort can lead to delays, cancellations and same day patient "no shows." This expert review, the first one to ever be published on this topic, will explore the medicolegal, regulatory, pharmacologic and pharmacokinetic issues involved on both sides of this debate need to be carefully considered and understood, considering the pros and cons of requiring an escort for same day post anesthesia discharge.
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Minerva anestesiologica · Aug 2018
Multicenter StudyWorkload and severity of illness of patients on intensive care units with available intermediate care units: a multicenter cohort study.
Intermediate Care Units (IMCU) are established in many hospitals to better match the requirements of patient care with respect to their personnel, equipment and other resources. This should relieve Intensive Care Unit (ICU) capacities for more severely ill patients and reduce readmissions to ICU. This study was conducted to investigate the effects of IMCU use on ICU populations. ⋯ The use of IMCUs influences resource utilization of ICUs. Severity of illness and workload was higher in ICUs with high IMCU and more scheduled discharges occurred during the main working hours while readmission rates were similar.
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Minerva anestesiologica · Aug 2018
μ-opioid receptor genetic polymorphisms and duration of epidural fentanyl analgesia during early labor.
Epidural fentanyl is commonly used for initiation of early labor analgesia. The aim of this prospective study is to test the hypothesis that duration of epidural fentanyl analgesia differs in nulliparous women requesting epidural analgesia in early labor who are variant allele carriers of the OPRM1 SNVs 118A>G rs1799971, IVS2+31G>A rs9479757, and IVS2+691G>C rs2075572. ⋯ OPRM1 SNVs did not affect the duration of epidural fentanyl administered for early labor analgesia in nulliparous women. These results should be confirmed in patients receiving epidural opioids in other clinical settings.