Minerva anestesiologica
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Minerva anestesiologica · Oct 2011
Randomized Controlled Trial Comparative StudyThe nerve stimulation technique versus the loss of resistance technique for the posterior approach to lumbar plexus block: a randomized, prospective, observer-blinded, pilot study.
This prospective, randomized, observer-blinded, pilot study compares the effects of the nerve stimulation guidance technique (NS) with the loss of resistance technique (LOR) on readiness for surgery during the posterior approach to lumbar plexus block. ⋯ Nerve stimulation allowed faster readiness for surgery than loss of resistance. Nevertheless, the two techniques seem to be comparable in terms of local anesthetic consumption, morphine requirements and pain scores.
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Over the last two decades, experimental and clinical data have begun to shape a more discriminating approach to intravascular (IV) fluid infusions in the resuscitation of trauma patients with presumed internal hemorrhage. This approach takes into account the presence of potentially uncontrollable hemorrhage (e.g., deep intra-abdominal or intra-thoracic injury) versus a controllable source (e.g. distal extremity wound). This limitation on fluid resuscitation is particularly applicable in the case of patients with penetrating truncal injury being transported rapidly to a nearby definitive care center. ⋯ While a more discriminating approach to fluid infusions have evolved, it has also become clear that positive pressure ventilatory support should be limited in the face of potential severe hemorrhage due to the accompanying reductions in venous return. Controversies over prehospital endotracheal tube placement are confounded by this factor as well as the effects of paramedic deployment strategies and related skills usage. Beyond these traditional areas of focus, a number of very compelling clinical observations and an extensive body of experimental data has generated a very persuasive argument that intravenous estrogen and progesterone may be of value in trauma management, particularly severe traumatic brain injury and burns.
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Minerva anestesiologica · Oct 2011
ReviewItalian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery.
Anticoagulant prophylaxis for preventing venous thrombembolism (VTE) is a worldwide established procedure in hip (HR) and knee replacement (KR) surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. ⋯ This inter-society consensus statement aims at simplifying the grading system reported in the literature, and thus at improving its proper application. Special focus is given to fragile patients, those with high bleeding risk, and on those receiving chronic antiplatelet and vitamin K antagonists treatment. A special chapter is dedicated to regional anesthesia and VTE prophylaxis.
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Sepsis is a significant public health problem that affects children and adults alike. Despite some similarities in the approach to pediatric and adult septic shock, there are key differences as it relates to pathophysiology, clinical presentation, and therapeutic approaches. In this review article, we discuss these differences under 4 headings: a) Developmental differences in the hemodynamic response, b) Activated Protein C, c) Thrombocytopenia associated multiple organ failure and d) Hemophagocytic Lymphohistiocytosis (HLH).
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Minerva anestesiologica · Oct 2011
Survey of non-invasive ventilation practices: a snapshot of Italian practice.
In Italy, NIV began to be employed in the late 1980s. Because it was adopted earlier than in Italy than in other countries, the pattern and rate of utilization of NIV may be different. We aim to determine factors that may influence Italian physicians' preferences towards NIV use, with a particular emphasis on the primary specialty of these physicians and the type of hospital in which they work. ⋯ Overall, Italian physicians perceived that NIV represents an essential tool when dealing with acute episodes of respiratory failure, irrespective of the type of hospital in which they worked.