Minerva anestesiologica
-
Minerva anestesiologica · May 2020
ReviewVasopressors to treat refractory septic shock: a narrative review.
Norepinephrine is the first line vasopressor used in patients with septic shock. However, norepinephrine doses above 1 µg/kg/min are associated with mortality rates of over 80%, suggesting a need to implement adjunctive strategies prior to reaching this dosage. The present study therefore sought to review the existing and emergent vasopressor agents for patients with refractory septic shock. ⋯ Angiotensin II is another emerging option that uses a different signaling pathway. However, nitric oxide synthase inhibitors and methylene blue do not appear to be appropriate in the management of patients with refractory septic shock. In conclusion, the use of different adjunctive agents in combination with the use of norepinephrine may be useful in patients with refractory septic shock, but care must be taken to avoid excessive vasoconstriction.
-
Minerva anestesiologica · May 2020
Meta AnalysisLidocaine for postoperative sore throat: a meta-analysis of randomized controlled trials.
Postoperative sore throat (POST) is a common complication after tracheal intubation. Various studies have examined the efficacy of interventions using lidocaine to prevent POST. Here, we present a meta-analysis assessing their efficacy. ⋯ This meta-analysis indicated that intracuff lidocaine and intravenous lidocaine are effective in preventing POST. In addition, intracuff lidocaine was associated with reducing the risk of both cough and hoarseness.
-
Minerva anestesiologica · May 2020
Randomized Controlled TrialGlideScope® versus Macintosh laryngoscope for assessment of post-thyroidectomy vocal cord dysfunction: prospective randomized study.
Early detection of post-thyroidectomy vocal cord dysfunction is crucial. This study compared GlideScope® with Macintosh direct laryngoscope (MDL) regarding the accuracy of assessment of post-thyroidectomy vocal cord dysfunction. ⋯ This study demonstrates that GlideScope® is a better alternative to MDL for an accurate detection of post-thyroidectomy vocal cord dysfunction.
-
Minerva anestesiologica · May 2020
Sedation in digestive endoscopy: innovations for an old technique.
Patient complexity, along with duration, number and invasiveness of procedures, increase every year in digestive endoscopy; so deep sedation, analgesia or general anesthesia requests are rising. The need for a safe, flexible, low cost and high-profile service play a central role in drugs, devices and monitoring development. The patient's degree of comfort and anxiety are also critical. ⋯ Nevertheless, these short and at low risk procedures can induce cognitive impairment. Currently, only anesthesiologists seem to have the competences to maintain high levels of safety by an appropriate evaluation and sedatives' choice, and a detailed protocol should be present in each gastrointestinal endoscopy department. In conclusion, the role of the anesthetist should be to supervise endoscopy activities at every level.