Minerva anestesiologica
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Minerva anestesiologica · Apr 2014
Observational StudyHyponatremia at the Emergency Department: a case-control study.
Hyponatremia (HNA) is a common electrolyte disturbance associated with morbidity and mortality. The aim of this study was to assess incidence and prognosis value of HNA in the Emergency Department (ED). ⋯ HNA was present in 2.4% of patients with a blood analysis and was associated independently with solid tumors and hospital death.
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Minerva anestesiologica · Apr 2014
Observational StudyAerophagia increases the risk of ventilator-associated pneumonia in critically-ill patients.
Gastric residual volume in ventilated critically ill may complicate gut function. Over the years studies suggested to tolerate progressively higher residuals. The relationship between such volumes and the development of ventilator-associated pneumonia (VAP) is still under debate. No reports deal with the relevant anecdotal finding of air in the stomach. Aim of the present study is to test the role of air in the development of VAPs. ⋯ High volumes of air in the stomach significantly increased the risk of developing VAP, while gastric residual volumes were not associated with the incidence of pneumonia.
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Minerva anestesiologica · Apr 2014
Randomized Controlled Trial Multicenter StudyEfficacy of a Novel Prewarming System in the Prevention of Perioperative Hypothermia. A prospective, randomized, multi-centre study.
Perioperative hypothermia is a common complication during general anesthesia. Although rewarming of patients before surgery has been used as a preventive measure and some guidelines recommend it, the implementation of prewarming for every surgical patient is cumbersome. Therefore, we sought to determine the efficacy of two novel prewarming methods that could facilitate prewarming in daily practice. ⋯ In our study active prewarming with a forced-air warmer and an insulating prewarming suit achieves significantly higher core temperatures during anesthesia and at the end of surgery and avoids hypothermia at the end of surgery compared to commercial or conventional insulation techniques.
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Minerva anestesiologica · Apr 2014
ReviewThe last truth for beta-blockers in non-cardiac surgery is still missing!
The perioperative use of beta-blockers (BBs) with the aim of decreasing perioperative adverse cardiac events has been strongly supported, especially after the publication of two small trial (McSPI and DECREASE I) that showed major benefits. However, some later trials did not confirm these benefits. The POISE trial, with 8351 patients, showed reduced primary outcomes (cardiac death, non-fatal myocardial infarction, non-fatal cardiac arrest) at the expense of significant harm, increasing all-cause and sepsis-related deaths, and doubling the incidence of stroke. ⋯ In this review the most recent available evidence, the changes in the guidelines and the criticism on POISE results are discussed together with reasons why recent meta-analyses may not have greater certainty. This is explained by the huge numeric influence of the POISE trial and the heterogeneity in the design of the trials on perioperative BBs. Thus all the evidence available must now be taken into consideration to develop more appropriate guidelines to minimise the risks and enhance the benefits of perioperative beta-blockade.
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Minerva anestesiologica · Apr 2014
Review Practice GuidelinePreoperative evaluation in infants and children: recommendations of the italian Society of pediatric and neonatal anesthesia and intensive care (sarnepi).
The preoperative assessment involves the process of evaluating the patient's clinical condition, which is intended to define the physical status classification, eligibility for anesthesia and the risks associated with it, thus providing elements to select the most appropriate and individualized anesthetic plan. The aim of this recommendation was provide a framework reference for the preoperative evaluation assessment of pediatric patients undergoing elective surgery or diagnostic/therapeutic procedures. ⋯ Preoperative evaluation is mandatory before any diagnostic or therapeutic procedure that requires the use of anesthesia or sedation. The systematic prescription of complementary tests in children should be abandoned, and replaced by a selective and rational prescription, based on the patient history and clinical examination performed during the preoperative evaluation.