Minerva anestesiologica
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Minerva anestesiologica · Nov 2020
Pediatric pain review: what has happened since the First World Congress on Pediatric Pain in 1988? The past, the present and the future.
The present article summarizes the development within the field of pediatric pain during the last 30 years, with a special focus on pediatric postoperative pain. Insights concerning pain ontogeny, how pain influences the neuro-endocrine stress response and the induction of a "pain memory" is discussed as well as established and new options with regards to treatment of postoperative pain. Lastly, some aspects concerning future development within this field is discussed. ⋯ The use of regional anesthetic techniques should be used whenever possible and combined with appropriate systemic options, thereby producing multi-modal analgesia. However, new concepts and drugs are unfortunately few and, thus, progress often lies in using established drugs in more efficient ways. The concept of Enhanced Recovery After Surgery (ERAS) also provides a framework where high-quality postoperative pain relief is of essence for the best possible outcome after both minor and major surgery.
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Minerva anestesiologica · Nov 2020
Observational StudyThe doctor's point of view: eye-tracking as an investigative tool in the extubationprocess in intensive care units. A pilot study.
Patient safety is a top priority in healthcare. Little is known about the visual behavior of professionals during high-risk procedures. The aim of this study was to assess feasibility, usability and safety of eye-tracking to analyze gaze patterns during the extubation process in the intensive care unit. ⋯ Eye-tracking can demonstrate that there is a mismatch between physicians' subjective evaluations and corresponding objective real-life measurements. Structured and standardized extubation processes should be performed to improve patient safety. In the immediate postextubation phase, long dwell time on the patient shows that clinical observation remains the most important cornerstone beyond monitoring devices.
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Minerva anestesiologica · Nov 2020
ReviewCoronavirus disease 2019 (COVID-19) in critically ill patients: can we re-program the immune system? A primer for intensivists.
In December 2019, Coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread around the word. The immune response is essential to control and eliminate CoV infections, however, multiorgan damage might be due to direct SARS-CoV2 action against the infected organ cells, as well as an imbalanced host immune response. In effect, a "cytokines storm" and an impaired innate immunity were found in the COVID-19 critically ill patients. In this review, we summarized the virus immune response steps, underlying the relevance of introducing the measurement of plasma cytokine levels and of circulating lymphocyte subsets in clinical practice for the follow-up of critically ill COVID-19 patients and support new therapy.