Minerva anestesiologica
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Minerva anestesiologica · Feb 2014
Randomized Controlled Trial Comparative StudyComparison of Sublingual Midazolam and Dexmedetomidine for Premedication in Children.
Premedication in children scheduled for surgery reduces preoperative anxiety and facilitates a smooth induction of anesthesia. Midazolam is a commonly used premedication in children but, because of its undesirable effects such as postoperative behavior changes and cognitive impairment, it is not an ideal premedicant. Dexmedetomidine, a highly specific a2-adrenergic receptor agonist, produces sedation which mimics natural stage 2 non-rapid eye movement sleep and helps in early postoperative recovery. The objective of our study was to evaluate the effectiveness of sublingual dexmedetomidine in comparison to sublingual midazolam as premedicant in children ⋯ Sublingual dexmedetomidine provides more effective preoperative sedation as compared to sublingual midazolam across all the age groups and allows a smooth anesthesia induction and awakening especially in the preschool children.
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During pregnancy most of women will experience some kind of pain, either as a result of a pre-existing condition (low back pain, headache, fibromyalgia, and rheumatoid arthritis) or as a direct consequence of pregnancy (weight gain, postural changes, pelvic floor dysfunction, hormonal factors). However, chronic pain management during pregnancy and lactation remains a challenge for clinicians and pregnant women are at risk of undertreatment for painful conditions, because of fear about use of drugs during pregnancy. ⋯ The aim of this paper is to review the safety profile in pregnancy or lactation of the commonly prescribed pain medications and non-pharmacological treatments. In addition to the conventional classifications from the Food and Drug Administration and the American Academy of Paediatrics, authors analyzed the currently available clinical data from literature.
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Minerva anestesiologica · Feb 2014
ReviewA Review of Therapeutic Attempts to Recruit the Microcirculation in Patients with Sepsis.
Microcirculatory dysfunction is a pivotal element of the pathogenesis of severe sepsis and septic shock. Technological development, including sidestream darkfield videomicroscopy, now allows for bedside assessment of the microcirculation. A number of clinical studies have established the importance of the microcirculation in sepsis. The objective of this review is to discuss human trials that have assessed interventions aimed at improving microcirculatory flow in patients with sepsis.
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Pleural effusion is a fluid collection within the pleural space and is a common finding in mechanically ventilated patients. It is frequently related to fluid overload, hyponcotic states, heart failure, and altered pleural pressure due to atelectasis or pneumonia. Recent literature has shown that its incidence within ARDS is increasing, even if, in most of cases, at least in the early phases, it seems of limited clinical relevance. ⋯ Aim of this review is to summarize the current evidence and opinions about the interaction between Pleural Effusion and positive pressure ventilation in the presence of ARDS, its impact on gas exchange and tidal mechanics, trying to figure out the best bedside management that is not available yet. The estimation of both lung and chest wall elastance may help in the clinical decision making whether to drain or not in order to improve respiratory mechanics and oxygenation. Further research is still needed to determine the effect of drainage on clinical outcome and to evaluate its application in the weaning strategies.