Minerva anestesiologica
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In an acute care setting, diuretics are often prescribed to maintain or increase urine output in patients presenting with acute kidney injury (AKI). The rationale behind giving diuretics is that they may protect the kidney from ischemic injury by maintaining a nonoliguric state. There have been many studies both supporting and criticizing diuretic use in AKI for improving overall patient outcomes. ⋯ Diuretics have been shown to be ineffective in the prevention of AKI or for improving outcomes once AKI occurs. At best, diuretics can help decrease symptoms of pulmonary edema secondary to volume overload.
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Minerva anestesiologica · May 2009
ReviewPropofol infusion syndrome: update of clinical manifestation and pathophysiology.
Propofol infusion syndrome (PRIS) is defined as acute bradycardia progressing to asystole combined with lipemic plasma, fatty liver enlargement, metabolic acidosis with negative base excess >10 mmol l(-1), rhabdomyolysis or myoglobinuria associated with propofol infusion. The purpose of this review was to provide a new update of reported case reports and to describe recent retrospective studies and animal research relevant for the pathophysiology and clinical presentation of PRIS. New case reports of PRIS have confirmed previously identified risk factors, and have also further revealed the incidence of PRIS in patients previously not estimated to be at risk for this syndrome. ⋯ PRIS has to be kept in mind if propofol is used for anesthesia or sedation. Recommendations for the limitation of propofol use have to be adhered to. Early warning signs must prompt immediate cessation of propofol infusion and adequate treatment.
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Minerva anestesiologica · May 2009
Randomized Controlled Trial Comparative StudyRegional anesthesia for carotid endarterectomy: a comparison between ropivacaine and levobupivacaine.
This study compares ropivacaine and levobupivacaine when administered for cervical plexus block. The authors therefore compared the arterial pressure profile and the incidence of hypotension between drugs. ⋯ Levobupivacaine has a greater vasodilatory effect than ropivacaine. Its higher incidence of hypotension, although not statistically significant, suggests ropivacaine as the drug of choice for cervical plexus block.
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Minerva anestesiologica · May 2009
Patients with comorbidities: what shall we do to improve the outcome.
The number of patients submitted to major surgery affected by one or more comorbidities is progressively increasing. Outcome is the final output measured as morbidity, mortality and quality of life, of diagnostic tests, procedures, therapy tools started in the preoperative period and fitted on single patients or groups of patients or typology of surgical acts. ⋯ In conclusion, a patient with comorbidities scheduled for major surgery needs a full anesthetist-intensivist involvement, which broadens the role of the anesthetist in the perioperative medicine. Outcome is the result of many interventions during patient course, including economic costs and the importance of an appropriate treatment.