Minerva anestesiologica
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Neuraxial analgesia and anesthesia are widely used in obstetric anesthesia. The most frequent complication after neuraxial blocks is post-dural puncture headache. It can occur after unintentional dural puncture during epidural procedures or after spinal anesthesia. ⋯ A wide variety of prophylactic and therapeutic measures have been tried. So far, the therapeutic epidural blood patch is the only treatment for which there is enough evidence to recommend its routine use for severe cases of post-dural puncture headache. Larger multicenter trials are needed to back up alternative treatment strategies.
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Minerva anestesiologica · May 2019
ReviewExtracorporeal blood purification techniques in children with hyper-inflammatory syndromes: a clinical overview.
Data on clinical applications of blood purification techniques in children are scarce. The aim of this review is to offer a clinical overview, as complete as possible, on blood purification in children with hyper-inflammatory syndromes (HS). A review of the literature using the PubMed, EMBASE, Web of Science, and Scopus databases, on the most recent data about blood purification in children was conducted until June 2018. ⋯ The use of polymixin B and other adsorbing columns in children with septic shock and HS is increasing, but results are still limited by the observational nature of the studies. Based on the low-level of available evidence, no conclusions can be drawn regarding the efficacy and safety of blood purification in children. Further research with more clinically robust data is needed to determine the impact of different extracorporeal blood purification techniques in this pediatric population.
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Minerva anestesiologica · May 2019
ReviewCoronary angiogram after cardiac arrest? Reasonably and sensibly.
The role of emergency coronary angiography after cardiac arrest and return of spontaneous circulation is not yet completely clear. While patients with a high risk of acute coronary lesion and with a presumed favorable neurological outcome should undergo a coronary angiography as soon as possible, the decision to perform it is questionable in patients who are less likely to have a coronary cause of arrest, and when clinical characteristics raise serious concerns regarding neurological outcome. In this paper, we analyze the main advantages and drawbacks of a coronary angiogram after a successfully resuscitated cardiac arrest.
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Minerva anestesiologica · May 2019
Review Meta AnalysisIntraoperative monitoring of nociception for opioid administration: a meta-analysis of randomized controlled trials.
Under-dosage or over-dosage of intraoperative analgesia can cause harm to patients. Many studies have demonstrated the clinical advantages of nociception monitoring tools, but with some conflicting results. To clarify the issue, this meta-analysis compared the effects of Analgesia Nociception Index (ANI), Surgical Pleth Index (SPI), and pupillometry monitoring methods with those of analgesia management practices of intraoperative opioid administration. ⋯ Nociception monitoring devices seem to have an advantage over standard clinical practice on intraoperative management of analgesia during general anesthesia. Future research should focus on identifying appropriate indicators to objectively assess the degree of pain in children and perform large-scale multicenter trials to prove clinical advantages of nociception measurements during propofol anesthesia.