Minerva anestesiologica
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Minerva anestesiologica · Apr 2004
Review[Moderate hypothermia in traumatic brain injury: results of clinical trials].
The concept of neuroprotection' by hypothermia dates back to ancient times. This paper reviews the results of clinical trials using mild hypothermia (3235 degrees C) in patients with severe traumatic brain injury over the past decade. Induced hypothermia has been used in experimental models mostly to prevent or attenuate secondary neurological injury and has been used to provide neuroprotection in traumatic brain injury, both in animal models and clinical trials. ⋯ These differences may be explained by differences in study protocols (i.e. speed and duration of cooling, speed of re-warming), prevention of side effects and various supportive measures in the ICU. Although induced hypothermia appears to be a highly promising treatment in various forms of neurological injury including traumatic brain injury, the difficulties in realising its therapeutic potential are underscored by the negative results from a large multi-center trial. Routine usage of hypothermia in traumatic brain injury can not currently be recommended.
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Minerva anestesiologica · Apr 2004
Randomized Controlled Trial Clinical TrialHemofiltration in the prevention of radiocontrast agent induced nephropathy.
The aim of the study was to investigate the role of hemofiltration in preventing contrast nephropathy in patients with renal failure. ⋯ In patients with renal failure undergoing PCI, peri-procedural hemofiltration is effective for the prevention of contrast nephropathy, and is associated with improved in-hospital and long-term outcome.
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Minerva anestesiologica · Apr 2004
ReviewPathophysiology of severe pulmonary hypertension in the critically ill patient.
Pulmonary hypertension (PH) is a threatening condition that can be associated with a great variety of both pulmonary and extrapulmonary diseases. In all forms of severe PH the pulmonary vascular bed looses its physiological features of a "high flow-low pressure system", putting an increased afterload on the right ventricle (RV). ⋯ This review addresses the main pathophysiological aspects of severe PH, focusing on the hemodynamic derangements occurring in the setting of acute cor pulmonale, and emphasizing the role of ventricular interdependence (the way right ventricular failure greatly affects diastolic and systolic function of the left ventricle), the risk of RV ischemia (the end stage of RV failure) and systemic organ hypoperfusion (caused by antegrade and retrograde heart failure). The understanding of the peculiar features of this type of cardiovascular insufficiency is necessary to both provide effective monitoring and adequate supportive therapy.
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Minerva anestesiologica · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialTranexamic acid in primary CABG surgery: high vs low dose.
Prophylactic administration of tranexamic acid decreases bleeding and transfusions after cardiac procedures but it is still unclear what the best dose and the most appropriate timing to get the best results are. ⋯ For elective, first time coronary artery bypass surgery, both dosages of tranexamic acid are equally effective. Theoretically, it seems safer to administer it when patients are protected from thrombus formation by full heparinization.
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Minerva anestesiologica · Mar 2004
Randomized Controlled Trial Comparative Study Clinical TrialPeri-intubation cardiovascular response during low dose remifentanil or sufentanil administration in association with propofol TCI. A double blind comparison.
The aim of this study was to compare the effects on cardiovascular modifications induced by tracheal intubation when low dose infusion of remifentanil or sufentanil are used in association with propofol target controlled infusion. ⋯ In healthy normotensive patients the use of a small dose of either remifentanil or sufentanil after standard midazolam premedication, proved to be an effective strategy to blunt the cardiovascular response to intubation.