Minerva anestesiologica
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Minerva anestesiologica · Aug 2010
The practice of therapeutic mild hypothermia in cardiac arrest survivors in the Czech republic.
The proper performance of therapeutic mild hypothermia (TH) in cardiac arrest survivors is a prerequisite for achieving the best possible outcome. We analyzed the recent technical issues of in-hospital TH practices in the Czech Republic. ⋯ The survey revealed the recent practice of TH management of cardiac arrest survivors in the Czech republic. The modes of TH practice were different in many aspects, and unifying the basic components is advisable.
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Recently, many trials have been published to validate different techniques in peripheral regional anesthesia, but it is important to understand why and when we have to choose a specific technique and which advantages are offered by each of them. We performed a review of the clinical trials from the last three years (January 2007-September 2009), finding 644 articles on this topic. Even if many clinical trials underline a better efficacy of ultrasound (US) rather than peripheral nerve stimulators (PNSs), it could be important to confirm these results with trials having larger sample sizes and to compare US to percutaneous electric guidance (PEG) and/or sequential electrical nerve stimulation (SENS) techniques rather than peripheral nerve stimulation. Finally, even if it is well recognized that peripheral regional anesthesia is a safe technique, it is important to underline how the "new" techniques can guarantee a further improvement in the safety and effectiveness of regional anesthesia.
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Minerva anestesiologica · Aug 2010
Comparative StudyComparison of the serial surveillance with quantitative and non-quantitative tracheal aspirate in predicting ventilator-associated pneumonia etiology in patients receiving antibiotic therapy.
The aim of this study was to investigate the value of serial quantitative (QC) and non-quantitative (NQC) endotracheal aspirate (ETA) surveillance cultures in predicting the causative pathogen of ventilator associated pneumonia (VAP) in patients receiving antibiotic therapy and the factors associated with their predictive value. This was a prospective observational cohort study carried out in the Intensive Care Unit of a tertiary hospital. ⋯ These results suggest that surveillance with NQ-ETA is better than the Q-ETA in predicting the development and causative pathogen of VAP in patients who have already been receiving antibiotic therapy.
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Minerva anestesiologica · Aug 2010
Practice GuidelinePostoperative pain treatment SIAARTI Recommendations 2010. Short version.
The aim of these recommendations is the revision of data published in 2002 in the "SIAARTI Recommendations for acute postoperative pain treatment". In this version, the SIAARTI Study Group for acute and chronic pain decided to grade evidence based on the "modified Delphi" method with 5 levels of recommendation strength. Analgesia is a fundamental right of the patient. ⋯ In order to improve an ACUTE PAIN SERVICE organization, we recommend: --a plan for pain management that includes adequate preoperative evaluation, pain measurement, organization of existing resources, identification and training of involved personnel in order to assure multimodal analgesia, early mobilization, early enteral nutrition and active physiokinesitherapy (Level A); --the implementation of an Acute Pain Service, a multidisciplinary structure which includes an anesthetist (team coordinator), surgeons, nurses, physiotherapists and eventually other specialists; --referring to high-quality indicators in establishing an APS and considering the following key points in its organization (Level C): --service adoption; --identifying a referring anesthetist who is on call 24 hours a day; --patient care during the night and weekend; --sharing, drafting and updating written therapeutic protocols; --continuous medical education; --systematic pain assessment; --data collection regarding the efficacy and safety of the implemented protocols; --at least one audit per year. --a preoperative evaluation, including all the necessary information for the management of postoperative analgesia (Level C); --to adequately inform the patient about the risks and benefits of drugs and procedures used to obtain the maximum efficacy from the administered treatments (Level D). We describe pharmacological and loco-regional techniques with special attention to day surgery and difficult populations. Risk management pathways must be the reference for early identification and treatment of adverse events and chronic pain development.
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Minerva anestesiologica · Aug 2010
Do videolaryngoscopes have a new role in the SIAARTI difficult airway management algorithm?
The rigid standard Macintosh laryngoscope is the instrument used to obtain an adequate view of the larynx in most patients. In cases of unpredicted severe laryngoscopic difficulties, the SIAARTI guidelines suggest waking the patient and using fiberoptic intubation with topical anesthesia. In the last decade, many videolaryngoscopes have been produced and introduced into clinical use. ⋯ Their role in the SIAARTI algorithm for difficult airway management is now better defined. In fact, their use could be suggested in cases of unpredicted severe laryngoscopic difficulty as a step before awakening the patient. Moreover, they could be used in predicted severe intubation difficulty as an alternative to flexible fiberscope.