Minerva anestesiologica
-
Since acupuncture provides analgesia it might be expected to reduce the need for conventional anaesthetic drugs during general anaesthesia. In this review we discuss four double blind, placebo controlled studies evaluating acupunture's ability to reduce analgesic or anesthetic requirement. Three studies (from Greif et al., Morioka et al. and Taguchi et al.) examined whether transcutaneous electrical stimulation of some acupuncture points reduces anaesthetic requirement. Kotani et al. tested the hypothesis that preoperative insertion of intradermal needles in the bladder meridian reduces postoperative pain and oppioid requirement. ⋯ none of the first three studies showed that the stimulation of the acupoints produces clinically important reductions in anaesthetic requirement. In contrast, Kotani et al. showed that at least some acupuncture techniques provide substantial postoperative analgesia and significantly reduce opioid requirement.
-
Minerva anestesiologica · Apr 2002
ReviewSedation in the Intensive Care Unit. The basis of the problem.
The authors briefly discuss the advantages and limits of sedation in critically ill patients. They also focus the importance of an individualized sedative approach which provides pain relief and modulates stress response, allowing patients to be easily arousable and cooperative as necessary.
-
Minerva anestesiologica · Apr 2002
ReviewSupplemental oxygen reduces the incidence of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) are unpleasent for patients and increase the risk of aspiration pneumonia. PONV is the leading cause of unexpected admission following planned day surgery. Despite new anaesthetic drugs and antiemetics, the incidence of PONV remains high. ⋯ Recently, the intraoperative inspired oxygen concentration was identified as a factor that influences PONV. Among the three studies that evaluated intraoperative supplemental O2 for prevention of PONV, two found that it halves PONV while the third failed to identify any benefit. Since supplemental O2 is inexpensive and essentially risk-free, it appears preferable to pharmacologic anti-emetics for prevention of PONV in abdominal surgery.
-
Corticosteroids were proposed to treat patients with severe sepsis as early as 1940. A summary of all available randomized controlled trials performed between 1966 and 1993 was provided in two systematic review that recommended to abandon the use of high dose coricosteroids to treat patients with severe infection. Nonetheless, a doubt still persist regarding the efficacy of a strategy of replacement therapy in cathecolamines-dependent shock. ⋯ The authors found a significant reduction in 28-day mortality in patient with occult renal insufficiency. In sum, short course with high doses of corticosteroids should not be given in severe sepsis, except for specific entitles like severe typhoid fever, pneumocystis carinii pneumonia in AIDS or bacterial meningitis in children. The rational for a replacement therapy with hydrocortisone in catecholamines-dependent septic shock grows stronger.
-
The goal of hemodynamic monitoring is to maintain adequate tissue perfusion. Classical hemodynamic monitoring is based on the invasive measurement of systemic, pulmonary arterial and venous pressures, and of cardiac output. Since organ blood flow cannot be directly measured in clinical practice, arterial blood pressure is used, despite limitations, as estimate of adequacy of tissue perfusion. ⋯ CVP is often used as sole parameter to monitor hemodynamic. However CVP alone may not differentiate between changes in volume (different venous return curve) or changes in contractility (different starling curve). Finally, other techniques such as echocardiography, transesophageal Doppler and volume-based monitoring system are now available.