Minerva anestesiologica
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Minerva anestesiologica · May 2012
Survey on controversies in airway management among anaesthesiologists in the UK, Austria and Switzerland.
While surveys about anaesthesia practice appear regularly in the anaesthesia literature, they are usually bound to one country. We compared the approach to specific airway management issues among anaesthesiologists from three different European countries. METHODS A questionnaire was distributed during the main session of three anaesthesia meetings in Austria(A), the UK, and Switzerland(CH). ⋯ CONCLUSION Answers from anaesthesiologists in the UK differed significantly from those in A and CH. Anaesthesiologists in the UK check mask ventilation after induction less frequently, but they check more often when risk factors of difficult mask ventilation are present. Cricoid pressure seems to remain an important part of the rapid sequence induction technique in the UK, whereas anaesthesiologists in Austria and Switzerland rely less on this technique.
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Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. ⋯ This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.
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Minerva anestesiologica · May 2012
Comparative StudyStandard vs. point-of-care measurement of fibrinogen: potential impact on clinical decisions.
Intraoperative major bleeding is a common complication during surgery and can lead to the transfusion of blood products and/or procoagulant drugs. This is a therapeutic challenge, and adherence to guidelines is desirable to preserve blood product resources. The intraoperative administration of fibrinogen concentrate, a pro-coagulant drug, in bleeding patients might reduce the use and therefore the risks associated with blood products. ⋯ The method used for intraoperative coagulation monitoring has a major impact on therapeutic decisions concerning the use of blood products and/or pro-coagulant drugs. If fibrinogen was measured by point-of-care thromboelastometry instead of the standard method according to Clauss, the use of fibrinogen concentrate would increase significantly and less fresh frozen plasma would be administered.