Minerva anestesiologica
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Minerva anestesiologica · Apr 2002
ReviewSedation in the Intensive Care Unit. The basis of the problem.
The authors briefly discuss the advantages and limits of sedation in critically ill patients. They also focus the importance of an individualized sedative approach which provides pain relief and modulates stress response, allowing patients to be easily arousable and cooperative as necessary.
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Minerva anestesiologica · Apr 2002
ReviewSupplemental oxygen reduces the incidence of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) are unpleasent for patients and increase the risk of aspiration pneumonia. PONV is the leading cause of unexpected admission following planned day surgery. Despite new anaesthetic drugs and antiemetics, the incidence of PONV remains high. ⋯ Recently, the intraoperative inspired oxygen concentration was identified as a factor that influences PONV. Among the three studies that evaluated intraoperative supplemental O2 for prevention of PONV, two found that it halves PONV while the third failed to identify any benefit. Since supplemental O2 is inexpensive and essentially risk-free, it appears preferable to pharmacologic anti-emetics for prevention of PONV in abdominal surgery.
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Direct costs of critical care are increasing more than in other health care sectors. Tools are needed to evaluate adequacy of ICU admission in order to have a proper allocation of ICU resources. ⋯ Despite the difficulties imposed by he rigid nurses' work organization in Italy, a daily data collection about level of care, severity of illness, workload utilization could provide, together with standard administrative indexes, the necessary framework to assess and to improve adequacy of ICU admission.
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Minerva anestesiologica · Apr 2002
Guideline[The SIAARTI document in preparation: recommendations on admission and discharge from intensive care units and on limits of treatments in intensive care].
The document in progress is intended to help the health care professionals in bioethical decision-making process in ICU. It will be probably written as Recommendations because it is a conceptual framework for making decision about intensive care, consensually derived from an Ad Hoc Sub-Committee of SIAARTI Ethics Committee. ⋯ These guidelines do not relieve health care professionals involved from their personal responsibility for decisions and action taken in individual cases. These guidelines are in line with the general ethical principles for the care of critically ill patients as formulated, as examples, in the following declarations and deontological codes: Declaration of Helsinki, Ethical Principles in Intensive Care (World Federation of Society of Intensive and Critical Care Medicine), Italian Medical Association's Deontological Code (3/10/98), European Convention of Bioethics Oviedo and in many others international consensus statements and guidelines.
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Since acupuncture provides analgesia it might be expected to reduce the need for conventional anaesthetic drugs during general anaesthesia. In this review we discuss four double blind, placebo controlled studies evaluating acupunture's ability to reduce analgesic or anesthetic requirement. Three studies (from Greif et al., Morioka et al. and Taguchi et al.) examined whether transcutaneous electrical stimulation of some acupuncture points reduces anaesthetic requirement. Kotani et al. tested the hypothesis that preoperative insertion of intradermal needles in the bladder meridian reduces postoperative pain and oppioid requirement. ⋯ none of the first three studies showed that the stimulation of the acupoints produces clinically important reductions in anaesthetic requirement. In contrast, Kotani et al. showed that at least some acupuncture techniques provide substantial postoperative analgesia and significantly reduce opioid requirement.