Minerva anestesiologica
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Minerva anestesiologica · May 2008
ReviewIntracranial pressure monitoring for traumatic brain injury: available evidence and clinical implications.
Following traumatic brain injury, uncontrollable intracranial hypertension remains the most frequent cause of death. Despite general agreement on the deleterious effects of elevated intracranial pressure (ICP), however, the evidence supporting the use of ICP monitoring has recently been questioned. The aim of this review was to evaluate the pros and cons of ICP monitoring and to discuss the hypothetical desirability and feasibility of a trial testing the benefits of ICP monitoring.
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Minerva anestesiologica · May 2008
Case ReportsRhabdomyolysis and respiratory failure: rare presentation of carnitine palmityl-transferase II deficiency.
Carnitine palmityl-transferase (CPT) II deficiency is a rare disorder of the fatty acid beta-oxidation cycle. CPT II deficiency can be associated with rhabdomyolysis in particular conditions that increase the requirement for fatty acid oxidation, such as low-carbohydrate and high-fat diet, fasting, exposure to excessive cold, lack of sleep and prolonged exercise. The best known CPT II deficiency is the muscular form with episodic muscle necrosis and paroxysmal myoglobinuria after prolonged exercise. ⋯ Biochemical investigation of muscle biopsy and genetic analysis showed a deficiency of CPT II. The onset of CPT II deficiency with respiratory failure is extremely rare, but a correct and early diagnosis of rhabdomyolysis is the key to successful treatment. A metabolic myopathy such as CPT II deficiency should be suspected in children affected by rhabdomyolysis if trauma, crash, infections, drugs or extreme exertion can be excluded.
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Minerva anestesiologica · May 2008
Randomized Controlled Trial Comparative StudyEfficacy of propofol compared to midazolam as an intravenous premedication agent.
It is common practice to administer a premedication to patients about to undergo anesthesia. This study compared the effects of a small intravenous bolus of propofol versus midazolam administered as a premedication. ⋯ Propofol may be an economical and safe alternative to midazolam for i.v. premedication.
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An early diagnosis of sepsis prior to the onset of clinical decline is of particular interest to health practitioners because this information increases the possibilities for early and specific treatment of this life threatening condition. In comparison to acute myocardial infarction or ischemic stroke, the time to initiate therapy is thought to be crucial and the major determining factor for surviving sepsis. The treatment of severe sepsis and septic shock consists of source control, early antimicrobial therapy, and supportive and adjunctive therapies. ⋯ However, implementing new medical advances in the management of sepsis into daily clinical intensive care remains a major hurdle. High quality management tools are necessary to bring evidence-based therapy to the bedside. With respect to recently published studies, the importance of the time taken to improve the outcome of sepsis can not be overemphasized.
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Minerva anestesiologica · Apr 2008
ReviewFunctional hemodynamic monitoring and dynamic indices of fluid responsiveness.
Knowing whether or not a fluid infusion can improve cardiac output (fluid responsiveness) is crucial when treating hemodynamically unstable patients. Generally, cardiac filling pressures (central venous pressure, pulmonary artery occlusion [''wedge''] pressure) and volumes (end-diastolic left and right ventricular volume) are used, although they are not reliable predictors of fluid responsiveness. For this reason, new indices, the so-called dynamic indices of fluid responsiveness, have been recently introduced in clinical use. ⋯ Among them, variation of cardiac output induced by passive leg raising (PLR) has raised particular interest since it can identify fluid responders even among spontaneously breathing and non-sinus rhythm patients. Although promising, the dynamic indices of fluid responsiveness have been studied only retrospectively in a relatively small number of patients and evidence that clinical use of these indices can improve outcome is still limited. Further investigations are needed to confirm their clinical validity.