Minerva anestesiologica
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Minerva anestesiologica · Oct 2008
Thromboembolic prophylaxis in head trauma and multiple-trauma patients.
The association between trauma and venous thromboembolism (VTE) is well recognized. VTE consists mainly of deep venous thrombosis (DVT) and pulmonary embolism, a complication that leads to mortality in nearly 50% of cases. Without thromboprophylaxis, the risk of DVT exceeds 50%, but even with routine use of prophylaxis,one third of patients may develop DVT. ⋯ Mechanical VTE prophylaxis by graduated compression stockings or intermittent pneumatic compression provides suboptimal protection, and its use is recommended only in combination with LMWH prophylaxis unless active bleeding is not controlled. The routine use of VTE prophylaxis in trauma patients is a standard of care. The use of LMWH, started once primary hemostasis has been accomplished, is safe, efficacious and cost-effective in the majority of trauma patients, including TBI patients.
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Minerva anestesiologica · Oct 2008
Randomized Controlled Trial Comparative StudyDoes the addition of ketorolac and dexamethasone to lidocaine intravenous regional anesthesia improve postoperative analgesia and tourniquet tolerance for ambulatory hand surgery?
The inability to provide effective postoperative analgesia is one of the major disadvantages of intravenous regional anesthesia (IVRA). We designed a prospective, randomized, double blind study to evaluate the analgesic effectiveness of adding both ketorolac and dexamethasone to lidocaine for IVRA. ⋯ IVRA with lidocaine and with the inclusion of ketorolac and dexamethasone provides effective perioperative analgesia for patients undergoing ambulatory hand surgery, when compared to the use of lidocaine alone or lidocaine with ketorolac IVRA.
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Minerva anestesiologica · Oct 2008
ReviewThe physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems.
Studies of regional anesthesia are increasing in popularity not only for the purpose of technical advancement, but also to better understand the effects of neural deafferentation on the function of various organs. Thoracic epidural anesthesia (TEA) is one of the most versatile and widely utilized neural deafferentation techniques. The aim of this article is to critically review published data regarding the most relevant effects of TEA on the cardiovascular, respiratory and gastrointestinal systems. ⋯ Improved gastrointestinal blood flow and motility are clear in animals, and in clinical studies, TEA has been shown to improve recovery after major abdominal surgery. TEA thus presents a powerful tool available to anesthesiologists for perioperative intervention, but its use alone cannot prevent postoperative morbidity and mortality. It is therefore necessary to address its use in the context of multimodal intervention.
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Minerva anestesiologica · Oct 2008
Comparative StudyPercutaneous versus surgical bedside tracheostomy in the intensive care unit: a cohort study.
To compare the outcomes, as well as the short and long term complications, of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) at the bedside. ⋯ Compared with ST, the main advantage of PDT is that it is more rapid and allows the tracheostomy to be performed earlier in the course of ventilatory failure. Early tracheostomy is associated with a shorter duration of mechanical ventilation and a reduced ICU length of stay.
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Minerva anestesiologica · Oct 2008
Improvement of the ventilator associated pneumonia rate with infection control practices in an Italian ICU.
To assess the impact of an intervention to improve respiratory infection control practices and reduce the ventilator associated pneumonia (VAP) rate in an intensive care unit, at the request of the ICU staff. ⋯ Despite our short study period, the results appear to be encouraging and show a measurable impact on the incidence of VAP.