Minerva anestesiologica
-
Minerva anestesiologica · Feb 2019
ReviewThinking outside the box; off-label use of the Bispectral Index (BIS) within context and limitations for conditions other than depth of anesthesia. Light and shadow of the BIS.
Numerous articles appeared in literature using brain function monitors (BFM), such as Bispectral Index (BIS) to assess cerebral cognitive conditions not related to depth of anesthesia. BIS cannot be considered a "true" reflection of the electroencephalography (EEG) signal nor an independent measure of brain function. BIS algorithm was retrospectively derived from EEG changes with incremental doses of γ-amino butyric acid (GABA)ergic anesthetic agents while measuring 3 descriptors. ⋯ Could we use BIS monitor outside the scope of the operating room to "grade" other EEG conditions? Actually the answer to that seems to be a "very cautious" yes. Because BIS is a rather appealing scale from 100 to 0, it is tempting to find numerical cut-off values for conditions that are already clinically graded like West Haven hepatic encephalopathy. Having said that I strongly argue against going as far as using BIS in Critical Care Unit (CCU) setting, there are too much heterogeneity and many disease states in the CCU patients, other than sedatives /hypnotics, that would strongly influence BIS values, in effect rendering BIS not only useless most of the time but can also be misleading.
-
Minerva anestesiologica · Feb 2019
ReviewWhy don't multicenter randomized controlled trials (RCT) confirm the positive findings of single center RCTs in acute care? (Zeno's Paradox of the Tortoise and Achilles revisited).
It is a common observation that many multicenter randomized controlled trials (mRCT) performed in critically ill patients do not achieve the positive findings often seen in single center studies (sRCT). This has, of course, relevant consequences for clinical practice, as mRCTs have higher scientific validity compared to sRCTs. The aim of this manuscript was to review and discuss the several potential causes of this phenomenon and to relate them to the future of mRCTs in critical care medicine. ⋯ However, sRCTs are more prone to several bias compared to mRCTs, such as local effect bias, selection and performance bias, detection and reporting bias, analysis and attrition bias, concomitant therapy bias, low fragility index and publication bias. In this sense, it is high time the critical care community should see the positive findings of sRTCs with a very high level of scientific caution, unless they are confirmed by mRCTs. MRCTs represent the final step of the process of evidence-based medicine and in the end (however slowly and painfully) such evidence catches up with sRCT and truly helps changes practice worldwide.
-
Minerva anestesiologica · Feb 2019
Multicenter Study Observational StudyProlonged sedation in critically ill children: is dexmedetomidine a safe option for younger age? An off-label experience.
Dexmedetomidine (DEX) is an alpha-2-adrenergic agonist, recently approved by Italian-Medicines-Agency for difficult sedation in pediatrics, but few data exist regarding prolonged infusions in critically-ill children, especially in younger ages. Aim of our study was to evaluate DEX use and safety for prolonged sedation in Pediatric Intensive Care Units (PICUs). ⋯ DEX was confirmed as useful and relatively safe drug for prolonged sedation in critically-ill children, particularly in younger ages. Main AEs were cardiovascular, reversible, related with higher doses, with the concomitant use of benzodiazepines or multiple sedation drugs and with the presence of withdrawal syndrome.
-
Minerva anestesiologica · Feb 2019
Randomized Controlled TrialInfluence of head and neck position on performance of the Ambu® AuraGain™ laryngeal mask: a randomized crossover study.
The purpose of this study was to investigate the influence of different head and neck positions on the performance of the Ambu® AuraGain™, a novel laryngeal mask with anatomical curvature. ⋯ Head and neck position affects the oropharyngeal seal of the AuraGain™, as evidenced by the oropharyngeal leak pressure, but not enough to impede positive-pressure ventilation. Neck flexion can be used when a better oropharyngeal seal is needed, and neck extension and right rotation of the head and neck may facilitate endotracheal intubation using the AuraGain™ as a conduit.
-
Minerva anestesiologica · Feb 2019
Observational StudyXenon anesthesia for awake craniotomy: safety and efficacy. A prospective observational case series.
The asleep-awake-asleep (AAA) craniotomy is a technique that offers the opportunity of having a patient fully cooperative during the awake phase, and minimizes the possible discomfort, due to the asleep phase. The aim of this prospective observational study was to test the use of xenon in the first asleep phase of an AAA craniotomy, in patients undergoing craniotomy for brain tumor resection. ⋯ In this case series, xenon anesthesia was successfully used for the sedative phase of an awake craniotomy accomplished with an AAA approach.