Minerva anestesiologica
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Minerva anestesiologica · Feb 2014
Randomized Controlled Trial Comparative StudyComparison of Sublingual Midazolam and Dexmedetomidine for Premedication in Children.
Premedication in children scheduled for surgery reduces preoperative anxiety and facilitates a smooth induction of anesthesia. Midazolam is a commonly used premedication in children but, because of its undesirable effects such as postoperative behavior changes and cognitive impairment, it is not an ideal premedicant. Dexmedetomidine, a highly specific a2-adrenergic receptor agonist, produces sedation which mimics natural stage 2 non-rapid eye movement sleep and helps in early postoperative recovery. The objective of our study was to evaluate the effectiveness of sublingual dexmedetomidine in comparison to sublingual midazolam as premedicant in children ⋯ Sublingual dexmedetomidine provides more effective preoperative sedation as compared to sublingual midazolam across all the age groups and allows a smooth anesthesia induction and awakening especially in the preschool children.
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Minerva anestesiologica · Feb 2014
Randomized Controlled TrialImpact of PEEP during laparoscopic surgery on early postoperative ventilation distribution visualised by electrical impedance tomography.
General anesthesia, mechanical ventilation and pneumoperitoneum affect ventilation distribution at different extent. It should be clarified if an intraoperative positive end-expiratory pressure (PEEP) level of 10 cmH2O influences early postoperative ventilation. Electrical impedance tomography (EIT) was used to assess changes in regional ventilation. ⋯ Changes of postoperative ventilation can be imaged by EIT. Intraoperative PEEP ventilation has a positive effect on early postoperative ventilation distribution, even though not all PEEP patients benefit from mechanical PEEP ventilation the same way. Intraoperative PEEP results in a more homogeneous ventilation distribution by trend.
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During the last decade, inhaled antibiotics, especially colistin, has been widely used worldwide as a therapeutic option, supplementary to conventional intravenous antibiotics, for the treatment of multidrug-resistant (MDR) Gram-negative nosocomial and ventilator-associated pneumonia (VAP). Antimicrobial aerosols are commonly used in mechanically ventilated patients with VAP, although information regarding their efficacy and optimal technique of administration has been limited. Recent studies showed that the administration of inhaled antibiotics in addition to systemic antibiotics provided encouraging results associated with low toxicity for the management of VAP mainly due to MDR Gram negative bacteria. ⋯ Additionally, this route of antibiotic delivery has not been approved until now neither by the FDA nor by the European Medicines Agency (EMEA) in patients with VAP. However, since the problem of VAP due to MDR bacteria has been increased worldwide RCTs are urgently needed in order to prove the safety, efficiency and efficacy of inhaled antimicrobial agents administered alone or in conjunction with parenteral antibiotics for the management of VAP in critically ill patients. Indeed, more data are needed to establish the appropriate role of inhaled antibiotics for the treatment of VAP.