Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Apr 2012
ReviewStrategies of empiric antibiotic therapy in severe sepsis.
Severe sepsis and septic shock remain the leading causes of multiple organ failure and mortality in surgical intensive care units. Early antibiotic therapy recently became a challenge, because of the increased number of infections caused by multiple drug resistant bacteria, with Gram-negative bacteria such as Klebsiella pneumoniae and Pseudomonas aeruginosa being the most frequently cultured pathogens. In this review, detailed recommendations for the treatment of various infections are presented and discussed, with particular emphasis on the determination of empiric antibiotic therapy in the early stages of sepsis and localised infections.
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Methods for the restoration of circulating blood volume, including the use of intravenous fluids, have been widely discussed over many years. There are no clear guidelines regarding the type of solutions, the total volume that should be transfused, or time schedules. Colloid solutions, usually hydroxyethyl starch compositions, are probably the most commonly used volume expanders in resuscitation, despite the lack of convincing trials and possible nephrotoxicity. ⋯ Among crystalloid solutions, balanced preparations such as acetates, lactates, malates or citrates are recommended to avoid hyperchloraemia, a common side effect of saline infusion. There is no agreement regarding colloid solutions. The fluid transfusion regimen in critically ill patients should therefore be based on clinical assessment and patient responses.
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Anaesthesiol Intensive Ther · Jan 2012
ReviewThe use of opioid adjuvants in perioperative multimodal analgesia.
Postoperative analgesia plays a crucial role in day-case surgery. Patients expect effective pain relief after surgery, without side effects, and this may not always be possible when more complicated procedures are performed in ambulatory settings. ⋯ Multimodal analgesia, combining different groups of analgesics, both opioid and non-opioid, with different mechanisms of action, and targets in central and peripheral nervous systems with minimal side effects may be an answer. In this review, we present and discuss the current status of knowledge, with special reference to the role of adjuvants to opioids in acute postoperative pain.