Minerva anestesiologica
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Minerva anestesiologica · Oct 2010
Randomized Controlled Trial Comparative StudyPropofol versus sevoflurane for fiberoptic intubation under spontaneous breathing anesthesia in patients difficult to intubate.
The most recommended technique for the management of patients with a difficult airway is fiberoptic intubation (FOI). The aim of this study was to compare propofol and sevoflurane for FOI performance in patients who were difficult to intubate. ⋯ Propofol and sevoflurane provide a high success rate for the performance of FOI in patients who are difficult to intubate.
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Minerva anestesiologica · Oct 2010
ReviewCoagulopathy and platelet disorders in critically ill patients.
Coagulation disorders are common among intensive care patients and may range from isolated thrombocytopenia or prolonged global clotting tests to complex defects, such as disseminated intravascular coagulation. There are many causes for deranged coagulation in critically ill patients and each of these underlying disorders may require specific therapeutic management. Hence, a proper differential diagnosis and the initiation of adequate (supportive) treatment strategies are crucial to reduce morbidity and mortality in critically ill patients with coagulation abnormalities.
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Minerva anestesiologica · Oct 2010
Case ReportsBoerhaave's syndrome - rapidly evolving pleural effusion; a radiographic clue.
Boerhaave's syndrome is the rare and often fatal condition of spontaneous esophageal rupture. Meckler's triad of vomiting, pain and subcutaneous emphysema are characteristic features of Boerhaave's syndrome. When these symptoms are absent, diagnosis is frequently late and often occurs as the result of incidental investigation. ⋯ Unless specifically considered in the differential diagnosis, this rare disease is frequently overlooked. The authors described the case of a patient in whom the diagnosis was made several days following presentation by observing that a large pleural effusion had evolved rapidly on chest radiographs. This uncommon radiological sign has relatively few causes and prompted a review of the history and diagnosis, followed by the initiation of additional investigations that confirmed Boerhaave's syndrome.
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Minerva anestesiologica · Oct 2010
Clinical TrialMultimodal prevention of pain, nausea and vomiting after breast cancer surgery.
Despite many one- or two-modal attempts to relieve postoperative nausea and vomiting (PONV) and pain, postoperative issues following breast cancer surgery remain a substantial problem. Therefore, the aim of this explorative, hypothesis-generating study was to evaluate the effect of a multimodal, opiate-sparing, evidence-based regimen for prevention of PONV and pain. ⋯ A multimodal, opiate-sparing regimen to prevent pain and PONV seems to be more effective than one- or two-component regimens on PONV and pain after breast cancer surgery, a result which calls for large-scale multi-center or randomized studies.
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Minerva anestesiologica · Oct 2010
Central venous pressure during the post-anhepatic phase is not associated with early postoperative outcomes following orthotopic liver transplantation.
Fluid management during orthotopic liver transplantation poses unique challenges for the anesthesiologist. Maintenance of hypovolemia as indicated by low central venous pressure has been associated with reduced blood loss and improved outcomes in some studies, but with higher 30-day mortality and increased incidence of renal dysfunction in others. The primary aim was to evaluate the association of central venous pressure management after liver allograft reperfusion with immediate postoperative patient outcomes. ⋯ Maintaining a lower central venous pressure during the post-anhepatic phase during orthotopic liver transplantation is not associated with any benefit in terms of immediate postoperative allograft function, graft survival or patient survival.