Minerva anestesiologica
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Minerva anestesiologica · Aug 2010
Do videolaryngoscopes have a new role in the SIAARTI difficult airway management algorithm?
The rigid standard Macintosh laryngoscope is the instrument used to obtain an adequate view of the larynx in most patients. In cases of unpredicted severe laryngoscopic difficulties, the SIAARTI guidelines suggest waking the patient and using fiberoptic intubation with topical anesthesia. In the last decade, many videolaryngoscopes have been produced and introduced into clinical use. ⋯ Their role in the SIAARTI algorithm for difficult airway management is now better defined. In fact, their use could be suggested in cases of unpredicted severe laryngoscopic difficulty as a step before awakening the patient. Moreover, they could be used in predicted severe intubation difficulty as an alternative to flexible fiberscope.
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Minerva anestesiologica · Aug 2010
Editorial CommentVideolaryngoscopy: is it only a change of view?
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Recently, many trials have been published to validate different techniques in peripheral regional anesthesia, but it is important to understand why and when we have to choose a specific technique and which advantages are offered by each of them. We performed a review of the clinical trials from the last three years (January 2007-September 2009), finding 644 articles on this topic. Even if many clinical trials underline a better efficacy of ultrasound (US) rather than peripheral nerve stimulators (PNSs), it could be important to confirm these results with trials having larger sample sizes and to compare US to percutaneous electric guidance (PEG) and/or sequential electrical nerve stimulation (SENS) techniques rather than peripheral nerve stimulation. Finally, even if it is well recognized that peripheral regional anesthesia is a safe technique, it is important to underline how the "new" techniques can guarantee a further improvement in the safety and effectiveness of regional anesthesia.
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Awareness during anesthesia has been the subject of much research and commentary in recent years. In this article, we review the recent publications in the area of anesthesia awareness and attempt to answer the question: Is awareness a problem without solutions? The incidence of awareness has been reported in benchmark studies to be about 0.1%, but two recent studies in Spain and China have reported incidences of awareness of 1% and 0.4%, respectively. ⋯ The best current evidence from one randomized trial suggests that bispectral index monitoring identifies the presence and reduces the incidence of awareness in high-risk patients. More trials are needed and two large ongoing trials are exploring the value of monitoring end-tidal gas concentrations and maintaining adequate age-adjusted values during surgery as an alternative method to prevent awareness.