Minerva anestesiologica
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Minerva anestesiologica · May 2012
Survey on controversies in airway management among anaesthesiologists in the UK, Austria and Switzerland.
While surveys about anaesthesia practice appear regularly in the anaesthesia literature, they are usually bound to one country. We compared the approach to specific airway management issues among anaesthesiologists from three different European countries. METHODS A questionnaire was distributed during the main session of three anaesthesia meetings in Austria(A), the UK, and Switzerland(CH). ⋯ CONCLUSION Answers from anaesthesiologists in the UK differed significantly from those in A and CH. Anaesthesiologists in the UK check mask ventilation after induction less frequently, but they check more often when risk factors of difficult mask ventilation are present. Cricoid pressure seems to remain an important part of the rapid sequence induction technique in the UK, whereas anaesthesiologists in Austria and Switzerland rely less on this technique.
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Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. ⋯ This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.
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Minerva anestesiologica · May 2012
Randomized Controlled Trial Comparative StudyA randomized controlled study to assess patients' understanding of and consenting for clinical trials using two different consent form presentations.
Informed consent is the ethical basis for clinical research. The physical appearance of the consent document may influence patients' willingness to carefully read the consent document. We therefore tested the hypothesis that presentation of consent documents in an enhanced format improves patients' attention, understanding and therefore willingness to consent for clinical research. ⋯ Consent forms in an enhanced format (i.e., printed on fine paper and presented in a folio) did not improve patients' understanding or willingness to consent to participate in clinical trials.
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Minerva anestesiologica · May 2012
A prospective pilot study of platelet function and its relationship with postoperative bleeding in pediatric cardiac surgery.
Postoperative bleeding is a major problem in pediatric cardiac surgery with cardiopulmonary bypass (CPB). It recognizes a multifactorial cause, inclusive of coagulation factors consumption, hyperfibrinolysis, incomplete heparin reversal, and platelet consumption. Limited information on platelet function is available. This pilot study investigates platelet function changes in pediatric cardiac operations and their relationship with postoperative bleeding. ⋯ In this pilot study, platelet function in pediatric patients undergoing cardiac surgery demonstrates a variable pattern and no association with postoperative bleeding. Confounding factors like age and cyanosis should be addressed with larger patient populations.
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Minerva anestesiologica · May 2012
The optimal effect site concentration of remifentanil in combination with intravenous midazolam and topical lidocaine for awake fibreoptic nasotracheal intubation in patients undergoing cervical spine surgery.
Remifentanil has been suggested as a suitable agent for conscious sedation during fibreoptic intubation. We evaluated the optimal effect site concentration (Ce) of remifentanil target-controlled infusion (TCI) for awake nasotracheal fibreoptic intubation in patients undergoing elective cervical spine surgery. ⋯ The estimated EC(95) of remifentanil Ce for smooth nasotracheal fibreoptic intubation with conscious sedation was 3.38 (95% CI 2.90-3.46) ng·mL-1 when used in combination with midazolam and topical lidocaine. Remifentanil TCI may provide a tolerable experience of awake fibreoptic intubation despite the high incidence of recall.