Minerva anestesiologica
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It is increasingly apparent that organ dysfunction in sepsis is caused, at least in part, by an acquired intrinsic derangement in cellular oxidative adenosine triphosphate (ATP) production. We have termed this phenomenon "cytopathic hypoxia". Although several different but mutually compatible mechanisms might account for the development of cytopathic hypoxia in sepsis, recent data from our laboratory point to activation of the nuclear enzyme, poly-ADP-ribosyl polymerase (PARP), as being the most important.
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Perioperative medicine starts with preoperative assessment and preparation of patients undergoing various procedures. It includes intraoperative care and continues postproceudral management, from recovery room to intensive care and step-down facilities. ⋯ Potential areas of anesthesia involvement, still unclear, include preoperative and postoperative ward management and complete preparation such as cardiology or pulmonary testing. Further steps to take in the direction of perioperative medicine are the development of a different model of resident training, and the improvement of information technology and medical record.
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The importance of sedation in the ICU. The authors shortly describe the use of sedation as useful tool to reduce patient discomfort and to modulate stress response, in critically ill patients.