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
Non-invasive ventilation outside the Intensive Care Unit for acute respiratory failure: the perspective of the general ward nurses.
The introduction of non-invasive ventilation outside the Intensive Care Unit (ICU) is an increasing phenomenon, motivated by the shortage of intensive care beds and growing confidence with the technique. However, although general ward nurses are responsible for carrying out the daily management of the treatment and the extra monitoring it requires, their perspective on non-invasive ventilation (NIV) has never before been studied, and as a result their training is often neglected. ⋯ Nurses indicated a strong demand for training on NIV, in order to improve their involvement with the therapeutic program and for better communication with the MET and ward doctors. We conclude that active research towards understanding their point of view should be included as part of the quality control of NIV treatments outside the ICU.
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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.