Minerva anestesiologica
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Abstract
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Minerva anestesiologica · Feb 2019
Comparison of axillary nerve block duration using mepivacaine in non-insulin diabetic or renal insufficiency patients: a controlled observational matched multicenter trial.
Although studies in diabetic patients demonstrated delayed recovery after long-acting local anesthetic, its effects with short-acting LA remains to be determined. Using mepivacaine, the authors evaluated the duration of axillary nerve blocks in diabetic (DP), renal failure (creatinine clearance <30 mL.min-1) (RP) and healthy patients (HP). ⋯ The short-acting LA (mepivacaine) are associated with similar pharmacodynamic effects in diabetic and renal failure patients as compared with healthy patients.
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Minerva anestesiologica · Feb 2019
ReviewThinking outside the box; off-label use of the Bispectral Index (BIS) within context and limitations for conditions other than depth of anesthesia. Light and shadow of the BIS.
Numerous articles appeared in literature using brain function monitors (BFM), such as Bispectral Index (BIS) to assess cerebral cognitive conditions not related to depth of anesthesia. BIS cannot be considered a "true" reflection of the electroencephalography (EEG) signal nor an independent measure of brain function. BIS algorithm was retrospectively derived from EEG changes with incremental doses of γ-amino butyric acid (GABA)ergic anesthetic agents while measuring 3 descriptors. ⋯ Could we use BIS monitor outside the scope of the operating room to "grade" other EEG conditions? Actually the answer to that seems to be a "very cautious" yes. Because BIS is a rather appealing scale from 100 to 0, it is tempting to find numerical cut-off values for conditions that are already clinically graded like West Haven hepatic encephalopathy. Having said that I strongly argue against going as far as using BIS in Critical Care Unit (CCU) setting, there are too much heterogeneity and many disease states in the CCU patients, other than sedatives /hypnotics, that would strongly influence BIS values, in effect rendering BIS not only useless most of the time but can also be misleading.
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Minerva anestesiologica · Feb 2019
Multicenter Study Observational StudyProlonged sedation in critically ill children: is dexmedetomidine a safe option for younger age? An off-label experience.
Dexmedetomidine (DEX) is an alpha-2-adrenergic agonist, recently approved by Italian-Medicines-Agency for difficult sedation in pediatrics, but few data exist regarding prolonged infusions in critically-ill children, especially in younger ages. Aim of our study was to evaluate DEX use and safety for prolonged sedation in Pediatric Intensive Care Units (PICUs). ⋯ DEX was confirmed as useful and relatively safe drug for prolonged sedation in critically-ill children, particularly in younger ages. Main AEs were cardiovascular, reversible, related with higher doses, with the concomitant use of benzodiazepines or multiple sedation drugs and with the presence of withdrawal syndrome.
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Minerva anestesiologica · Feb 2019
ReviewWhy don't multicenter randomized controlled trials (RCT) confirm the positive findings of single center RCTs in acute care? (Zeno's Paradox of the Tortoise and Achilles revisited).
It is a common observation that many multicenter randomized controlled trials (mRCT) performed in critically ill patients do not achieve the positive findings often seen in single center studies (sRCT). This has, of course, relevant consequences for clinical practice, as mRCTs have higher scientific validity compared to sRCTs. The aim of this manuscript was to review and discuss the several potential causes of this phenomenon and to relate them to the future of mRCTs in critical care medicine. ⋯ However, sRCTs are more prone to several bias compared to mRCTs, such as local effect bias, selection and performance bias, detection and reporting bias, analysis and attrition bias, concomitant therapy bias, low fragility index and publication bias. In this sense, it is high time the critical care community should see the positive findings of sRTCs with a very high level of scientific caution, unless they are confirmed by mRCTs. MRCTs represent the final step of the process of evidence-based medicine and in the end (however slowly and painfully) such evidence catches up with sRCT and truly helps changes practice worldwide.