Minerva anestesiologica
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Minerva anestesiologica · Mar 2005
GuidelineConscious sedation during endoscopic retrograde colangiopancreatography: implementation of SIED-SIAARTI-ANOTE guidelines in Belluno Hospital.
In this study we describe the results of adoption of local guidelines for conscious sedation (CS) during endoscopic-retrograde-cholangiopancreatography (ERCP) in Belluno Hospital. Local guidelines were created referring to SIED-SIAARTI-ANOTE guidelines for CS in gastrointestinal endoscopy. ⋯ In our experience, CS during ERCP can be safely performed autonomously by a gastroenterologist in the majority of cases. Drug prescription protocol and the presence of an anesthesia nurse create ideal conditions for the operator, patient comfort and good results with a low incidence of undesired events and few calls for the anesthesiologist. To allow safe and effective performance of CS, the Department of Anesthesia should promote the in-service training and up dating of gastroenterologists and anesthesia nurses.
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Minerva anestesiologica · Jan 2005
Randomized Controlled Trial Clinical TrialDoes supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?
An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. ⋯ The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.
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A diffuse cerebral dysfunction is often present in sepsis and may ensues even before signs of other organ failure. It is better defined as ''Sepsis Associated Encephalopathy'' (SAE), in order to stress the absence of direct infection of the central nervous system. The main sign of SAE is an altered mental status. ⋯ Pathophysiology of SAE is not still completely understood, and it is probably multifactorial. Indeed, brain dysfunction in sepsis may be related to action of micro-organisms toxins, to the effects of inflammatory mediators, to metabolic alterations and to abnormalities in cerebral circulation. At this moment a specific treatment for SAE does not exist and outcome relies upon prompt and appropriate treatment of sepsis as a whole.
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This has not been a comprehensive review of problems with general anaesthesia for Caesarean section, but major issues have been considered. The old problems are still with us, but their manifestations are perhaps more subtle as anaesthesia has become more sophisticated. Most of the problems are of our own making, but hindsight is only useful if we apply it to the future. Maternal safety is best served by a continuing expansion in the use of regional anaesthesia, but we must prepare for the problems that we create by ensuring that anaesthetists are adequately trained for the occasional general anaesthetic, possibly with more help from simulation.