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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Sepsis remains a major cause of admissions to Intensive Care Units (ICU) and has a high mortality rates and significant morbidity in survivors. There are physical, cognitive and psychological sequelae from severe sepsis that have a negative effect on the patients' health related quality of life in the longer term and a social care and humanitarian impact. Although muscle mass loss during the septic period happens very quickly, recovery takes a considerable time and requires the patient to commit to exercising and eating well to rebuild. ⋯ The use of techniques such as ICU diaries to help patients to understand their illness and deal with delusional memories they may have from their ICU stay has been shown to aid psychological recovery in general ICU patients, a percentage of whom will have suffered from sepsis. The use of a self-guided manualised 6 week rehabilitation program, the ICU Recovery Manual, has been shown to accelerate physical recovery in general ICU patients. Considerable amounts of money are spent treating patients with severe sepsis in ICU and not completing the job of returning them to as close as possible to their normal functioning does not make financial sense.
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Minerva anestesiologica · Nov 2013
Glide video laryngoscope for the management of foreign bodies impacted at the hypopharyngeal level in adults.
Cricopharyngeal foreign bodies (FBs) impaction in adults is a common clinical problem; without treatment, the sequelae may be lethal due to local and/or mediastinal infection. When direct laryngoscopy and flexible fiberoptic endoscopy are ineffective, rigid endoscopy is the method of choice requiring general anesthesia. The new video laryngoscopes represent a great advancement in the assessment of the laryngeal inlet. Aim of the study was to assess the feasibility of identifying and removing FBs impacted at crycofaringeal and upper oesophageal sphincter by the video laryngoscope. ⋯ In our experience video laryngoscope, because of the magnified vision, the better patient comfort and no requirement of general anesthesia, represents a great improvement in identifying and removing in conscious sedation even small and thin foreign bodies not recognized by radiological and otolaryngology examination and not readily detected by direct endoscopy.
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Minerva anestesiologica · Nov 2013
Randomized Controlled Trial Comparative StudyEffect of feedback content on novices' learning ultrasound guided interventional procedures.
Feedback, of various forms, is effective at improving performance of medical procedures in simulated and clinical settings. Our objectives were to compare the effects of two forms of feedback on i) novice learning of in-plane technique for ultrasound-guided interventional procedures and ii) to evaluate novice retention of skill 24 hours after a standard learning session. ⋯ When feedback was based on KP, novices acquired pre-defined skills more quickly and made fewer errors during the learning phase (compared with controls). When feedback content was based on KR novices acquired pre-defined skills more quickly but made similar numbers of errors during the learning phase (compared with controls). In conclusion, these findings should inform development of training and assessment programs for peripheral nerve blockade.