Minerva anestesiologica
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Minerva anestesiologica · Nov 2013
Neuraxial anaesthesia in patients with intracranial hypertension or cerebrospinal fluid shunting systems: what the anaesthetist should know?
The management of patients with central nervous system disorders such as brain tumours, hydrocephalus, intracranial hypertension, or subarachnoid haemorrhage has improved in recent years resulting in increased life expectancy. Consequently, the prevalence of patients with increased intracranial pressure or cerebrospinal fluid shunting devices presenting for non-neurological procedures has increased. ⋯ It describes current knowledge, exposes and weighs the real benefits and risks of this technique in this setting. It provides several scenarios and anaesthetic options to help the practitioner with choosing a tailored approach in this specific population.
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Minerva anestesiologica · Nov 2013
Editorial CommentCellular energetic crisis during human septic shock.
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Minerva anestesiologica · Nov 2013
ReviewNoninvasive ventilation in acute respiratory failure with altered consciousness syndrome: a bargain or an hazard?
Non-invasive ventilation (NIV) is contraindicated or at least not recommended in patients with altered consciousness syndrome (ACS) given to the poor compliance of confused/agitated patients, difficult management of accumulated secretion in depressed cough reflex, and risk of aspirative pneumonia in absence of airways protection. Conventional mechanical ventilation (CMV) via endotracheal intubation (ETI) has been usually considered as the "golden standard" ventilator treatment in ACS. However, the possibility of avoiding ETI-related life-threatening complications by means of NIV, especially in fragile, older patients with multiple comorbidities, is an appealing option. ⋯ In this clinical scenario, an initial cautious NIV trial may be attempted as long as there are no other contraindications and the technique is provided by experienced caregivers in a closely monitored setting where ETI is always readily available. The concomitant use of techniques for removing secretion and/or controlled analgo-sedation performed by expert teams may be considered in highly selected cases. The purpose of this paper was to review rationale, clinical feasibility, advantages and risks correlated with the use of NIV in ACS.