Minerva anestesiologica
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Enteral nutrition (EN) is a well established approach to nutritional support in the ICU. Parenteral nutrition (PN) represents an additional safe approach, substituting or complementing EN when its delivery fails completely or partially. This article attempts to summarize the ESPEN guidelines of PN in the ICU based on the available literature, which is often limited due to quality and methodology heterogeneity; the recommendations are therefore largely expressed as expert opinions.
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Minerva anestesiologica · Nov 2011
Pain, postdural puncture headache, nausea, and pruritus after cesarean delivery: a survey of prophylaxis and treatment.
The need for a cesarean delivery may interfere negatively with the overall experience of childbirth. Several factors related to anesthesiological management such as postoperative pain and discomfort, nausea and pruritus, and postdural puncture headache (PDPH), may lead to dissatisfaction and have a negative impact on early mobilization and a new mother's ability to care for her newborn baby. Optimal prophylaxis and treatment decrease these complications, increase satisfaction, and prevent chronic pain. This survey determined how prophylaxis and treatment of pain, PDPH, nausea, and pruritus after cesarean section (CS) is managed. ⋯ Apart from conservative treatment of PDPH, prophylaxis and treatment of pain after cesarean delivery, PDPH, nausea, and pruritus varied widely, indicating the need for the qualitative evaluation of overall management.
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Minerva anestesiologica · Nov 2011
The use of the Foley Airway Stylet Tool® to guide tracheal intubations through an intubating laryngeal mask airway.
Blind insertion of endotracheal tubes through the intubating laryngeal mask airway (ILMA) is unsuccessful in almost 50% of cases on the first attempt, with an overall success rate of approximately 90%. We used a portable fiber optic device (Foley Airway Stylet Tool® FAST) to detect the reasons for failed intubations and tested its use in facilitating endotracheal tube placement. ⋯ A grade II view or worse indicated misalignment of the ILMA with the glottis. An endotracheal tube inserted blindly through the misaligned ILMA will impinge on and potentially damage laryngeal structures. The use of a portable fiber optic device can help reduce the failure rate of endotracheal intubations by utilizing ILMA in emergent situations.