Minerva anestesiologica
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Minerva anestesiologica · Apr 2010
Transcatheter implantation of an aortic valve: anesthesiological management.
Aortic stenosis (AS) is the most common form of valvular disease in adults. This condition also causes significant morbidity and mortality, especially among the elderly. Recent progress in balloon and stent technologies has offered the potential to transform the management of aortic stenosis. ⋯ Notably, TAVI probably requires a "failing health patient" score. In our opinion, the evaluation of procedural risk should include the specific scoring of newer parameters that are not currently in use. TAVI offers a number of advantages to patients and medical teams, but there are still accompanying anesthesiological risks, and the hemodynamic periprocedural setting is an important issue for this type of procedure.
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Minerva anestesiologica · Apr 2010
Review Meta AnalysisLevosimendan reduces mortality in critically ill patients. A meta-analysis of randomized controlled studies.
Critically ill patients often need catecholamines, but these agents could be associated with an increased risk of death and other adverse cardiac events. Levosimendan is a calcium sensitizer that is able to enhance myocardial contractility without increasing myocardial oxygen use. We conducted a meta-analysis to determine the impact of levosimendan on mortality in critically ill patients. ⋯ Levosimendan has cardioprotective effects that could result in a reduced mortality in critically ill patients. A large randomized controlled study is warranted in this setting.
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Minerva anestesiologica · Apr 2010
Randomized Controlled Trial Comparative StudyComparison of two ketamine-propofol dosing regimens for sedation during interventional radiology procedures.
Invasive diagnostic and therapeutic interventional radiological procedures can be painful and anxiety provoking. The combination of propofol and ketamine may minimize the need for supplemental opioid analgesics and has the potential to provide better sedation with less toxicity than either drug alone. ⋯ In conclusion, the two different dosages of ketamine coadministered with propofol for sedation during interventional radiological procedures showed no clinically significant hemodynamic changes or side effects, and both appeared to prompt early recovery time. We recommend propofol 0.5 mg.kg-1 + ketamine 0.5 mg.kg-1 for sedation and analgesia during interventional radiological procedures, rather than propofol 0.5 mg.kg-1 + ketamine 0.25 mg.kg-1 because the former combination is associated with reduced rescue propofol requirements and therefore less oversedation.
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Minerva anestesiologica · Apr 2010
Randomized Controlled TrialEffects of fenoldopam infusion in complex cardiac surgical operations: a prospective, randomized, double-blind, placebo-controlled study.
Fenoldopam mesylate is a short-acting dopamine-1 agonist that has been suggested to be a possible reno-protective agent in patients undergoing cardiac surgery. The present study is a prospective, randomized, double-blind placebo controlled trial conducted to determine the effects of fenoldopam in a population of patients undergoing complex cardiac operations. ⋯ Fenoldopam improves the quality of perfusion during CPB. In patients receiving catecholamines to treat a postoperative low cardiac output state, fenoldopam significantly improves renal function and prevents AKI and major morbidity.
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Minerva anestesiologica · Apr 2010
Case ReportsBispectral index (BIS) monitoring of acute encephalitis with refractory, repetitive partial seizures (AERRPS).
Diagnosis of ictal discharges during epileptic activity should be based on raw electroencephalography (EEG). The apparatus necessary for such a diagnosis would typically require time to properly set up and operate. The bispectral index (BIS), an EEG-derived parameter that is easy to establish and easy to use, has been shown to correlate with numerous EEG conditions and may represent a useful tool. ⋯ During induced pharmacologic barbiturate/diazepam coma, BIS decreased to near isoelectricity (11.9+/-2.5) with a steady increase in suppression ratio (65.5+/-9.7). The characteristic BIS profile of repetitive 1-2 min high EEG/EMG activity could serve as an indicator of a global increase in cerebral activity with seizures. Our report suggests that BIS, an easy-to-use device, might be helpful in monitoring clinical trends after EEG confirmation of diagnosis as well as in successfully depicting the efficacy of therapy.