Minerva anestesiologica
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Minerva anestesiologica · Jun 2006
ReviewPreoperative parental information and parents' presence at induction of anaesthesia.
Preoperative preparation of paediatric patients and their environment in order to prevent anxiety is an important issue in paediatric anaesthesia. Anxiety in paediatric patients may lead to immediate negative postoperative responses. When a child undergoes surgery, information about the child's anaesthesia must be provided to parents who are responsible for making informed choices about healthcare on their child's behalf. ⋯ The issue of parental presence during induction of anaesthesia has been a controversial topic for many years. Potential benefits from parental presence at induction include reducing or avoiding the fear and anxiety that might occur in both the child and its parents, reducing the need for preoperative sedatives, and improving the child's compliance even if other studies showed no effects on the anxiety and satisfaction level. The presence of other figures such as clowns in the operating room, together with one of the child's parents, is an effective intervention for managing child and parent anxiety during the preoperative period.
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Minerva anestesiologica · Jun 2006
ReviewMetabolic treatment of critically ill patients: energy balance and substrate disposal.
Oxidation of substrates is the main biochemical process used by the human body to produce energy. Different substrates (carbohydrates, lipids, and proteins) have different effects on oxygen consumption and carbon dioxide production: during the critical phase of pathologies it could be relevant pay attention to the use of various nutrients, that have some altered effect respect to the normal subjects metabolism, and during the length of metabolic treatment, too. ⋯ Adequate amount of energy intake in carbohydrates determine an increase of RQ, that means a shift from a more lipid-based to a more glucose-based oxidation. Composition of dietary intake can be usefully different for each pathology, and also for different periods of the same pathology, because critically ill patients have a variety of metabolic needs during their stay in ICU.
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Minerva anestesiologica · Jun 2006
ReviewRole of extracorporeal lung assist in the treatment of acute respiratory failure.
For patients with most severe acute respiratory distress syndrome (ARDS) conservative treatment with lung protective ventilation is often not sufficient to prevent life-threatening hypoxemia and additional strategies are necessary. Extracorporeal lung assist (ECLA) or extracorporeal membrane oxygenation (ECMO) using capillary membrane oxygenators can provide sufficient gas exchange and lung rest. In 2 randomized trials mortality was unchanged for ECMO. ⋯ Oxygenators with even less flow resistance could be implanted paracorporeal using the right ventricle as driving force. An intravascular oxygenator has been developed using the combination of a miniaturized blood pump and an oxygenator for implantation in the vena cava. Well designed clinical trials are necessary to demonstrate a clinical benefit for these experimental devices.
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Minerva anestesiologica · Jun 2006
Review Comparative StudyLow vs high positive end-expiratory pressure in the ventilatory management of acute lung injury.
Positive end-expiratory pressure (PEEP) has become an essential component of the care of many critically ill patients who require ventilatory support. The application of PEEP is expected to improve lung mechanics and gas exchange as it recruits lung volume. ⋯ Although the data from those animal studies and clinical trials could be seen as very convincing, there are insufficient data to propose an universal approach for the use of PEEP in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In this article I will review the basic mechanisms of PEEP and the current knowledge of the effects of PEEP on the evolution and outcome of ALI/ARDS.
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Minerva anestesiologica · Jun 2006
Review Multicenter StudyCaudal anesthesia in pediatrics: an update.
Caudal anesthesia is one of the most used-popular regional blocks in children. This technique is a useful adjunct during general anesthesia and for providing postoperative analgesia after infraumbilical operations. The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug. Although it is a versatile block, one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. The most frequently used method to further prolong postoperative analgesia following caudal block is to add different adjunct drugs to the local anesthetics solution. Only few studies evaluated quality and duration of caudal block against the volume of the local anaesthetic applied. After reviewing recent scientific literature, the authors compare the duration of postoperative analgesia in children scheduled for hypospadia repair when 2two different volumes and concentrations of a fixed dose of ropivacaine are used. ⋯ In children undergoing hypospadia repair, caudal block with a ''high volume, low concentration'' regimen produces prolonged analgesia and less motor block, compared to a ''low volume, high concentration'' regimen.