Minerva anestesiologica
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Minerva anestesiologica · Jan 2013
Review Meta AnalysisAn updated meta-analysis to understand the variable efficacy of drotrecogin alfa (activated) in severe sepsis and septic shock.
Significant debate continues over the efficacy of drotrecogin alpha activated (DAA) in sepsis. This updated meta-analysis provides an updated summary effect estimate and explores the reasons for outcome heterogeneity in placebo-controlled randomized clinical trials of DAA on 28-day all-cause mortality in patients with severe sepsis or septic shock. ⋯ DAA is not associated with improved survival in patients with severe sepsis or septic shock. Further studies should be done to determine whether changes in supportive therapy for sepsis explain the variable efficacy of DAA in randomized controlled clinical trials observed over time.
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Minerva anestesiologica · Jan 2013
ReviewMaternal hypotension during spinal anesthesia for caesarean delivery.
The aim of the study was to review maternal hypotension during caesarean delivery with spinal anesthesia. Obstetric complications, such as obstetric hemorrhage and problems related to concomitant maternal diseases are not considered. Reports of hypotension during spinal anesthesia for elective caesarean delivery are frequent (70-80%) when pharmacological prophylaxis is not used. ⋯ Preoperative tests and new monitoring devices are available to predict or permit early detection of hypotension, but their feasibility and reliability in routine clinical practice is not yet established. With these tools, it may become possible to tailor prophylaxis to the assessed risk of the individual. Combining a prophylactic vasopressor regimen with hydroxyethylstarch preloading, hydroxyethylstarch coloading or crystalloid coloading is the best method to decrease the incidence and severity of hypotension during spinal anesthesia for caesarean delivery.
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Minerva anestesiologica · Jan 2013
Randomized Controlled Trial Comparative StudyDesflurane versus sevoflurane: a comparison on stress response.
Neurohumoral, immunologic and metabolic alteration characterize surgical procedures in relation with the intensity of injury, the total operating time and the anesthetic technique. We, therefore, compared the effects of desflurane versus sevoflurane anesthesia on intra and postoperative release of the stress hormones and inflammatory cytokines. ⋯ In the present study we demonstrated that desflurane and sevoflurane produced a different stress response in the setting of laparoscopic surgery. The greater release of catecholamines during desflurane anesthesia could have adverse effects in patients with pre-existing cardiovascular disease. In low stress surgery desflurane, as compared to sevoflurane, was associated with a better control of intraoperative cortisol and ACTH response (T2). Moreover, the ACTH secretion resulted attenuated also postoperatively (T3-T4). Both gases did not influence the plasmatic levels of Il-6, CRP and glucose.
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Minerva anestesiologica · Jan 2013
ReviewGlucose and insulin administration while maintaining normoglycemia: the GIN concept.
The benefits of tight glucose control in critically ill and surgical patients remains a subject of debate. While some studies demonstrated a survival benefit associated with intensive insulin therapy, more recent studies have failed to demonstrate this correlation. ⋯ If properly applied, this therapy potentially reduces the morbidity and mortality associated with hyperglycemia and confers the pharmacological advantages of hyperinsulinemia. Further understanding of the underlying molecular mechanisms, as well as the development of a continuous intravenous glucose monitoring device would facilitate the routine clinical use of GIN therapy.