Minerva anestesiologica
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Minerva anestesiologica · Mar 2015
Review Meta AnalysisDexmedetomidine in the pediatric population : A review.
Dexmedetomidine, an alpha-2 agonist approved only for sedation in adult intensive care patients, is increasingly used off-label in- and outside Europe in the pediatric setting for various indications such as to prevent agitation, as premedication in the form of intranasal, buccal and oral solution, as adjunct for elective surgery, as sedative for magnetic resonance imaging, as intraoperative analgesia, for extracorporeal shock wave lithotripsy, and as adjuvant to ropi- and bupivacaine for nerve blocks. Dexmedetomidine is also used intravenously at different intensive care units with the purpose of sedation of children. In this paper, we assess 51 minor trials in the form of 44 randomized controlled trials and 7 prospective observational studies in an attempt to update the available evidence on dexmedetomidine use in pediatrics. ⋯ Based on the best current evidence dexmedetomidine is found suitable and safe for various indications. However, in order to discover its full potential, indications, dosing and safety profile for various ages and procedures, it should urgently be examined by conducting good quality pediatric trials. Finally, we provide the readers with guidance on how to apply and dose dexmedetomidine for pediatric sedation and for other indications.
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Minerva anestesiologica · Feb 2015
Review Meta AnalysisTransversus abdominis plane block for analgesia after cesarean delivery. A systematic review.
Cesarean delivery is a major surgical procedure, after which a woman can experience substantial postoperative discomfort or pain. Inadequate postoperative analgesia is one of the most common reasons for poor patient satisfaction following cesarean delivery. Although spinal or systemic opioids are currently the gold standard to achieve effective analgesia, they are often associated with side effects. ⋯ In this systematic review of articles published as of 31 December 2013, we searched the principal medical databases for randomized controlled trials that assessed the efficacy of ultrasound (US)-guided TAP block following cesarean delivery and reported on postoperative opioid consumption and pain score, opioid-related side-effects and patient satisfaction. Although controversy surrounds the utility of US-guided TAP block in cesarean section, evidence suggests that when correctly executed as part of a multimodal analgesic regimen, TAP block may reduce postoperative opioid consumption and opioid-related side effects, improving postoperative pain control and patient satisfaction. Further studies are necessary to explore this field of research.
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Minerva anestesiologica · Dec 2014
Review Meta AnalysisThromboelastometry for Guiding Bleeding Management of the Critically Ill Patient: A Systematic Review of the Literature.
A systematic review of the published literature clearly demonstrates the usefulness of thromboelastometry (ROTEM®) in detecting coagulation disorders in severe trauma, cardiac and aortic surgery, liver transplantation, and postpartum haemorrhage reliably and within a clinically acceptable turn-around time. In all of the above-mentioned scenarios, the transfusion of any allogeneic blood products could be reduced significantly using ROTEM®-guided bleeding management, thereby minimising or avoiding transfusion-related side effects. Based on the current body of evidence as assessed by the GRADE system, the use of ROTEM® may be recommended in particular for management of severe bleeding after trauma and during cardiac and aortic surgery. However, as laboratory testing contributes only one part of severe bleeding management, the implementation of safe and effective treatment algorithms must be ensured at the same time.
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Minerva anestesiologica · Oct 2014
Review Meta AnalysisA systematic review of antifibrinolytics and massive injury.
Every year, more than a million people die as a result of trauma. This huge mortality could be partially explained by the development of an acute traumatic coagulopathy, present in a large part of all major trauma patients, soon after injury, which contributes to ongoing hemorrhage. The coagulopathy induced by trauma is independently associated with mortality, increased transfusion requirements, multiple organ dysfunction, infections, increased intensive care unit (ICU) length of stay, and costs. ⋯ This study aims at determining the safety and efficacy of TXA administration in this particular setting. Our experience from the cardiac surgery setting highlighted a dose-dependent increased seizure incidence associated with the administration of TXA. For this reason, further studies are needed to better define the "optimal" dose scheme based on pharmacokinetic and pharmacodynamic studies.
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Minerva anestesiologica · Sep 2014
Review Meta AnalysisUpdate of recommendations for analgosedation in Pediatric Intensive Care Unit.
Effective and adequate therapy to control pain and stress are essential in managing children in Pediatric Intensive Care Unit (PICU) undergoing painful invasive procedures, this should be, but is not yet, one of our main aims. Aware that this difficult mission must be pursued in a systematic, multimodal and multitasking way, the Studying Group on Analgosedation in PICU from the Italian Society of Neonatal and Paediatric Anesthesia and Intensive Care (SARNePI) is providing its recommendations.