Minerva anestesiologica
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Minerva anestesiologica · Oct 2010
Review Comparative StudyContent development for EUROPEAN GUIDELINES on the use of opioids for cancer pain: a systematic review and Expert Consensus Study.
Workpackage 3.1 (WP 3.1), within the European Palliative Research Collaborative (EPCRC), was aimed at critically revising and updating the European Association for Palliative Care recommendations on cancer pain management. The aim of this paper is to report the results of the first phase in the revision process which consists of a literature review and an expert consensus about the contents to be considered relevant in the development of the new guidelines. A systematic literature search was carried out from 2001 to 2008 through various databases including Medline, Cinahl, Cochrane Database of Systematic Reviews, Embase and Google. ⋯ Through the responses given by the experts (25 after the first round and 19 after the second) and after a revision by the WP 3.1 local and steering committees, a final list of 22 topics was generated to answer all identified key-points. Each of these topics will be the object of systematic literature reviews. The final version of the "Evidence-based guidelines for the use of opioid analgesics in the treatment of cancer pain: the EAPC recommendations" will be based on the results of the 22 systematic literature reviews.
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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are major health problems worldwide. Critical care physicians have long recognized that there are patients who progress poorly despite therapy while others do unexpectedly better than it might be predicted. It is now well accepted that these responses might be related to variations in the genome. ⋯ The identification of important associations between genotype and clinical outcomes will have an impact on the development of more efficient genotype- or phenotype-guided therapies for patients with ALI/ARDS. Using this point of view, we will discuss some of the advances in genetic association studies in relation to the occurrence and severity of ALI/ARDS. In addition, we will also discuss the strategic and medical implications of using genetic testing to detect or predict the occurrence and prognosis of ALI/ARDS.
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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
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.