Minerva anestesiologica
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Minerva anestesiologica · Apr 2013
ReviewRecommendations for anesthesia and perioperative management of patients with neuromuscular disorders.
Patients with neuromuscular disorders are at high risk of intraoperative and postoperative complications. General anesthesia in these patients may exacerbate respiratory and cardiovascular failure due to a marked sensitivity to several anesthetic drugs. Moreover, succinylcholine and halogenated agents can trigger life-threatening reactions, such as malignant hyperthermia, rhabdomyolysis and severe hyperkalemia. ⋯ Anesthesia and perioperative management of patients with neuromuscular disorders are described in this article. To grade the strength of recommendations and the quality of evidence we adopted the GRADE approach. In case of low-quality evidence, these recommendations represent the collective opinion of the expert panel.
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Minerva anestesiologica · Apr 2013
ReviewPatient-ventilator dyssynchrony during assisted invasive mechanical ventilation.
Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. ⋯ To date, technological complexity has made it impossible to evaluate patient-ventilator synchrony throughout the course of mechanical ventilation. Studies have shown that a high index of dyssynchrony may increase the duration of mechanical ventilation. Better training, better ventilatory modes, and/or computerized systems that permit better synchronization of patients' demands and ventilator outputs are necessary to improve patient-ventilator synchrony.
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Fever is a common symptom in intensive care unit (ICU) patients and is caused by a wide variety of infectious and noninfectious disorders. The presence of fever often results in the act of diagnostic tests and procedures that considerably increase medical costs and expose the patient to inappropriate use of antibiotics which eventually results in antibiotic resistance. ⋯ Currently, managing ICU patients with fever should be towards a more restrictive approach than simply starting antibiotic therapy. This review summarizes the common causes of fever in ICU patients and outlines a clinical approach to the management of these patients.
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Minerva anestesiologica · Apr 2013
Case Reports Observational StudyLong-lasting beneficial effects of periradicular injection of meloxicam for treating chronic low back pain and sciatica.
Chronic low back pain (LBP) and sciatica can occur without obvious structural causes and are often resistant to conventional analgesic drugs. The effect of periradicular injection of meloxicam on LBP with or without a radicular component was assessed. A secondary objective of this prospective observational study was to assess the effect of meloxicam on functional recovery. ⋯ Periradicular injections of meloxicam (10 mg) appear to be a useful alternative to opioid and non-opiod analgesics for patients with intractable LBP due to nerve root inflammation.