Minerva anestesiologica
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Minerva anestesiologica · Mar 2012
Randomized Controlled TrialUsefulness of an anesthetic conserving device (AnaConDa™) in sevoflurane anesthesia.
The anesthetic conserving device (AnaConDaTM) is a disposable vaporizer that can save consumption of inhalational anesthetic used in low sevoflurane concentration. This study was performed to investigate whether AnaConDa when used at high sevoflurane concentration (1.5% to 2.0%) could save sevoflurane consumption and hasten emergence from anesthesia without any adverse effects. ⋯ In general anesthesia with sevoflurane 1.5% to 2.0%, AnaConDa could save sevoflurane consumption and fasten emergence from anesthesia compared to conventional vaporizer, while water accumulation in the filter should be cautioned.
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Analgesics and sedatives are commonly prescribed in the ICU environment for patient comfort, however, recent studies have shown that these medications can themselves lead to adverse patient outcomes. Interventions that facilitate a total dose reduction in analgesic and sedative medications e.g. the use of nurse controlled protocol guided sedation, the combination of spontaneous awakening and breathing trials, and the use of short acting medications, are associated with improved outcomes such as decreased time of mechanical ventilation and ICU length of stay. This purpose of this review is to provide an overview of the pharmacology of commonly prescribed analgesics and sedatives, and to discuss the evidence regarding best prescribing practices of these medications, to facilitate early liberation from mechanical ventilation and to promote animation in critically ill patients.
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Prothrombin complex concentrates (PCCs) are purified drug products with hemostatic activity derived from a plasma pool. Today, PCCs contain a given and proportional amount of four non-activated vitamin K-dependent coagulation factors (II, VII, IX, and X), a variable amount of anticoagulant proteins (proteins C and S, and in some antithrombin) and low-dose heparin. In some countries PCC products contained only three clotting factors, II, IX, and X. ⋯ They may be considered as safe preparations if they are used for their approved indications at the recommended dosage with adequate precautions for administration, and have been shown to be effective for reversing the effect of VKAs. Their adequate use based on decision algorithms in the perioperative setting allows a rapid normalization of International Normalized Ratio (INR) for performing emergency surgery, minimizing bleeding risk. This review aims to propose two algorithms for the use of PCCs in the perioperative setting, one to calculate the PCCs dose to be administered in a bleeding patient and/or immediately before urgent surgery, based on patient's clinical status, prior INR and INR target and another for reversing the action of oral anticoagulants depending on urgency of surgery.
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Minerva anestesiologica · Mar 2012
Comparative Study Clinical TrialAssessing sedation in a pediatric intensive care unit using Comfort Behavioural Scale and Bispectral Index: these tools are different.
The aim of this paper was to monitor comfort in pediatric critical ill patients which is necessary to adequate analgesic and sedative therapy. The primary objective of this prospective observational study was to measure the level of sedation in a Pediatric Intensive Care Unit (PICU) of a tertiary care Hospital, using Comfort Behavioural Scale (CBS) and Bispectral Index (BIS), evaluating the agreement between these tools; secondly we analyzed the correlation of an adequate level of sedation and patient's outcome. ⋯ Our data support the risk of oversedation in critically ill patients and the difference between CBS and BIS, especially in evaluating light oversedation state. The presence of an excessive level of sedation evaluated by BIS was associated with duration of hospitalization and sedative administration.