Minerva anestesiologica
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Minerva anestesiologica · Jul 2020
Review Meta AnalysisDrugs for anaesthesia and analgesia in the preterm infant.
There is largely an absence of validated evidence-based therapies in term- and preterm newborn infants, due to a lack of pharmacological clinical trials. As a consequence, the drugs and doses used in clinical practice are extrapolated from dose-ranging trials performed in older patients. Drugs administered to the preterm infant are invariably off-label. The aim of this current review is to identify commonly used anesthetic and analgesic agents in this patient population, assess the existing evidence base, in terms of safety, efficacy, pharmacokinetics and pharmacodynamics, current indications and doses. ⋯ Preterm infants are characterized by remarkable metabolic and developmental differences when compared with adults. It is not possible to derive guidelines or clinical recommendations based on the existing evidence.
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The standard conditions of critical illness (including sepsis, acute respiratory distress syndrome, and multiorgan failure) cause enormous global mortality and a growing economic burden. Increasing evidence suggests that critical illness may be associated with loss of commensal microbes and overgrowth of potentially pathogenic and inflammatory bacteria. ⋯ Although the precise mechanisms of microbiome-directed treatments such as prebiotics, probiotics, and fecal microbiota transplantation remain to be determined, they can be utilized in the Intensive Care Unit (ICU) setting. The current review aims to offer intensivists an evidenced-based approach on what we currently know about the role of the microbiome in critical illness and how the microbiome could be targeted in the clinical practice to improve ICU-related outcomes.
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Minerva anestesiologica · Jul 2020
Randomized Controlled TrialComparison of the i-gelTM with the AuraGainTM laryngeal mask airways in patients with a simulated cervical immobilization: a randomized controlled trial.
The use of second generation supraglottic airway devices is recommended for airway rescue in failed tracheal intubation. This study was performed to compare the clinical performance of the i-gel™ with that of the AuraGain™ in patients with simulated cervical immobilization. ⋯ The i-gel™ and the AuraGain™ showed comparable oropharyngeal leak pressures and success rates in the first attempt in patients with simulated cervical immobilization. However, the i-gel™ was easier to insert and required less time for insertion than the AuraGain™.
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Prognostic models are often used to assess the quality of healthcare. Several scores were developed to predict mortality after cardiac surgery, but none has reached optimal performance in subsequent validations. We validate the most used scores (EUROSCORE I and II, STS, and ACEF) on a cohort of cardiac-surgery patients, assessing their robustness against case-mix changes. ⋯ Cardiac surgery scores calibrate poorly when the case-mix of validation and development samples differs. To grant reliability for benchmarking, they should be validated in the clinical settings on which they are applied and updated periodically. Advanced statistical tools are essential for the correct interpretation and application of severity scores.
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Minerva anestesiologica · Jul 2020
Observational StudyNeuromuscular monitoring using TOF-Cuff® versus TOF-Scan®: an observational study under clinical anesthesia conditions.
Anesthesia guidelines advise objective neuromuscular monitoring. Acceleromyography, the standard technique used in clinical practice, is commonly used with the train-of-four (TOF) nerve stimulation pattern. Objective of this study was to compare the performance of two devices, TOF-Scan® and TOF-Cuff®. ⋯ TOF-Cuff® consistently recorded the endpoints earlier than TOF-Scan®. Despite large intra-individual variations found with both devices, these results could be meaningful in a clinical setting.