Minerva anestesiologica
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Minerva anestesiologica · Jun 2009
Randomized Controlled Trial Comparative StudyAssessment of recovery, dreaming, hemodynamics, and satisfaction in postcardiac surgery patients receiving supplementary propofol sedation with S(+)-ketamine.
S(+)-ketamine is an analgesic and sedative drug with dissociative attributes. When it is used without sedatives, nightmares have been described. The aim of this study was to assess the effects of postoperative analgosedation with propofol and S(+)-ketamine when compared to standard propofol analgosedation in terms of recovery, dreaming, hemodynamics, and patient satisfaction. ⋯ Patients receiving S(+)-ketamine showed higher satisfaction for pain management and dreamed more often, but they did not have more nightmares.
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Post-thoracotomy pain is one of the most severe types of postoperative pain. It can last up to 2 months and can become chronic in 30% of patients. Pain relief after thoracic surgery is of particular significance, not only for ethical considerations but also for reduction of postoperative pulmonary and cardiac complications. ⋯ This is effective in controlling postoperative pain and in preserving pulmonary function. Other techniques, such as intercostal and interpleural blocks, are rarely utilized, whereas a single shot of intrathecal injection of a hydrophilic opioid, such as morphine, appears to be effective. Cryoanalgesia, which is successful in the immediate postoperative period, has been abandoned for its brief duration and increased incidence of chronic pain.
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Minerva anestesiologica · Jun 2009
Therapeutic hypothermia in Italian intensive care units: a national survey.
The aim of this study was to investigate the use of therapeutic hypothermia (TH) in Italian Intensive Care Units (ICUs). ⋯ Despite authoritative data supporting its effectiveness and safety, use of TH as part of the therapy in a post-resuscitation period in Italian ICUs remains low. The reasons for not using it are not completely justified and suggest that an educational program is advisable in order to boost the utilization of TH in Italy.
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Minerva anestesiologica · May 2009
ReviewRevolving back to the basics in cardiopulmonary resuscitation.
Since the 1970s, most of the research and debate regarding interventions for cardiopulmonary arrest have focused on advanced life support (ALS) therapies and early defibrillation strategies. During the past decade, however, international guidelines for cardiopulmonary resuscitation (CPR) have not only emphasized the concept of uninterrupted chest compressions, but also improvements in the timing, rate and quality of those compressions. In essence, it has been a ''revolution'' in resuscitation medicine in terms of ''coming full circle'' to the 1960s when basic CPR was first developed. ⋯ New devices have now been developed to modify, in real-time, the performance of basic CPR, during both training and an actual resuscitative effort. Several new adjuncts have been created to augment chest compressions or enhance venous return and evolving technology may now be able to identify ventricular fibrillation (VF) without interrupting chest compressions. A renewed focus on widespread CPR training for the average person has also returned to center stage with ground-breaking training initiatives including validated video-based adult learning courses that can reliably teach and enable long term retention of basic CPR skills and automated external defibrillator (AED) use.