Minerva anestesiologica
-
Minerva anestesiologica · Jun 2012
Five years of therapeutic drug monitoring in the intensive care did not change vancomycin prescription behaviour: perceived needs for decision support.
This study aims to assess clinicians' behaviour in prescribing vancomycin in the Intensive Care Unit (ICU) and their adherence to local guidelines for therapeutic drug monitoring (TDM). ⋯ Five years of TDM did not achieve the desired prescription behaviour in the ICU and clinicians feel there is a need for computerized decision support. Local projects should measure adherence and implement appropriate solutions.
-
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
Randomized Controlled TrialInfluence of a prolonged lateral position on induction of spinal anesthesia for cesarean delivery: a randomized controlled trial.
Maternal hypotension occurs commonly during cesarean delivery under spinal anesthesia. We evaluated whether hypotension due to aortocaval compression could be prevented by maintaining a lateral position after an intrathecal injection. ⋯ During spinal anesthesia for elective cesarean delivery, maintaining the lateral position for 6 min after an intrathecal injection of hyperbaric bupivacaine resulted in a more gradual and higher cephalad sensory block, without an increase in the incidence of maternal hypotension.