Minerva anestesiologica
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Minerva anestesiologica · Nov 2013
ReviewRegional anesthesia in patients with significant comorbid disease.
An increasing body of evidence suggests that regional anesthesia does not only provide better pain control compared to systemic analgesic and anesthetic techniques but that it is associated with improved perioperative outcomes. As these benefits may be especially prominent in the patient population suffering from high comorbidity burden, anesthesiologists have to be familiar with associated factors that may complicate the decision to use regional anesthetics. This manuscript is intended to provide a brief overview of the recent literature regarding beneficial outcomes associated with the use of regional versus general anesthesia, before focusing on the discussion of the implications of specific comorbid states on the performance of regional anesthetic techniques.
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Minerva anestesiologica · Nov 2013
Comparative Study Observational StudyComparison of acquisition of resistant microorganisms and infections in critically-ill patients with and without malignancies.
Patients with malignancies are often considered at risk of acquiring infections by resistant or potentially resistant microorganisms (RPRMs). However, data supporting this contention is scarce. We have compared critically ill patients with haematological malignancies (HM), solid tumours (ST) and without cancer (NC) in terms of acquisition of RPRMs, infections and mortality. ⋯ Critically ill cancer patients did not show a higher rate of RPRMs acquisition nor ICU-acquired infections. Mortality was higher in the HM group and it was not accurately predicted on admission by APACHE II score.
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Minerva anestesiologica · Nov 2013
Randomized Controlled TrialInfluence of acute normovolemic hemodilution on the pharmacokinetics of Cisatracurium Besylate.
Acute normovolemic hemodilution (ANH) is an efficacious blood conservation strategy for avoiding or reducing allogeneic blood transfusion. In a previous publication, on a different cohort of patients, we demonstrated that cisatracurium's potency and duration of action were not influenced by ANH, but we could not establish which role, if any, pharmacokinetics played. ⋯ ANH altered some pharmacokinetic parameters such as significantly larger volumes of distribution. Other parameters such as elimination half-life were considerably longer albeit not statistically significant.
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Minerva anestesiologica · Nov 2013
Observational StudyElevated adipose tissue lactate to pyruvate (L/P) ratio predicts poor outcome in critically ill patients with septic shock: a microdialysis study.
Sepsis is a disease affecting tissue metabolism; in vivo microdialysis (MD) is a bedside technique enabling researchers to monitor tissue metabolic changes. We conducted this study aiming to evaluate the relationship between lactate to pyruvate (L/P) ratio, a sensitive marker of tissue oxygenation and perfusion, and mortality in critically ill septic patients. ⋯ Elevated adipose tissue L/P ratio is associated with poor outcome in critically ill patients with septic shock. Microdialysis deserves to be further studied as a research tool in the multi-modal monitoring of septic critically ill patients.
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The use of antibiotic therapy combining at least two drugs remains controversial in patients with severe sepsis and septic shock. Some studies have suggested an improvement in patients' outcome with combination therapy over monotherapy, especially in those patients with expected mortality exceeding 25%. ⋯ Also, mortality rates were similar at 28 days and at 90 days in both groups. Considering some opposite observations coming from other recent non-randomized studies, we aimed to discuss the raisons of these conflicting findings on antimicrobials combination in patients with severe sepsis and septic shock.