Minerva anestesiologica
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Minerva anestesiologica · Jul 2014
Review Meta AnalysisEffectiveness of oral chlorhexidine on nosocomial pneumonia, causative microorganisms and mortality in critically ill patients: a systematic review and meta-analysis.
We carried out a systematic review and meta-analysis of randomized trials to explore the effectiveness of oral chlorhexidine on nosocomial pneumonia, causative bacteria, and mortality. PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for randomized trials in critically ill patients receiving oral chlorhexidine. Odds ratios (OR) were pooled with the random effects model. ⋯ Mortality was not affected. This review indicates that in critically ill, mainly surgical, patients, oral chlorhexidine reduces nosocomial pneumonia, ventilator-associated pneumonia, nosocomial pneumonia due to Gram-positive and Gram-negative bacteria, and due to "normal" flora, without affecting mortality. Further studies should explore the efficacy of oral chlorhexidine in non-surgical critically ill population.
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Minerva anestesiologica · Jul 2014
Review Meta AnalysisEffect of epinephrine on survival after cardiac arrest: a systematic review and meta-analysis.
The use of epinephrine is currently recommended as a treatment option for patients with cardiac arrest. The primary objective of this systematic review was to determine if epinephrine use during cardiac arrest is associated with improved survival to hospital discharge. MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, International Pharmaceutical Abstracts, and Biological Abstracts (BIOSIS Previews), and bibliographies of previous systematic reviews. ⋯ But epinephrine was associated with decreased survival in observational-A studies (OR 0.43, 95% CI 0.40 to 0.48; P<0.01; I2=0.00%). Epinephrine use during cardiac arrest is not associated with improved survival to hospital discharge. Observational studies with a lower-risk for bias suggest that it may be associated with decreased survival.
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Minerva anestesiologica · Jul 2014
Randomized Controlled Trial Comparative StudyPropofol versus thiopental by target controlled infusion in patients undergoing craniotomy.
For decades thiopental has been considered as the hypnotic drug of choice for intracranial surgery. However, total intravenous anesthesia performed with thiopental is associated with delayed recovery, whereas early post-operative neurological evaluation is critical. For this reason, target controlled infusion (TCI) of propofol is increasingly used for maintenance of anesthesia. However, a thiopental TCI has never been assessed for this purpose. We tested the hypothesis that a thiopental TCI provides an acceptable way to achieve early recovery compared to a propofol TCI during supratentorial surgery. ⋯ Even with TCI and bispectral index monitoring, thiopental is associated with an inappropriate delayed recovery from supratentorial surgery compared to propofol TCI.
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Minerva anestesiologica · Jul 2014
Randomized Controlled Trial Comparative StudyComparison of palonosetron with palonosetron-dexamethasone combination for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.
This randomized double-blind study was designed to compare palonosetron with palonosetron-dexamethasone combination for prevention of post operative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy. ⋯ The palonosetron-dexamethasone combination was more effective as compared to only palonosetron for reducing PONV after laparoscopic cholecystectomy.
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Minerva anestesiologica · Jul 2014
ReviewThe Need To Clot: A review of current management strategies for adverse bleeding events with new oral anticoagulants.
The new factor Xa inhibitors and direct thrombin inhibitors have offered alternatives to traditional anticoagulants, with benefits of no routine monitoring, less drug interactions, and oral administration. Current approved uses of these agents include prophylaxis of stroke in non-valvular atrial fibrillation and prevention of venous thromboembolism (VTE) following hip and knee arthroplasty. However, concern over bleeding risk in the context of having no specific antidotes available is a topic of focus for many physicians in an acute care setting. ⋯ Literature published over the last 18 months (2011/07/01-present) was gathered from PubMed, Ovid, and Medline under a combined search strategy covering bleeding, reversal, and new oral anticoagulants, both factor Xa and direct thrombin inhibitors. The use of prothrombin complex concentrate, fresh frozen plasma, activated recombinant factor VII, activated prothrombin complex concentrate, as well as adjuncts of charcoal, hemodialysis, and antifibrinolytics are discussed. Recommendations are based on the determination of the severity of the bleed and physiological markers of anticoagulation, and involve the use of prothrombin complex concentrate, activated recombinant factor VII, and adjunctive therapy as appropriate.