Minerva anestesiologica
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Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety; its use is supported by the existence of extensive data from the international literature underlining the safety and efficacy of this technique. Safer drugs and dedicated pediatric tools are the keys to this success. Indeed, if we compare the drugs available to pediatric anesthesiologists for use in performing a block years ago with those in use today, it can be seen that progress in this area has been tremendous. ⋯ Real-time ultrasound guidance for peripheral regional anesthesia is not a foolproof technique. New data have emerged suggesting that the novice ultrasonographer may often commit repeated errors, the two most common being failure to visualize the needle during advancement and unintentional probe movement. For this reason, the American Society of Regional Anesthesia and the European Society of Regional Anesthesia created a Joint Committee, and a document was produced ''to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of ultrasound-guided regional anesthesia services".
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Minerva anestesiologica · Oct 2009
Randomized Controlled Trial Comparative StudyPosterior psoas vs 3-in-1 approach for lateral femoral cutaneous and obturator nerve block for anterior cruciate ligament repair.
The aim of this article was to test the hypothesis that the posterior psoas compartment approach to the lumbar plexus help to achieve better blockade of the lateral femoral cutaneous and obturator nerves than the classic anterior 3-in-1 femoral nerve block. ⋯ The posterior psoas compartment approach provides a more reliable block of the lateral femoral cutaneous and obturator nerves than the anterior 3-in-1 approach.
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Minerva anestesiologica · Oct 2009
ReviewVentilator associated pneumonia (VAP): an impossible diagnosis? Call for a pragmatic approach.
Many years after the introduction of the protected specimen brush (PSB) by Wimberley et al. as a tool to diagnose ventilator associated pneumonia (VAP), new sampling techniques have increased the controversy concerning the diagnosis of VAP. Agreement exists only on the high sensibility and low specificity of the clinical symptoms combined with imaging data. ⋯ Because a proven diagnosis is very rare, a more pragmatic approach to VAP diagnosis seems necessary. More specifically, the questions we must focus on include the following: ''Which patients with possible pneumonia or lower respiratory infection require antibiotic treatment ?'' and ''In which patients with possible/suspected VAP is empiric treatment not immediately necessary and for which of these patients can empiric treatment be limited or discontinued?''
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Minerva anestesiologica · Oct 2009
Randomized Controlled Trial Comparative StudyTraining resident anesthesiologists in adult challenging intubation comparing Truview EVO2 and Macintosh laryngoscope: a preliminary study.
Teaching airway management continues to be of high importance to the anesthesiologist, since the care of each individual patient depends on the expertise, training and knowledge of the anesthetist with different airway devices, techniques and algorithms. The aim of our study was to compare intubation performed by resident anesthesiologists in training, under senior supervision, using Truview EVO2 (Group 1) or Macintosh blade (Group 2) in a group of adult patients undergoing elective surgery. ⋯ The resident managed to intubate all patients on the first attempt with the Truview, which led to a lower incidence of complications. Despite the exiguity of the population in the study, Truview EVO2 and other videolaryngoscopes can be considered to be useful tools in training resident anesthesiologists in elective intubation.
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Minerva anestesiologica · Oct 2009
Can routine surveillance samples from tracheal aspirate predict bacterial flora in cases of ventilator-associated pneumonia?
The aim of this study was to investigate the hypothesis that periodical sampling of the tracheo-bronchial tree in the absence of clinical suspicion of pneumonia is useful to identify bacteria responsible for subsequent late ventilator associated pneumonia (VAP). This was a retrospective observational human study carried out in two medical-surgical intensive care units of two different hospitals. From January 1999 to December 2000, 559 patients, who received invasive respiratory support for more than 48 hours, were screened. ⋯ TA cultures in ventilated patients may help to predict pathogens. Early detection may lead to earlier treatment in long term ventilated patients when VAP is suspected.