Minerva anestesiologica
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Minerva anestesiologica · Aug 2019
The effects of ropivacaine 0.0625% and levobupivacaine 0.0625% on uterine and abdominal muscle electromyographic activity during the second stage of labor.
This study investigated the effect of ropivacaine on uterine and abdominal muscle electromyographic activity during the second stage of labor. ⋯ In conclusion 0.0625% ropivacaine does not suppress abdominal muscle electromyographic activity during the second stage of labor. Maternal and neonatal outcomes were similar in patients receiving ropivacaine or no PCEA.
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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.
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Minerva anestesiologica · Aug 2019
Randomized Controlled TrialVeno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome: should the EOLIA Study results change our clinical approach?
The original discouraging results of extracorporeal membrane oxygenation (ECMO) application in acute respiratory failure caused the technique to be almost abandoned. Fortunately, ECMO survived thanks to the good results obtained in neonates. The interest on ECMO renewed after the publication of the CESAR Trial in 2009. ⋯ In 2018 the group of investigators led by Alain Combes designed and implemented the EOLIA Study to test the efficacy of veno-venous ECMO in patients with severe acute respiratory distress syndrome (ARDS). This article discusses the primary and secondary results of the trial and the considerations emerged in the medical community. We will also discuss how ECMO could evolve to maximize lung protection rather than just prevent hypoxic death.