Minerva anestesiologica
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Labor epidural failure is a challenging situation for the obstetric anesthetist, especially when associated to high risk of caesarean delivery, obesity, and difficult airway predictors. Labor epidural failure is still not standardly defined, consequently its incidence is uncertain: improving the knowledge of risk factors related to failure will increase epidural block success rate. Prolonged labors, previous history of epidural failure, and repeated top-ups needed during labor are recognized risk factors for failure. ⋯ Software-controlled infusion pumps seem to increase epidural analgesia success rate. Among non-technical skills, good communication among medical team members and parturient women is another pivotal point to achieve a satisfactory analgesia for labor. Clear algorithms should be promoted where epidural failure during labor or caesarean delivery may occur.
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Minerva anestesiologica · Nov 2017
Age-related outcome of patients after traumatic brain injury: a single-centre observation.
The purpose of the present study was to analyze clinical features of patients with traumatic brain injury (TBI), their age-related outcomes and determinants of long-term outcome. ⋯ Older patients are at higher risk for long-term unfavorable outcomes than younger patients. Use of anticoagulants and/or antiplatelet agents and lower hemoglobin levels during rescue phase are associated with unfavorable long-term outcomes. Fall prevention in the elderly should be a key target of intervention programs.
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Minerva anestesiologica · Nov 2017
Multicenter Study Observational StudyIndividual duration of axillary brachial plexus block is unpredictable: a prospective double centred observational study.
The duration of effect for axillary plexus block using ropivacaine is highly variable. The available literature does not offer any plausible means of predicting time of block offset for individual patients, making it difficult to give accurate information and plan postoperative analgesics. This study was designed to identify factors influencing axillary plexus block offset time. ⋯ This prospective study demonstrates a large inter individual variation in time of axillary plexus block offset using ropivacaine 0.75%. The lack of association between offset time and both demographic and block performance factors, makes predictability of individual duration of axillary plexus blocks in clinical practice extremely difficult. We suggest that all patients should be made aware of such variability in duration prior to block placement.
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Minerva anestesiologica · Nov 2017
Multicenter Study Comparative StudyElderly versus non-elderly patients with intra-abdominal candidiasis in the ICU.
Intra-abdominal candidiasis (IAC) has a considerable cost in terms of mortality and morbidity. We sought to study the epidemiology, characteristics and outcome of elderly (>75 years old) versus non-elderly patients with IAC and risk factors for mortality in elderly patients. ⋯ Factors independently predicting mortality in elderly patients with IAC were ESRD and inadequate abdominal source control. Elderlies were found to have more pulmonary and cardiac morbidities and had higher mortality than non-elderlies.
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Minerva anestesiologica · Nov 2017
Randomized Controlled TrialCervical spine motion during tracheal intubation with king visionTM video laryngoscopy and conventional laryngoscopy: a crossover randomized study.
The King Vision™ (KVL) videolaryngoscope with a wide field of view could potentially reduce cervical spine motion during intubation. We aimed to compare the extent of cervical spine movement during laryngoscopy using the KVL and Macintosh laryngoscopes. ⋯ In patients with normal cervical spine, KVL resulted in less extension of the cervical spine than direct laryngoscopy.