Minerva anestesiologica
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Minerva anestesiologica · Jan 2009
A survey of 1000 consecutive epidural catheter placements performed by inexperienced anesthesia trainees.
Education is the core activity of academic anaesthesia departments. One of the main difficulties appears to be the development of realistic high-quality 'training' practices that are safe for patients. The aim of this study was to determine the incidence of complications occurring after epidural catheter placement by inexperienced anaesthesia trainees and their possible relationship with the experience of the operator. ⋯ Epidural catheterization performed under supervision by inexperienced anaesthesia residents is not associated with a significantly greater number of complications than reported in the literature. Moreover, at the early stage of training, we could not demonstrate any correlation between the experience of the operator and the incidence of complications incidence.
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Minerva anestesiologica · Jan 2009
The 2008 international guidelines for management of severe sepsis and septic shock: merits and weaknesses.
The Guidelines are intended to provide standard guidance for the care of patients by grouping evidence-based interventions into bundles that can be easily used by clinicians to improve patient outcome. The 2008 International guidelines for management of severe sepsis and septic shock is a large and extraordinary update of the literature offered by current leaders in the field. ⋯ Furthermore, they can change if new participants take part in the process. By considering the merits and weaknesses of practice guidelines, we conclude that guidelines cannot replace a physician's judgments, but rather should be a starting point for more robust and proficient scientific evidence.
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Minerva anestesiologica · Dec 2008
Randomized Controlled Trial Comparative StudyComparison of forced-air warming and resistive heating.
Perioperative hypothermia is common during anesthesia and surgery and is accompanied by several complications. Forced-air warming is recognized as an effective procedure to prevent hypothermia. The aim of this study was to compare a resistive heating device with a forced-air warming device. ⋯ Heat transfer in the resistive heating system was significantly greater than that of the forced-air warming system.
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Minerva anestesiologica · Dec 2008
ReviewIntrathecal therapy with ziconotide: clinical experience and considerations on its use.
Ziconotide is a synthetic peptide equivalent of an w-conotoxin, obtained from the marine snail Conus magus, which acts by blocking N-type calcium channels in the spinal cord, reducing the perception of pain. It is a newly marketed drug, exclusively for intrathecal use, indicated for severe chronic pain. Ziconotide came to the physicians' table with both doubts and promises; to determine its safety and efficacy, one of the largest and most well-designed randomized double-blind studies in the history of intrathecal therapy was undertaken, and this drug demonstrated efficacy in relieving chronic pain in patients coming from many years of different therapies and therapy failures. ⋯ We noted differences between the well-known activity of morphine on pain and mood, and the more focused action of ziconotide on pain. In addition, it is important to consider the lack of addiction, opioid-induced hyperalgesia and other systemic effects that are common with morphine. These are the reasons why the Polyanalgesic Consensus Conference of 2007 put ziconotide in the first line of intrathecal therapy management.