Minerva anestesiologica
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Minerva anestesiologica · Jan 2006
ReviewStandards of care for ambulatory surgery. Are we up to speed.
Ambulatory surgeries are becoming increasingly more common in daily anesthesia practice, placing greater demands on anesthesia providers to offer timely and thorough preoperative evaluation and preparation, optimal patient and surgical selection, and efficient, safe, and timely postanesthesia care, all of which necessitate an active participation of an anesthesiologist in all aspects of the organization and coordination of perioperative management. Numerous studies over the last couple of decades have introduced various organizational models for pre-anesthesia screening, with a goal of improving patient satisfaction, controlling the cost, and decreasing surgical delays. Having recognized the importance of anesthesia selection regarding patient comfort and the duration of post-anesthesia recovery in the ambulatory setting, many anesthesiologists have focused their attention on studying various anesthesia modalities and techniques with new emphasis on preemptive interventions (e.g. preoperative antiemetics, continuous peripheral nerve blocks). Finally, a concept of bypassing traditional recovery period in the post-anesthesia recovery rooms (''fast tracking'') that had been scrutinized over the last decade has been accepted as cost effective and safe, providing adequate patient selection.
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Minerva anestesiologica · Jan 2006
Clinical TrialProcalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis.
To determine in critically ill patients the value of procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) score and white blood cell count in diagnosis and monitoring of sepsis. ⋯ PCT and CRP may be useful together with bacteriological data in sepsis diagnosis; PCT and SOFA closer correlate with the infection severity; PCT is the better parameter to estimate severity, prognosis or further course of the disease.
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Minerva anestesiologica · Dec 2005
Clinical TrialSystemic and organ dysfunction response during infusion of recombinant human activated protein C (rhAPC) in severe sepsis and septic shock.
The aim of this study was the assessment of the efficacy of recombinant human activated protein C (rhAPC) in septic patients. ⋯ RhAPC is the first biological agent approved for the treatment of severe sepsis and septic shock. Our experience is confined to patients with severe sepsis and septic shock, and some severity indexes showed a modulation of the inflammatory processes and haemostatic balance, 2 factors which play a key role in the evolution of sepsis and organ dysfunction.
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Minerva anestesiologica · Dec 2005
Randomized Controlled Trial Comparative StudySimilar preoperative hemodynamic response to pancuronium and rocuronium in high-risk cardiac surgical patients.
Rocuronium may be a good alternative to pancuronium in cardiac surgical patients. We evaluate the hemodynamic response to rocuronium and pancuronium administered to cardiac surgical patients. ⋯ Rocuronium can be a safe alternative to pancuronium for patients requiring cardiac surgical procedures.
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Adequate restoration of intravascular volume remains an important therapeutic manoeuvre in managing the surgical, medical and the critically ill intensive care patient. Definition of the ideal volume replacement strategy still remains one of the burning problems. The choice between colloid and crystalloid solutions continues to generate controversy. ⋯ New concepts about critical care such as organ perfusion and organ function, the role of inflammation, immunological aspects, and wound healing may change this point of view. Volume replacement has been hitherto often based on art, dogma and personal beliefs. Further well-performed studies in this area will help more to shed new light on the ideal volume replacement strategy of the hypovolemic patient than more meta-analyses that are pooling old-to-very old studies to solve this problem.