Minerva anestesiologica
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Minerva anestesiologica · Mar 2015
Review Meta AnalysisDexmedetomidine in the pediatric population : A review.
Dexmedetomidine, an alpha-2 agonist approved only for sedation in adult intensive care patients, is increasingly used off-label in- and outside Europe in the pediatric setting for various indications such as to prevent agitation, as premedication in the form of intranasal, buccal and oral solution, as adjunct for elective surgery, as sedative for magnetic resonance imaging, as intraoperative analgesia, for extracorporeal shock wave lithotripsy, and as adjuvant to ropi- and bupivacaine for nerve blocks. Dexmedetomidine is also used intravenously at different intensive care units with the purpose of sedation of children. In this paper, we assess 51 minor trials in the form of 44 randomized controlled trials and 7 prospective observational studies in an attempt to update the available evidence on dexmedetomidine use in pediatrics. ⋯ Based on the best current evidence dexmedetomidine is found suitable and safe for various indications. However, in order to discover its full potential, indications, dosing and safety profile for various ages and procedures, it should urgently be examined by conducting good quality pediatric trials. Finally, we provide the readers with guidance on how to apply and dose dexmedetomidine for pediatric sedation and for other indications.
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This paper is an overview of the literature concerning the "know how" of the GlideScope® use in adults. We summarized the main evidences of the last 10 years with particular attention to experts' suggestions about clinical practice of the GlideScope®, noticing matters still debated on GlideScope® use. ⋯ All works that made a point worth including were cited in the discussion. Our research confirms the value of GlideScope® use in airway management and highlights the debate about the use of videolaryngoscopes in routine cases and the operators who may use them in clinical practice.
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Minerva anestesiologica · Mar 2015
Competence for transcranial color-coded duplex sonography is rapidly acquired.
Transcranial color-coded Duplex sonography (TCCD) is a non-invasive bedside tool with broad diagnostic potential in the intensive care setting. Implementation of TCCD requires repeated reliable measurements of flow velocities despite data acquisition by multiple operators with varying experience. Thus the learning curve of TCCD and agreement of measurements between experienced and inexperienced operators is of great interest and unstudied so far. ⋯ TCCD of the MCA in volunteers is an easy to learn tool with a favorable learning curve. A short-term learning program including initial supervised measurements yields reliable results in the hands of inexperienced operators.
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Minerva anestesiologica · Mar 2015
Measured versus calculated resting energy expenditure in critically ill adult patients. Do mathematics match the gold standard?
Indirect calorimetry (IC) is considered to be the standard method for estimating energy requirements in intensive care unit (ICU) patients. Hence, most ICU clinicians still rely on various mathematical formulas to calculate caloric requirements in their patients. We assessed whether measurements obtained by IC reached agreement with the results of such commonly used equations. ⋯ In critically ill adult patients, measured REE poorly correlated with calculated values, regardless what formula was used. Our findings underscore the important role of IC to adequately estimate energy requirements in this particularly frail population.
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Minerva anestesiologica · Mar 2015
Stability of generic brands of meropenem reconstituted in isotonic saline.
Meropenem is a relatively unstable compound when dissolved. Currently, all available data have been derived from tests on the original product from Astrazeneca, and it is unsure if these data can be extrapolated to the stability of other commercially available vials. The aim of this study was therefore to assess the stability of four different brands of meropenem to be used as a prolonged or continuous infusion. ⋯ All tested commercially available vials of meropenem in a concentration of 10 and 20 mg/mL were stable for 12 hours at 25 °C when diluted in 0.9% sodium chloride. The 40 mg/mL solutions were stable for a maximum of 8 hours. This report is the first to show equivalent stability between different commercially available vials of meropenem.