Minerva anestesiologica
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Minerva anestesiologica · Aug 2018
ReviewThe role of cannabinoids in pain control: the good, the bad, and the ugly.
Cannabinoids appear to possess many potential medical uses, which may extend to pain control. A narrative review of the literature has found a variety of studies testing botanical and synthetic cannabinoids in different pain syndromes (acute pain, cancer pain, chronic noncancer pain, fibromyalgia pain, migraine, neuropathic pain, visceral pain, and others). Results from these studies are mixed; cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic noncancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain. ⋯ Cannabinoid-based analgesia has been linked to potential memory deficits and cognitive impairment. A great deal more remains to be elucidated about cannabinoids which may emerge to play an important role in the treatment of neuropathic and possibly other painful conditions. There remains a great deal more to learn about the role of cannabinoids in pain management.
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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.