Minerva anestesiologica
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Minerva anestesiologica · Aug 2019
ReviewJoint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU.
Proper management of patients undergoing robotic-assisted urologic and gynecologic surgery must consider a series of peculiarities in the procedures for anesthesiology, critical care medicine, respiratory care, and pain management. Although the indications for robotic-assisted urogynecologic surgeries have increased in recent years, specific guidance documents are still lacking. ⋯ This consensus document provides guidance for the management of urologic and gynecologic patients scheduled for robotic-assisted surgery. Moreover, the identified unmet needs highlight the requirement for further prospective randomized studies.
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Minerva anestesiologica · Aug 2019
Meta AnalysisMusic therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials.
The underlying clinical condition and the Intensive Care Unit (ICU) environment make critical illness a stressful event. Although the usual management consists of sedation, non-pharmacological interventions such as music therapy have been suggested for their drug-sparing effect. Aim of the present review is to assess the current evidence on the effectiveness of music therapy in reducing stress and anxiety in critically ill, adult patients. ⋯ Despite significant heterogeneity in trial designs, timing and features of the intervention, music therapy is consistently associated with a reduction in anxiety and stress of critically ill patients.
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Minerva anestesiologica · Aug 2019
ReviewUsing opioid therapy for pain in clinically challenging situations: questions for clinicians.
Healthcare professionals and organizations increasingly face the conundrum of treating patients with active substance use disorder, a history of personal or familial substance use disorder, or those at elevated risk for substance abuse. Such patients need compassionate care when facing painful conditions; in fact, denying them pain control makes it likely that they will seek out ways to self-medicate with illicit drugs. Yet it remains unclear how to safely and effectively treat patients in these challenging situations. ⋯ It is tempting but inaccurate to label these individuals as "inappropriate patients," rather they are high-risk individuals in very challenging clinical situations. The challenge is that both options - being in pain or being treated with opioids to control pain - expose the patient to a risk of rekindling an addiction. The question is how do we, as clinicians, adequately respond to these very perplexing clinical challenges?