Minerva anestesiologica
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Minerva anestesiologica · Dec 2017
Meta AnalysisRisk of spontaneous fungal peritonitis (SFP) in hospitalized cirrhotic patients with ascites: a systematic review of observational studies and meta-analysis.
Spontaneous fungal peritonitis (SFP) is an infection of ascitic fluid occurring in cirrhotic patients. SFP prevalence varies from 0% to 41% of patients with spontaneous peritonitis (SP) and a positive ascitic fluid culture. Cirrhotic patients with SFP who fail to show improvement with empirical antibiotic therapy, before the identification of the fungal pathogen, have high mortality (89.5-100%). Although the weight of the disease is so dramatic, more recent guidelines on infections in cirrhosis do not consider SFP management. The aim of this meta-analysis was to investigate the association between hospitalization (at least 48-72 hours after admission) and risk of SFP. ⋯ This meta-analysis suggests that hospitalization is related to a significant increase of SFP risk.
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Minerva anestesiologica · Aug 2017
Meta AnalysisBlood purification with continuous venovenous hemofiltration in patients with sepsis or acute respiratory distress syndrome. A systematic review and meta-analysis of randomized evidence.
Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings. ⋯ Overall, low-quality evidence indicates that blood purification with CVVH might be associated with a significant reduction in mortality when performed in patients with sepsis or ARDS. The evidence is still insufficient to support a definitive conclusion of benefit. Further high-quality randomized controlled trials, adequately powered for mortality, are needed to clarify the impact of CVVH on these conditions.
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Minerva anestesiologica · Aug 2017
Meta AnalysisEffect of remifentanil for general anaesthesia on parturients and newborns undergoing caesarean section: a meta-analysis.
The results presented by studies investigating the effect of remifentanil on both parturients and newborns during cesarean section differed significantly. Therefore, we performed a meta-analysis to estimate the effect of remifentanil on these patients. ⋯ Remifentanil shows potential value of maternal circulation response during general anesthesia, which reduces maternal blood pressure in response to intubation and surgery. However, whether it is beneficial for the neonate is still controversial. More randomized-controlled trials with larger sample size are required to assess the adverse effects of remifentanil.
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Minerva anestesiologica · Jul 2017
Meta AnalysisEffect of anesthesia methods on postoperative major adverse cardiac events and mortality after non-cardiac surgeries: a systematic review and meta-analysis.
Postoperative major adverse cardiac events (MACEs) are the main cause of postoperative mortality, and controversies exist regarding the effects of anesthesia methods on postoperative MACEs and mortality in high-risk cardiac patients after non-cardiac surgeries. ⋯ Sevoflurane anesthesia, or epidural combined with general anesthesia can provide short-term myocardial protective effect in high-risk cardiac patients undergoing intermediate- or high-risk non-cardiac surgeries.
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Minerva anestesiologica · Feb 2017
Meta AnalysisAnalgesia-Nociception monitoring for opioid guidance: meta-analysis of randomized clinical trials.
The adequate suppression of nociception is, besides induction of unconsciousness and immobility, the main objective during anesthesia. Analgesics, most commonly opioids, are usually titrated by established clinical surrogates of nociception. Recently, monitoring techniques became available to evaluate analgesia/nociception during anesthesia and provide better measures then clinical evaluation alone. They are primarily derived from autonomic response on physiologic standard measures. ⋯ Monitoring analgesia/nociception is often reliant on regular physiologic conditions, like sinus rhythm. Opioid guidance dependent on analgesia/nociception monitoring during anesthesia may have beneficial and clinically relevant effects, however the number of currently available randomized controlled studies is low and conclusions are hampered by heterogeneity. More studies with focussed clinical endpoints are therefore needed.