Minerva anestesiologica
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Minerva anestesiologica · Apr 2019
Meta AnalysisBispectral index monitoring of sedation depth during endoscopy: a meta-analysis with trial sequential analysis of randomized controlled trials.
The Bispectral Index (BIS) provides an objective measure of the level of sedation and general anesthesia. We performed this meta-analysis and trial sequential analysis (TSA) of randomized clinical trials to clarify whether BIS monitoring is helpful in enhancing intraprocedual safety, shortening procedure duration or promoting recovery during sedation for endoscopic procedures. ⋯ More high-quality large-sampled RCTs are needed to confirm whether BIS monitoring for endoscopy sedation helps reduce intraprocedural hypoxia. BIS monitoring fails to shorten procedure duration, promote recovery or boost satisfaction among patients and endoscopists.
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Minerva anestesiologica · Apr 2019
Randomized Controlled Trial Comparative StudyComparison of surgical pleth index guided analgesia using fentanyl versus conventional analgesia technique in laparoscopic cholecystectomy.
Surgical Pleth Index (SPI) is an objective index and reflects the patient's nociception-antinociception balance during surgery. There are few studies on clinical implication of use of SPI in laparoscopic surgery. The aim of this study was to compare fentanyl requirement using SPI guided administration versus conventional analgesia technique in laparoscopic cholecystectomy. ⋯ Higher doses of fentanyl are required intraoperatively with lesser postoperative rescue analgesic requirements when SPI is used to guide intraoperative analgesia as compared to conventional analgesia technique.
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Minerva anestesiologica · Apr 2019
Comparative Study Observational StudyInterscalenic versus suprascapular nerve block: can the type of block influence short- and long-term outcomes? An observational study.
While interscalenic nerve block (INB) is still considered the gold standard for shoulder arthroscopy, its postoperative analgesic effectiveness has recently been called into question. Meanwhile, in light of its high-quality postoperative pain relief, a renewed interest has emerged in suprascapular nerve block (SNB). The first aim of our study was to compare the postoperative analgesia effects of these two types of block at two, four and six hours after surgery. We also assessed shoulder functional recovery over a 6-month follow-up period. ⋯ INB showed better analgesic efficacy in the immediate postoperative period. Both types of block showed similar results in terms of functional recovery over the six-month follow-up. SNB without motor block seems matched better with ambulatory surgery and with an early rehabilitation program.
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Minerva anestesiologica · Apr 2019
ReviewWhat have we learned from network meta-analysis applied to critical care? A narrative review.
It is widely accepted in modern medicine that medical decisions must be supported by scientific evidence. Identifying the best intervention when several options are available constitute a great challenge for every clinician. Traditional meta-analysis (TMA) allows summarizing evidence from studies that compare the same two interventions for one event (head to head studies or direct comparisons). ⋯ As a conclusion, NMA is an established, robust, objective and reproducible statistic technique that has been applied to several critical care areas. Clinical practice guidelines have started to include NMA evidence to support their recommendations. In future years, it seems highly probable that this technique will increase it applicability in almost all areas of critical care medicine.
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Minerva anestesiologica · Apr 2019
Observational StudyThe Weaning Index combining EtCO2 and respiratory rate early identifies Spontaneous Breathing trial failure. A pilot study.
We aimed to evaluate the predictive value of the end-tidal CO2 (EtCO2) alone or combined with ventilation related parameters on Spontaneous Breathing Trial (SBT) outcome on mechanically ventilated patients. ⋯ In unselected mechanically ventilated patients, the Weaning Index is helpful to early identify patients who will fail the SBT during a first and a second trial.