Minerva anestesiologica
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Minerva anestesiologica · Aug 2019
Comparative StudyComparison of the incidence of perioperative cardiovascular risk events among patients with and without a history of neoadjuvant chemotherapy.
Chemotherapy predisposes individuals to increased risk for future cardiac events. ⋯ Patients who underwent neoadjuvant chemotherapy prior to radical mastectomy were more prone to cardiovascular risk events than those without chemotherapy history.
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Minerva anestesiologica · Aug 2019
Randomized Controlled Trial Multicenter StudyProportional Assist Ventilation feasibility in the early stage of respiratory failure: a prospective randomized multicenter trial.
Proportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV). ⋯ The use of high-assistance PAV+ in the early phase of MV does not present benefits compared to V-ACV. The high rate of PAV+ failure reinforces the need for sedative optimization, learning curve, and better patient selection.
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Minerva anestesiologica · Aug 2019
Meta AnalysisMusic therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials.
The underlying clinical condition and the Intensive Care Unit (ICU) environment make critical illness a stressful event. Although the usual management consists of sedation, non-pharmacological interventions such as music therapy have been suggested for their drug-sparing effect. Aim of the present review is to assess the current evidence on the effectiveness of music therapy in reducing stress and anxiety in critically ill, adult patients. ⋯ Despite significant heterogeneity in trial designs, timing and features of the intervention, music therapy is consistently associated with a reduction in anxiety and stress of critically ill patients.
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Minerva anestesiologica · Aug 2019
ReviewUsing opioid therapy for pain in clinically challenging situations: questions for clinicians.
Healthcare professionals and organizations increasingly face the conundrum of treating patients with active substance use disorder, a history of personal or familial substance use disorder, or those at elevated risk for substance abuse. Such patients need compassionate care when facing painful conditions; in fact, denying them pain control makes it likely that they will seek out ways to self-medicate with illicit drugs. Yet it remains unclear how to safely and effectively treat patients in these challenging situations. ⋯ It is tempting but inaccurate to label these individuals as "inappropriate patients," rather they are high-risk individuals in very challenging clinical situations. The challenge is that both options - being in pain or being treated with opioids to control pain - expose the patient to a risk of rekindling an addiction. The question is how do we, as clinicians, adequately respond to these very perplexing clinical challenges?
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Minerva anestesiologica · Aug 2019
Comparative StudyInterscalene brachial plexus catheter versus single-shot interscalene block with periarticular local infiltration analgesia for shoulder arthroplasty.
Interscalene brachial plexus block is a commonly employed regional anesthetic technique for total shoulder arthroplasty, and a continuous catheter is often placed to extend the analgesic benefit of the block. As periarticular local infiltration analgesia (LIA) for total joint arthroplasty is a re-emerging trend, we evaluated the analgesic efficacy of continuous interscalene block (CISB) compared to single-shot interscalene block (SSISB) with LIA. ⋯ SSISB with LIA may provide clinically similar postoperative analgesia compared to CISB, but with escalating doses of opioid requirements.