Minerva anestesiologica
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Minerva anestesiologica · Apr 2001
Selective decontamination of the digestive tract as infection prevention in the critically ill. Does it lead to resistance?
Several meta-analysis showed the efficacy of selective decontamination of the digestive tract (SDD) in the reduction of infections in critically ill patients, particularly for ventilator associated pneumonia and bloodstream infections, thereby reducing mortality and morbidity. The principle of SDD is that by means of application of non-absorbable antibiotics in the intestinal canal and oropharyngeal cavity, potentially pathogenic microorganisms are eliminated, thereby reducing the incidence of organ site infections. The endogenous anaerobic flora is preserved as a factor contributing to defence against colonization. ⋯ The results of a recent meta-analysis and of several studies, which confirmed the virtual absence of any reported AR with SDD and that did not find AR after stopping SDD, are presented. The eradication of the reservoir of abnormal bacteria located in the gut by topical non-absorbable antibiotics appears to significantly reduce morbidity, mortality and resistance. Using only systemic antibiotics in ICU may contribute to maintain an abnormal population of bacteria among which AR is encouraged.
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Minerva anestesiologica · Apr 2001
[The role of transesophageal echocardiography in intraoperative hemodynamic monitoring].
Transesophageal echocardiography (TEE) is a semi-invasive diagnostic tool which allows a unique intraoperative visualization of cardiac chambers and valves. It is mainly used for intraoperative monitoring during cardiac surgery and in cardiopathic patients undergoing major non cardiac surgical procedures. ⋯ Based on TEE data, the anesthesiologist is able to modify in real time vasoactive therapy and fluid management. TEE data concern: 1) preload: left ventricular endodiastolic area is measured and this is considered an index of volemia; 2) systolic function: the circumferential shortening fraction, which correlates with LV ejection fraction, is measured; 3) onset of ischemia: ischemia is detected as a regional modification of normal kinetics; 4) causes of hemodynamic instability; 5) assessment of sovrahepatic anastomoses during liver transplantation.
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Minerva anestesiologica · Mar 2001
Randomized Controlled Trial Clinical TrialApplication of the self-inflating bulb to a hollow intubating introducer.
The aspiration test, performed by a self-inflating bulb (SIB), is a simple and reliable method to detect an accidental esophageal intubation. The aim of the study, in case of employment of a hollow intubating introducer (HII), was to verify the possibility to directly perform the test with the introducer and its efficacy in allowing the detection of its position. ⋯ The aspiration test with the SIB allows the proper detection of the introducer in esophagus. When used in combination with a HII, both time and local trauma associated with an erroneous, introducer-guided esophageal intubation in case of difficult laryngoscopy may be reduced.
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Minerva anestesiologica · Mar 2001
Review Comparative StudyOptions on the use of muscle relaxants in clinical anaesthesia.