Minerva anestesiologica
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Physician-patient relationship is the key-point for an optimal management of any medical procedure. Before performing any diagnostic or therapeutic procedure, clinical communication with patients is necessary. It should regard the nature and purpose of a proposed procedure including potential risks and benefits. ⋯ Cognitive impairment may limit the ability to actively participate in the process. In this context, physicians deal with three different situations on a daily basis: 1) patients with good cognitive functioning; 2) patients with various degrees of cognitive impairment; 3) patients with a legal guardian. The aim of this review was to discuss patterns of an accurate, empathetic and effective communication process that may be used during the informed consent process with a particular attention to the emerging problems in the practice of anesthesia in the elderly.
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Minerva anestesiologica · Feb 2012
Risk factors of postoperative vomiting in children receiving continuous intravenous morphine.
Risk factors of postoperative vomiting (POV) have been less extensively explored in children compared to adults. We analyzed the risk factors of POV in children receiving continuous intravenous (i.v.) morphine in a standardized manner without POV prophylaxis after major surgery. ⋯ Female gender, which is usually considered a risk factor after puberty, should be taken into account independent of age to guide the POV prophylaxis in children receiving a postoperative continuous i.v. morphine infusion.
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Minerva anestesiologica · Feb 2012
Arterial lactate above 2 mM is associated with increased brain lactate and decreased brain glucose in patients with severe traumatic brain injury.
Lactate fuels cerebral energy-consuming processes and it is neuroprotective. The impact of arterial lactate on brain metabolism determined by microdialysis was investigated retrospectively in patients with severe traumatic brain injury (TBI). ⋯ Increased arterial lactate levels were associated with increased cerebral lactate uptake and elevated brain lactate. At the same time brain glucose uptake and brain glucose were significantly reduced. It remains unclear whether arterial lactate is the driving force for the increased cerebral lactate levels or if the reduced glucose uptake also contributed to the increased cerebral lactate levels. Further studies are required to assess the impact of lactate infusion under clinical conditions.