Minerva anestesiologica
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Minerva anestesiologica · Jul 2010
ReviewSome current issues in the pharmacokinetics/pharmacodynamics of antimicrobials in intensive care.
Infections, particularly those caused by resistant pathogens, are a common cause of morbidity and mortality in critically ill patients. However, the availability of effective antimicrobial agents is limited. Critical illness itself can influence the pharmacokinetic/pharmacodynamic (PK/PD) parameters of antimicrobials by altering their volume of distribution and the rate of their excretion and elimination and by impairing their penetration into tissues. ⋯ On the other hand, aminoglycosides exhibit a concentration-dependent pattern of killing and should be administered at high doses once daily or at extended intervals, and their levels in the plasma should by strictly monitored to avoid both underexposure and toxicity. The problem of antimicrobial resistance now involves agents traditionally considered reliable in that aspect, such as vancomycin. Strict monitoring of vancomycin MIC for methicillin-resistant Staphylococcus aureus and the prudent use of the available alternative agents as well as de-escalation strategies might be reasonable strategies for dealing with this problem.
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Minerva anestesiologica · Jul 2010
Randomized Controlled TrialEffect of earplugs on propofol requirement and awareness with recall during spinal anesthesia.
investigator either placed or did not place earplugs into the patients' ears (PLUG or noPLUG groups, respectively). Propofol requirements for stable sedation guided by the bispectral index and incidence of postoperative recall of intraoperative events were assessed in a double-blinded fashion. ⋯ Although no sedative-sparing effect could be found in patients who wore earplugs during elective orthopedic surgery under spinal anesthesia, we nevertheless recommend using single-use paraffin wax earplugs. Beside their beneficial effect against potential harmful intraoperative noise, they reduce the incidence of intraoperative awareness with recall.
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Minerva anestesiologica · Jul 2010
Randomized Controlled Trial Comparative StudyThe Anesthesia Preoperative Evaluation Clinic (APEC): a prospective randomized controlled trial assessing impact on consultation time, direct costs, patient education and satisfaction with anesthesia care.
Anesthetic preoperative evaluation clinics (APECs) are relatively new institutions. Although cost effective, APECs have not been universally adopted in Europe. The aim of this study was to compare preoperative anesthetic assessment in wards with an APEC, assessing time, information gain, patient satisfaction and secondary costs. ⋯ The APEC reduced consultation times and costs and had a positive impact on patient education. The cost savings are related to personnel costs and, therefore, are independent of other potential savings of an APEC, whereas global patient satisfaction remains unaltered.
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Minerva anestesiologica · Jul 2010
Current status of extracorporeal life support (ECMO) for cardiopulmonary failure.
Extracorporeal life support with artificial heart and lung for cardiopulmonary failure is commonly called extracorporeal membrane oxygenation (ECMO). ECMO can provide partial or total support, is temporary, and requires systemic anticoagulation. ECMO controls gas exchange and perfusion, stabilizes the patient physiologically, decreases the risk of ongoing iatrogenic injury, and allows ample time for diagnosis, treatment, and recovery from the primary injury or disease. ⋯ However, nowadays, the new devices allow only minor bleeding that is rarely a fatal complication. Research on non-thrombogenic surfaces holds the promise of prolonged extracorporeal circulation without anticoagulation and without bleeding. The next decade may bring routine application of ECMO to all advanced Intensive Care Units where patients with profound respiratory and cardiac failure are treated.
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Minerva anestesiologica · Jul 2010
Cerebral oxygenation in the beach chair position before and during general anesthesia.
Ischemic brain damage related to the beach chair position is a matter of concern. The current study was designed to evaluate whether the beach chair position before and during general anesthesia differentially induces changes in cerebral oxygenation as determined by near-infrared spectroscopy (NIRS) in surgical patients. ⋯ Under general anesthesia, the beach chair position does not alter cerebral oxygenation in patients showing normal preoperative cerebral TOI values.