Minerva anestesiologica
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Minerva anestesiologica · Jun 2020
Randomized Controlled TrialPsychology versus medication for pre-anesthesia preparation of children: a randomized controlled trial.
Reducing preoperative anxiety is important as inadequate preoperative management can potentially give rise to behavioral problems in the postoperative course, leading to incalculable quantitative and qualitative handicaps later in life. We compared preanesthetic administration of midazolam to a psychological strategy of walking the children through the operating room and playfully demonstrating anesthesia equipment. ⋯ All psychometric instruments used in this study indicated that our psychological strategy of preanesthesia preparation was capable of successfully reducing anxiety in paediatric patients and their parents.
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Minerva anestesiologica · Jun 2020
Electroencephalographic density spectral array monitoring during propofol sedation in teenagers, using the narcotrend electroencephalographic monitor.
Recently published articles address concerns about the safe use of currently available index-based depth of hypnosis monitors. Electroencephalographic Density Spectral Array monitoring facilitates the interpretation of unprocessed electroencephalogram data, providing the anesthesiologist with real-time drug-specific information on hypnotic depth. The primary aim of this study was to investigate the clinical applicability of Density Spectral Array with a commercially available monitor as the Narcotrend EEG monitor in teenagers under procedural sedation using propofol. ⋯ We were able to show that DSA displayed in real time, on a commercially available DoA monitor (the Narcotrend EEG monitor), can provide the anesthesiologist with understandable information regarding the dose-dependent EEG effects of propofol in teenagers.
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The intensive care unit (ICU) represents one of the most ethically burdensome health care settings where uncertainties and disagreements concerning proportionate treatments, goals of care and patients' best interests frequently come up. Clinical ethics consultation (CEC) is a service available to hospital staff, patients and their family members to handle and resolve such moral doubts and conflicts. Considered as the most challenging activity of clinical ethics, it aims to improve the quality of patient care and to increase both health care professionals' familiarity with ethical issues and their competence in identifying and analyzing moral problems. ⋯ First, we show what use CEC can have in an ICU, especially in the process of shared decision making. Then, we analyze two attitudes which may prevent CEC from being fully integrated in the health care system. Lastly, we illustrate the advantages of implementing a clinical ethics service where the full spectrum of ethics support activities are ensured on an ongoing basis.
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From the initial hypothesis considering 30 years ago the gut as the "motor" of multiple organ failure (MOF) related to an induced hyperpermeability leading to bacterial translocation into the systemic circulation, the reality becomes significantly more complex. The gut contains three interplaying components - the epithelium, the microbiome, and the immune system - that have to cooperate to maintain two opposite function: adsorption of nutrients and maintenance of a barrier to prevent the crossing of intraluminal microbes or their products to avoid host response. ⋯ This review tries to give a comprehensive description of these mechanisms, focused on induced sepsis. Some new therapeutic strategies are discussed.