Minerva anestesiologica
-
Minerva anestesiologica · Jun 2012
Monitors of the hypnotic component of anesthesia - correlation between bispectral index and cerebral state index.
The current study examines whether analysis of identical EEG data results in a high correlation coefficient of BIS and CSI values during all anesthetic levels and assesses the concordance of both EEG monitors for displaying the level of anesthesia as defined by the manufacturers. ⋯ In contrast to previous studies, our current approach combines the following conditions: analysis on basis of identical underlying EEG data from deep to light anesthesia, no guidance of anesthetic administration by one of the EEG-based monitors, avoidance of simultaneous EEG readings and the use of two different anesthetic regimens. Though the result of EEG analysis during anesthesia is similar with both monitors, CSI performance during propofol anesthesia was superior to sevoflurane anesthesia. Consequently, a lower agreement of classification of anesthetic levels between BIS and CSI was reached with the use of sevoflurane. Thus, CSI calculation seems not to be independent from anesthetic agent.
-
Critically ill cirrhotic patients are characterized by unique and complicated clinical scenarios related to some characteristic and clear-cut pathophysiological features of their chronic end-stage liver disease that challenge Intensive Care Unit (ICU) physicians with several management problems. This class of patients may require admission to the ICU because of decompensation of their pre-existing liver disease or due to medical problems independent of cirrhosis as pneumonia, trauma or surgery. ⋯ Despite some improvement that was recently reported, patients with decompensated cirrhosis pose to ICU physicians several and, sometimes, dramatic dilemmas in terms of therapeutic strategies and efficacy of the treatments also due to the lack of large specific studies on this particular class of patients. This review will focus on kidney, cardiopulmonary and cerebral complications of severe cirrhosis as well as those related to portal hypertension and their management.
-
Minerva anestesiologica · Jun 2012
Case ReportsLaryngeal tube as airway rescue device from prehospital tracheostomy: a case report.
Airway management is a priority for the critically ill patient. The insertion of a cuffed tracheal tube is the best practice to obtain an airway control; however, it is associated with many practical problems in prehospital trauma care. When this common procedure is not available, it can be substituted by an extraglottic airway. ⋯ Due to the impossibility of endotracheal intubation the patient underwent surgical tracheostomy as suggested by the ear nose throat surgeon consultant. This case suggests that LT could be an important alternative device for airway management in trauma patients after a failed tracheal intubation. LT is a precious tool to achieve good ventilation and oxygenation from the field to the operatory theatre.
-
Minerva anestesiologica · Jun 2012
Randomized Controlled Trial Comparative StudyIntercomparison of three recruitment maneuvers in acute respiratory distress syndrome: the role of Body Mass Index.
The aim of this paper was to investigate the effectiveness of three different recruitment maneuvers (RMs) on respiratory and hemodynamic indexes, in patients with acute respiratory distress syndrome (ARDS), and determine the impact of patients' body mass index (BMI) on RMs efficacy. ⋯ In our cohort, recruitment by two sustained inflations resulted in a more persistent improvement of oxygenation as compared with recruitment by pressure controlled ventilation or consecutive sighs with the same airway pressure. BMI seems to have an impact on RMs effectiveness, most probably by altering the effective transpulmonary pressure. More studies are required to elucidate this observation.
-
Minerva anestesiologica · Jun 2012
Meta AnalysisThe efficacy of NMDA receptor antagonists for preventing remifentanil-induced increase in postoperative pain and analgesic requirement: a meta-analysis.
Meta-analysis was performed to evaluate the preventive effects of N-methyl-D-aspartate (NMDA) receptor antagonists on remifentanil-induced increase in postoperative pain and analgesic requirement in patients. ⋯ These data do not support the use of NMDA receptor antagonists, ketamine and magnesium sulfate to prevent the development of remifentanil-induced postoperative hyperalgesia and tolerance.