Minerva anestesiologica
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Minerva anestesiologica · Jan 2015
ReviewNovel multi-drug resistant microorganisms in critically ill: a potential threat.
Infections due to multidrug resistant (MDR) pathogens are among the major threats in critically ill patients. Reduced vancomycin susceptibility in Staphylococcus aureus, high-level aminoglycoside resistance in enterococci, extended spectrum beta-lactamase and carbapenemases production in Enterobacteriaceae, carbapenem and colistin resistance in Pseudomonas spp. and Acinetobacter spp. are increasing in many intensive care units around the world. In the last few years some new anti-Gram-positive agents have been developed, whereas for Gram-negatives the available options are very limited. Infections control and antimicrobial stewardship programs are currently the only available options to avoid a further increase of these pathogens.
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Minerva anestesiologica · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyAutonomic cardiovascular modulation with three different anesthetic strategies during neurosurgical procedures.
Autonomic cardiovascular modulation during surgery might be affected by different anesthetic strategies. Aim of the present study was to assess autonomic control during three different anesthetic strategies in the course of neurosurgical procedures by the linear and non-linear analysis of two cardiovascular signals. ⋯ Despite an important reduction of cardiovascular signal variability, the analysis of RR and SAP signals were capable to detect information about autonomic control during anesthesia. Symbolic analysis (non-linear) seems to be able to highlight the differences of both the sympathetic (slow) and vagal (fast) modulation among anesthetics, while spectral analysis (linear) underlines the same differences but only in terms of balance between the two neural control systems.
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Minerva anestesiologica · Jan 2015
ReviewCoagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding.
Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. ⋯ Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII.
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Minerva anestesiologica · Jan 2015
Randomized Controlled TrialValidity and fidelity of the upper airway in two high-fidelity patient simulators.
Human patient simulators are frequently used for airway management training and research. However, little is known about their fidelity and validity. The use of these simulators as a benchmark model remains highly questionable. The objective of this study was to evaluate the validity and fidelity of two patient simulators (compared to actual patients) for anaesthesia residents performing three airway management techniques. ⋯ Patient simulators are not a valid alternative to human patients for conducting scientific evaluations of supraglottic airway management techniques. HAL and SimMan do have adequate validity for endotracheal intubation, but the fidelity and validity are low when a laryngeal mask is used or if mask ventilation is performed. Therefore, previous simulation-based airway device evaluation studies must be interpreted with great caution.