Minerva anestesiologica
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Minerva anestesiologica · Oct 2011
Randomized Controlled Trial Comparative StudyThe nerve stimulation technique versus the loss of resistance technique for the posterior approach to lumbar plexus block: a randomized, prospective, observer-blinded, pilot study.
This prospective, randomized, observer-blinded, pilot study compares the effects of the nerve stimulation guidance technique (NS) with the loss of resistance technique (LOR) on readiness for surgery during the posterior approach to lumbar plexus block. ⋯ Nerve stimulation allowed faster readiness for surgery than loss of resistance. Nevertheless, the two techniques seem to be comparable in terms of local anesthetic consumption, morphine requirements and pain scores.
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Over the last two decades, experimental and clinical data have begun to shape a more discriminating approach to intravascular (IV) fluid infusions in the resuscitation of trauma patients with presumed internal hemorrhage. This approach takes into account the presence of potentially uncontrollable hemorrhage (e.g., deep intra-abdominal or intra-thoracic injury) versus a controllable source (e.g. distal extremity wound). This limitation on fluid resuscitation is particularly applicable in the case of patients with penetrating truncal injury being transported rapidly to a nearby definitive care center. ⋯ While a more discriminating approach to fluid infusions have evolved, it has also become clear that positive pressure ventilatory support should be limited in the face of potential severe hemorrhage due to the accompanying reductions in venous return. Controversies over prehospital endotracheal tube placement are confounded by this factor as well as the effects of paramedic deployment strategies and related skills usage. Beyond these traditional areas of focus, a number of very compelling clinical observations and an extensive body of experimental data has generated a very persuasive argument that intravenous estrogen and progesterone may be of value in trauma management, particularly severe traumatic brain injury and burns.
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Minerva anestesiologica · Oct 2011
Changes in heart rate variability across different degrees of acute dilutional anemia.
We investigated changes in heart rate variability (HRV) across different degrees of acute dilutional anemia (hemoglobin [Hb]=9, 7, 5, 4, and 3 g/dL) in a pig model. ⋯ Acute dilutional anemia resulted in significant changes in different time- and frequency-domain variables in HRV analysis. These changes occurred considerably earlier than did commonly recognized transfusion triggers or signs of general tissue hypoxia. Further investigation is warranted to elucidate whether these changes can be considered as indicators of imminent tissue hypoxia.
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Minerva anestesiologica · Oct 2011
A new difficult airway management algorithm based upon the El Ganzouri Risk Index and GlideScope® videolaryngoscope: a new look for intubation?
An El Ganzouri risk index test (EGRI) score of seven and the ability to achieve difficult laryngeal exposure with the GlideScope® may represent a highly predictive decisional threshold. Hence, we hypothesized that a new difficult airways algorithm that is EGRI- and GlideScope®-based may enable tracheal intubation in every patient. ⋯ Adherence to the decisional process of the algorithm and to GlideScope® videolaryngoscopy achieved successful tracheal intubation in our cohort of patients.
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Minerva anestesiologica · Oct 2011
Survey of non-invasive ventilation practices: a snapshot of Italian practice.
In Italy, NIV began to be employed in the late 1980s. Because it was adopted earlier than in Italy than in other countries, the pattern and rate of utilization of NIV may be different. We aim to determine factors that may influence Italian physicians' preferences towards NIV use, with a particular emphasis on the primary specialty of these physicians and the type of hospital in which they work. ⋯ Overall, Italian physicians perceived that NIV represents an essential tool when dealing with acute episodes of respiratory failure, irrespective of the type of hospital in which they worked.