Minerva anestesiologica
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Minerva anestesiologica · Apr 2001
Case ReportsExperiences with continuous intra-arterial blood gas monitoring.
Management of critically ill patients requires frequent arterial blood gas analyses for assessing the pulmonary situation and adjusting ventilator settings and circulatory therapeutic measures. Continuous arterial blood gas analysis is a real-time monitoring tool, which reliably detects the onset of adverse pulmonary effects. It gives rapid confirmation of ventilator setting changes and resuscitation and helps to ensure precise adjustment of therapy. ⋯ The Paratrend 7+ sensor proved to be clinical feasible and showed an improved precision in terms of clinical situations with an arterial pO2 smaller than 50 kPa. However, the results are not much different regarding the findings with older systems consisting of hybrid technology combining optodes and electrochemical oxygen measurement. The advantages might be seen if the sensor is used for a period over several days in patients on ICU as demonstrated by the two case reports.
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Minerva anestesiologica · Apr 2001
Historical ArticleAccidents and mishaps in anesthesia: how they occur; how to prevent them.
The problem of safety and accidents prevention is a primary issue in modern anesthesia. Throughout the last twenty years, much effort has been made to assess the causes of mishaps, introducing new technology and safer drugs. The author presents a well known model to describe factors affecting accidents causality, proposing old and new strategies to ensure safety during the everyday practice.
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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.