Minerva anestesiologica
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Minerva anestesiologica · Feb 2015
ReviewMesenchymal Stromal cell therapies - potential and pitfalls for ARDS.
Mesenchymal stem/stromal cells (MSCs) offer considerable promise as a novel therapeutic strategy for acute respiratory distress syndrome (ARDS). MSCs may be able to "reprogramme" the immune response to reduce destructive inflammatory elements while preserving the host response to pathogens. In addition, MSCs may be able to enhance the repair and resolution of lung injury. ⋯ The fact that MSCs are in clinical studies for a wide range of disease processes is a clear advantage for translating MSCs to clinical testing in patients with ARDS. However, some important knowledge gaps exist that may impede clinical translation. The ultimate success of MSCs as a therapy for patients with ARDS will likely be dependent on a greater knowledge of their mechanisms of action and the determination of the optimal strategies for their use in the clinical setting.
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Minerva anestesiologica · Feb 2015
Review GuidelineRevised ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Implications for preoperative clinical evaluation.
Each year, an increasing number of elderly patients with cardiovascular disease undergoing non-cardiac surgery require careful perioperative management to minimize the perioperative risk. Perioperative cardiovascular complications are the strongest predictors of morbidity and mortality after major non-cardiac surgery. A Joint Task Force of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) has recently published revised Guidelines on the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery, which represent the official position of the ESC and ESA on various aspects of perioperative cardiac care. ⋯ The ESC/ESA Guidelines discourage indiscriminate routine preoperative cardiac testing, because it is time- and cost-consuming, resource-limiting, and does not improve perioperative outcome. They rather emphasize the importance of individualized preoperative cardiac evaluation and the cooperation between anesthesiologists and cardiologists. We summarize the relevant changes of the 2014 Guidelines as compared to the previous ones, with particular emphasis on preoperative cardiac testing.
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Minerva anestesiologica · Feb 2015
Review GuidelineItalian Intersociety Recommendations (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC) on Pain Management in the Emergency Setting.
Pain is the primary reason for admission to the Emergency Department (ED). However, the management of pain in this setting is often inadequate because of opiophagia, fear of excessive sedation, and fear of compromising an adequate clinical assessment. ⋯ The diagnostic-therapeutic pathway of pain management in emergency should be implemented, through further interdisciplinary trials, in order to improve the EBM level of specific guidelines.
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Minerva anestesiologica · Feb 2015
Observational StudyDoes the child behavior checklist predict levels of preoperative anxiety at anesthetic induction and postoperative emergence delirium? A prospective cohort study.
preoperative anxiety at induction and postoperative emergence delirium (ED) in children are associated with postoperative behavioral changes and adjustment disorders. This study's aim is to assess the value of the Child Behavior Checklist (CBCL) score in order to predict anxiety during induction and emergence delirium after anesthesia in children undergoing elective day-care surgery. ⋯ The CBCL predicted anxiety at induction but not ED.
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Minerva anestesiologica · Feb 2015
Elevated soluble endothelial protein C receptor levels at ICU admission are associated with sepsis development.
The endothelial protein C receptor (EPCR) is a protein that regulates the protein C anticoagulant and anti-inflammatory pathways. A soluble form of EPCR (sEPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in the septic process is under investigation. In this study, we assessed the role of sEPCR levels as an early indicator of sepsis development. ⋯ Upon ICU admission, sEPCR levels in initially non-septic critically-ill patients appear elevated in the subjects who will subsequently become septic.