Minerva anestesiologica
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Minerva anestesiologica · Jul 2012
Randomized Controlled TrialS+ -ketamine for control of perioperative pain and prevention of post thoracotomy pain syndrome: a randomized, double-blind study.
Post-thoracotomy pain syndrome (PTPS) often complicates the long term outcome of patients; its appearance has been related to perioperative acute pain. The main goal of this study was to evaluate a possible role of S(+)-ketamine in the prevention of PTPS up to 6 months and secondarily its efficacy in the control of perioperative pain when added to thoracic epidural analgesia (TEA) and adjuvants. ⋯ S(+)-ketamine had no effects in respect to placebo in the prevention of PTPS at 3 and 6 months but had a significant role in maintaining a NRS≤3 in the early postoperative period. A tight control of perioperative pain seems to be associated with a low incidence of moderate and severe PTPS.
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Non-invasive ventilation (NIV) is increasingly used in patients with acute respiratory failure, but few data exist regarding current sedation practices during NIV. Mask intolerance or claustrophobia, and delirium and agitation, may lead to NIV failure, requiring endotracheal intubation. Judicious use of sedation during NIV could be one of the valuable options for some of these patients at risk of intubation. ⋯ Pilot studies suggest that continuous infusion of a single sedative agent may decrease patient discomfort, with no significant effects on respiratory drive, respiratory pattern, or hemodynamics. In addition, gas exchange improved under NIV with sedation. While the current limited data available suggests that sedation during NIV is safe and feasible, more widespread application should await the results of randomized clinical trials.
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Little is known about current use of neuromuscular blocking agents by Italian anesthetists. This paper reports the results of a survey conducted to obtain information about current management of neuromuscular block in Italy. ⋯ Clinical signs are used by most of the Italian anesthetists to assess the recovery from neuromuscular blockade. There is poor awareness about their inability to indicate even a significant degree of residual neuromuscular block. A more extensive use of quantitative instrumental monitoring is required for the more rational use of neuromuscular blocking agents.
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Minerva anestesiologica · Jul 2012
Mortality and morbidity of nosocomial respiratory syncytial virus (RSV) infection in ventilated children--a ten year perspective.
Respiratory syncytial virus (RSV) is one of the most common pathogens involved in nosocomial infection in children. The aim of the study was to determine the impact of nosocomial RSV infection on mortality and pediatric intensive care unit (PICU) morbidity of ventilated children. ⋯ Nosocomial RSV infection was independently associated with increased mortality and was the strongest predictor of duration of ventilation and length of stay in children on PICU. Decreasing nosocomial RSV infection would reduce deaths in ventilated children.