Minerva anestesiologica
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The use of enteral formulas supplemented with immunonutrients has been demonstrated to modulate gut function, inflammatory and immune response after trauma in both experimental and clinical settings. Most studies have focused on glutamine, arginine, w-3 fatty acids and nucleotides. ⋯ Data collected in two different recent metaanalysis consistently confirmed that enteral formulas enriched with, arginine, w-3 fatty acids and nucleotides reduced infectious complications and hospital stay after planned surgery, and decreased infectious complications, hospital stay and ventilator days in the critically ill. Mortality seems not to be affected by enteral administration of immunonutrients.
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Minerva anestesiologica · May 2000
Review[Bispectral index: clinical effectiveness and role in reducing anesthetic drug consumption].
A numeric value derived from bispectral analysis of EEG, the bispectral index (BIS), has been recently introduced as a monitor of the hypnotic component of anaesthesia. Application of BIS monitoring in anaesthesia appears extremely interesting to drugs titration and drugs economy, and in the evaluation of time for discharge in a one day surgery regimen. In this prospective study ASA I-II patients for Day-Surgery were enrolled in three groups: subaracnoid anaesthesia (SA), general anaesthesia (GA) with BIS and GA without BIS monitoring. ⋯ No significant differences were measured between the GA groups. A longer time of recovery was necessary in the SA group. A greater amount of anaesthetic in BIS group could be attributed to a better monitoring of sedation which prevents intraoperative awakening.
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Drug development in anaesthesia poses specific challenges. Describing the development of remifentanil highlights some of these. A new drug in anaesthesia must achieve its clinical goals in all patients and significant levels of toxicity are unacceptable. ⋯ The insertion of an alkyl ester group into this 4-anilidopiperidine molecule has resulted in a compound which, whilst retaining the desired mu-opioid receptor pharmacology, is susceptible to metabolism by non-specific esterases in the blood and tissues. The rapid onset and offset of action means that the anaesthetist can deliver high doses of opioid resulting in stable anaesthesia and the lack of accumulation ensures that even after prolonged infusion remifentanil does not compromise recovery. This ability to control the anaesthetic process has relevance in both short and long procedures and the unique characteristics of remifentanil may also in the future prove to have utility in the intensive care setting.
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Minerva anestesiologica · May 2000
ReviewCytopathic hypoxia. A concept to explain organ dysfunction in sepsis.
The most common cause of death in patients with sepsis is the multiple organ dysfunction syndrome (MODS). One important factor underlying the pathogenesis of MODS may be sepsis-induced alterations in cellular energy metabolism due to acquired intrinsic derangements in cellular respiration, a phenomenon that might be called "cytopathic hypoxia". A number of different biochemical mechanisms have been postulated to account for cytopathic hypoxia in sepsis, including reversible inhibition of cytochrome oxidase by nitric oxide, irreversible inhibition of one or more mitochondrial respiratory complexes by peroxynitrite, and activation of the nuclear enzyme, poly-(ADP-ribosyl)-polymerase.