Minerva anestesiologica
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Minerva anestesiologica · Mar 2017
Utilizing bi-spectral index (BIS) for the monitoring of sedated adult ICU patients: a systematic review.
The ideal level of sedation in the ICU is an ongoing source of scrutiny. At higher levels of sedation, the current scoring systems are not ideal. BIS may be able to improve both. We evaluated literature on effectiveness of BIS monitoring in sedated mechanically ventilated (MV) ICU patients compared to clinical sedation scores (CSS). ⋯ BIS monitoring in the mechanically ventilated ICU patient may decrease sedative drug dose, recall, and time to wake-up. The studies suggesting this are severely limited methodologically. BIS, when compared to subjective CSSs, is not, at this time, clearly indicated. An appropriately powered randomized, controlled study is needed to determine if this monitoring modality is of use on the ICU.
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Minerva anestesiologica · Mar 2017
Observational StudyPropofol sedation reduces diaphragm activity in spontaneously breathing patients: ultrasound assessment.
The diaphragm is the most important respiratory muscle in humans, and the close relationship between inspired volume and diaphragmatic movement in normal subjects has led to investigations into diaphragmatic activity using ultrasound, during spontaneous breathing and sedative drug infusion. ⋯ Our study showed that deep propofol sedation affects muscle activity in healthy patients. While diaphragmatic strength decreased during sedation, there was no clinically relevant effect on SpO2. The study also confirmed that ultrasound is suitable for measuring diaphragm activity during a normal clinical procedure.
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Opioids are the most frequently administered analgesics in the perioperative period. The analgesic potency of opioids is without question. While the opioid- free or opioid-less perioperative care concept is not a reality in most surgical centers of the United States and other developed countries, there is a significant number of healthcare problems (i.e. adverse events, opioid-induced hyperalgesia and opioid diversion) related to the indiscriminate use of opioids that warrants the implementation of multimodal analgesia strategies. Although it has been suggested an association between the use of opioids and cancer progression, there is a need of well-designed studies to confirm that association.
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Minerva anestesiologica · Mar 2017
Regional anaesthesia and antithrombotic agents: instructions for use.
The use of anticoagulant agents represents a serious limitation of regional anesthesia, due to the risk of spinal hematoma. Examining all the principles currently available, it has been possible to notice that published guidelines are very often incomplete or also differ significantly on the rules to be followed relating to a specific drug. ⋯ The comparison between the main guidelines often highlights substantial disparities and weak evidences, so operators must carry out a careful risk / benefit analysis prior to regional anesthesia.
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Minerva anestesiologica · Mar 2017
Altered liver function in patients undergoing veno-arterial extracorporeal membrane oxygenation (ECMO) therapy.
Multiple organ dysfunction can occur in patients undergoing Veno-arterial Extra Corporal Membrane Oxygenation (VA-ECMO); however, liver function has not been well studied in this setting. ⋯ A substantial proportion of patients needing VA-ECMO have early ELE, which usually improves over days. The prognostic implications are not evident.