Minerva anestesiologica
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Minerva anestesiologica · Mar 2006
ReviewLung protective ventilation in ARDS: the open lung maneuver.
This review addresses the current state of lung protective strategies and their physiological rationale. Lung protective ventilation can reduce mortality in adult respiratory distress syndrome (ARDS) patients. We review the latest knowledge on the progression of lung injury by mechanical ventilation. ⋯ Furthermore, we discuss possible future improvements to mechanical ventilation; especially the open lung maneuver. The rationale behind the open lung maneuver and steps to accomplish an open lung are described, as well as data from animal and human studies. Finally, guidelines for future strategies and/or investigations are presented.
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Postoperative pain management an important clinical issue. The clinicians tool-bag remains incomplete. Improvements in the management of postoperative pain will ultimately translate into the broader, safer application of surgical procedures upon a wider patient population. The application of multimodal therapy that includes non-pharmacologic therapies, preemptive therapies, and new medications for the treatment of postoperative pain is an emerging concept that provides significant immediate as well as potential future advantages.
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Severe sepsis is a common disease process in the critically ill and is associated with substantial morbidity and mortality. Continuing research has provided considerable insight into the pathophysiology of sepsis over recent years, enabling various aspects of the sepsis response to be targeted. Discoveries related to the link between coagulation and inflammation have been particularly exciting, leading to the development of recombinant activated protein C. This review will discuss current definitions of sepsis, describe new approaches to classification and diagnosis of patients with sepsis, present recommendations for management, and briefly highlight areas of ongoing and future research.
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Minerva anestesiologica · Mar 2006
ReviewResidual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period.
The residual effects of neuromuscular blocking agents may persist into the early postoperative recovery period, even when neuromuscular blockade is carefully monitored and reversed in the operating room. Recent data suggest that mild degrees of residual paresis (train-of-four TOF ratios of 0.7-0.9) may be associated with significant impairment of respiratory and pharyngeal muscle function. Therefore, the new gold standard reflecting acceptable neuromuscular recovery is a TOF ratio > or =0.9. ⋯ Several techniques may be used to reduce the risk of postoperative residual paresis, which include avoidance of long-acting muscle relaxants, use of neuromuscular monitoring in the operating room, routine reversal of neuromuscular blockade at a TOF count of 2-3, and early administration of reversal agents. Careful management of neuromuscular blockade may limit the occurrence of adverse events associated with residual postoperative paralysis. Large-scale outcome studies are needed to clearly define the impact of residual neuromuscular block on major morbidity and mortality in surgical patients.