Minerva anestesiologica
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Minerva anestesiologica · Jul 2009
Randomized Controlled TrialSubarachnoid anesthesia vs monitored anesthesia care for outpatient unilateral inguinal herniorrhaphy.
Inguinal herniorrhaphy is one of the most commonly performed surgical procedures in a same-day surgery setting. The prerequisite of having to discharge the surgical outpatient on the same day has an influence on the choice of the anesthetic technique. ⋯ LA+TCI was shown to be more effective than selective SA at low doses in terms of shorter time to recovery after unilateral inguinal herniorrhaphy procedures.
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Minerva anestesiologica · Jul 2009
ReviewNon-invasive ventilation outside the Intensive Care Unit for acute respiratory failure.
Non invasive ventilation (NIV) has been shown to be an effective therapy in selected patients with acute respiratory failure. Due to its benefit and relative ease of use, NIV is frequently used. ⋯ Choosing the right time and type of patient with acute respiratory failure to improve the chances of success with NIV requires an appropriate environment and monitoring. This review presents and discusses the currently available data regarding NIV success outside the intensive care unit, the optimal ventilatory strategy, possible solutions to the mechanical problems and the minimum monitoring required.
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Minerva anestesiologica · Jul 2009
Randomized Controlled TrialEffects of recombinant human activated protein C on the fibrinolytic system of patients undergoing conventional or tight glycemic control.
Recombinant human activated protein C (rh-APC) and tight glycemic control (TGC) have been shown to reduce mortality in septic patients. Both interventions can reduce the plasma concentration and/or activity of the most powerful suppressor of fibrinolysis, plasminogen activator inhibitor-1 (PAI-1). Our aim was to evaluate the effects on the fibrinolytic system after the administration of rh-APC in septic patients undergoing conventional or TGC. ⋯ Both rh-APC and TGC appear to improve fibrinolysis in septic patients. The reduction in the impairment of fibrinolysis associated with rh-APC treatment seems greater in patients undergoing conventional glycemic control than in those undergoing TGC.
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The use of sedation is required for the majority of mechanically ventilated patients in order to ensure comfort. For many years, deep sedation was the standard of care to avoid unpleasant memories and anxiety and provide comfort. Research over the past decade has shown the importance of using different tools to assess the level of sedation in order to guide appropriate dosing of sedatives and to measure the clinical response to sedation. ⋯ Intensivists should combine the goals of ensuring patient comfort and avoiding unpleasant memories with other important goals that can be achieved with these new strategies (i.e. SATs plus SBTs or the so-called ''wake up and breathe approach''), such as a three day reduction in time spent on the ventilator, a four day reduction in ICU and hospital stays and a 14% absolute reduction in death at one year. New choices for sedation, such as alpha-2 agonists and ultra short narcotics, are also being actively investigated, which may lead to complementary improvements in the future management of these critically ill, vulnerable patients.