Minerva anestesiologica
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Minerva anestesiologica · Jun 2006
ReviewCritical bleeding in pregnancy: a novel therapeutic approach to bleeding.
In the developed countries the frequency of life threatening post-partum hemorrhages (PPH) is 1 in 1,000 deliveries with a risk of death of 1-2/100,000 deliveries. Hysterectomies for intractable bleeding are carried out in approximately 50% of the cases. The majority of PPH have obstetrical causes, most frequently atony of the uterus. Hereditary and acquired hemostatic defects are very rare. Guidelines of standard surgical and medical measures are available. In this paper we focus on the use of activated recombinant factor VII (rFVIIa) in PPH. ⋯ The bleeding can occur in a series of events conductive to metabolic complications, hypoxia, disseminate intravascular coagulation, organ damage and multiorgan failure, progressively exhaustive. The therapeutic intervention must be instituted as early as possible before successive complications ensue. These preliminary reports in PPH after failure of conventional standard therapy suggest that rFVIIa is an active agent but should be administered as early as possible before the consequences of severe and intractable bleeding.
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The recording of dead space will give information on how much of total ventilation that reaches both ventilated and perfused alveoli and thus allows gas exchange between alveoli and pulmonary blood. Realising that CO2 retention can be an effect not only of low total ventilation but also of increased dead space is one important information. Moreover, dead space will give insight into the matching of ventilation and perfusion. ⋯ However, both are subjected to potential errors that have to be considered to make a dead space recording meaningful. A correct measurement and calculation of the dead space will give valuable information on the ventilatory support of the critically ill patient and can also be a valuable diagnostic tool. It should therefore not be forgotten in the intensive care setting.
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Minerva anestesiologica · Jun 2006
ReviewAcquired weakness in the ICU: critical illness myopathy and polyneuropathy.
Illnesses commonly encountered in the ICU, such as sepsis, have frequently been associated with neuromuscular weakness and may play a role in the development of CIM and CIP, whose incidence in the critically ill is greater than initially reported. Although difficult to diagnose from history and clinical/laboratory findings alone, the use of electromyographic and nerve conduction testing is helpful in establishing these diagnoses. ⋯ Acquired neuromuscular weakness in the ICU affects a significant number of patients and may continue to affect their quality of life long after discharge. Although diagnostic techniques are readily available, additional research is necessary to obtain adequate prognostic information and therapeutic options for these patients.
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Minerva anestesiologica · Jun 2006
ReviewPreoperative parental information and parents' presence at induction of anaesthesia.
Preoperative preparation of paediatric patients and their environment in order to prevent anxiety is an important issue in paediatric anaesthesia. Anxiety in paediatric patients may lead to immediate negative postoperative responses. When a child undergoes surgery, information about the child's anaesthesia must be provided to parents who are responsible for making informed choices about healthcare on their child's behalf. ⋯ The issue of parental presence during induction of anaesthesia has been a controversial topic for many years. Potential benefits from parental presence at induction include reducing or avoiding the fear and anxiety that might occur in both the child and its parents, reducing the need for preoperative sedatives, and improving the child's compliance even if other studies showed no effects on the anxiety and satisfaction level. The presence of other figures such as clowns in the operating room, together with one of the child's parents, is an effective intervention for managing child and parent anxiety during the preoperative period.
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Minerva anestesiologica · Jun 2006
ReviewMicrocirculatory recruitment maneuvers correct tissue CO2 abnormalities in sepsis.
The rises in tissue partial pressure of carbon dioxide have been observed in critically ill patients with shock and sepsis for a long time and have been proposed to be an earlier and more reliable marker of tissue hypoxia than traditional markers. However, the mechanisms leading to those increases, especially in sepsis and endotoxemia, are not well understood. Recent studies provided further data, supporting the idea that the origin of those increases in partial pressure of CO2 in sepsis as being caused by microcirculatory perfusion deficit resulting in mitochondrial depression by time. ⋯ Recent findings support the idea that the progression from early to severe sepsis is accompanied or possibly even caused by microcirculatory dysfunction, which leads to mitochondrial dysfunction by time. Therefore early identification of microcirculatory dysfunction and correction with microcirculatory recruitment maneuvers are needed to ensure adequate microcirculatory perfusion and tissue oxygenation. Microcirculatory imaging, such as SDF imaging technique, appears to be a very useful tool for this task and its combination together with other systemic and regional tissue oxygenation measurements may provide more information regarding the tissue oxygenation and will be a very promising tool for microcirculatory researchers and the management of critically ill patients at the bedside.