Minerva anestesiologica
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Comparative StudyPilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph®) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy.
This study aims at investigating the effect of a single pre-operative oral administration of morphine sulphate (Oramorph®) on pain after laparoscopic cholecystectomy (LC). ⋯ Within a multimodal approach, a single preoperative oral administration of 30 mg of morphine sulphate in patients undergoing LC did not improve pain at rest, but improved NRS on movement during the first 3 hours after awakening. Group P required a higher mean dose of tramadol compared to Group M, although not significantly. The safety profile of Oramorph® allowed fast extubation and awakening times as well as prompt home discharge within 6 hours from surgery.
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Comparative StudyTotal Intravenous Anesthesia using Remifentanil in Extracorporeal Shock Wave Lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial.
Extracorporeal Shock Wave Lithotripsy is usually performed in day surgery setting, consequently people who undergo to this procedure need a safe and fast recovery. Conscious sedation with remifentanil can relieve from pain and keep patients in touch with anaesthesiologists. Few publications tell about infusion rates administered to perform this procedure7. The aim of this study is to assess which is the most appropriate infusion rate. ⋯ According with previous results remifentanil at the infusion rate of 0.05 µg/kg/min provides an effective analgesia, causing a lower incidence of side effect than 0.1 µg/kg/min, granting a fast and safe recovery.
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Minerva anestesiologica · Jan 2014
Multicenter Study Observational StudyAccuracy of leptin serum level in diagnosing ventilator-associated pneumonia: a case-control study.
Undernutrition causes a reduction of body-fat mass and a decrease in the circulating concentration of leptin which impairs the production of proinflammatory cytokines and increases the incidence of infectious diseases. The main objective of this study was to determine whether leptin deficiency is a risk factor for ventilator-associated pneumonia (VAP). ⋯ In our study, leptin level was not associated with VAP occurrence. Further studies are needed to confirm our results, and to define the exact inflammatory role of leptin, and its interest as a biomarker in ICU patients.
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Coagulation is a complex cascade whose intact functioning is essential in helping control hemorrhage after injury. While traditionally ascribed to the combined effects of acidosis, hypothermia, factor consumption and factor dilution, coagulopathy is also directly related to injury as well as hypofibrinogenemia and hyperfibrinolysis. ⋯ Both conditions offer opportunities for therapeutic intervention, and inhibition or abrogation of hyperfibrinolysis in particular may significantly improve survival in patients with injury and massive hemorrhage. Herein, we explore the underpinnings of trauma associated coagulopathy, the basic science behind the role of fibrinogen in acute traumatic coagulopathy, and the rationale behind and the data derived from management of hypofibrinogenemia as well as hyperfibrinolysis.
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Minerva anestesiologica · Jan 2014
Randomized Controlled Trial Clinical TrialBlood from the right atrium may provide closer estimates of mixed venous saturation than blood from the superior vena cava. A pilot study.
As a rule, central venous catheters (CVC) should not be positioned in the right atrium (RA) to avoid the risk of perforation and cardiac tamponade. However, in ICUs where ECG monitoring can detect any initial damage of the atrial wall, CVCs may probably be safely positioned in the RA. We investigated whether mixed venous saturation (SvO2) was better estimated by measuring central venous saturation (ScvO2) in the RA or in the superior vena cava (SVC) in patients undergoing cardiac surgery. ⋯ In monitored patients, positioning CVC tips in the RA rather than in the SVC may allow closer estimates of SvO2 and may be safe. Yet, safety should be confirmed by further studies with larger samples of patients.