Minerva anestesiologica
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Minerva anestesiologica · Jun 2005
ReviewNeurologic deficit after peripheral nerve block: what to do?
Regional nerve injury is a recognized complication of plexus anesthesia. Nerve damage after regional anesthesia is the most frightening complication for the patient, the anesthetist and the surgeon too. ⋯ The principles to avoid anesthetic-related nerve damage during regional anesthesia are given. Finally treatment and surveillance, after nerve damage has occurred, are explained.
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Patients with chronic airflow obstruction and difficult weaning from mechanical ventilation are at increased risk for intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Non-invasive positive-pressure ventilation (NPPV) may revert most of the pathophysiologic mechanisms associated with weaning failure in these patients. Several randomised controlled trials have shown that the use of NPPV in order to advance extubation in difficult to wean patients can result in reduced periods of endotracheal intubation, complication rates and survival. ⋯ In addition the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. It remains to be seen whether NPPV has a role in other patients' groups and situations. The technique is however a usual addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.
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Protein C (PC) is a plasma glycoprotein implicated in modulating coagulation and inflammation. Its levels decrease in sepsis and related diseases, where it has also proved to be a prognostic indicator of outcome. Infusion of exogenous PC, although not able to decrease mortality in severe sepsis and septic shock, can safely resolve the coagulation imbalances related to these pathological states. ⋯ Although PC is included in guidelines for management of severe sepsis and septic shock, only 38%, of observed patients received PC treatment. Even in the treated group, patients received a lower dosage of PC, and for a shorter period, than recommended. In accordance to previous studies, we did not observe differences in mortality between treated and untreated patients. Our results showed a significant increase in plasma PC activity, following infusion of PC concentrate. This increase in PC appeared sufficient to restore some, but not all, of the abnormalities in the coagulation system. A large randomized, phase 3, placebo-controlled trial in children with severe sepsis and septic shock is advisable to establish effective role of therapy with PC in reducing mortality of these patients.
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Minerva anestesiologica · May 2005
Randomized Controlled Trial Clinical TrialEffect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site.
The purpose of this prospective, randomized, controlled study was the comparison of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) vs control precautions (mask, cap, sterile gloves, small drape) and of transparent polyurethan film vs gauze dressing for use on central venous (CVC) nontunneled catheters, inserted via the jugular vein. Skin colonization at the insertion site (defined by quantitative skin cultures performed at the time of insertion and in days 2 and 5) was used as a primary endpoint. Catheter tip colonization was also assessed through qualitative culture and CVC related sepsis was defined by the isolation of the same organism from the catheter tip and the blood, with clinical sepsis of no other apparent source. ⋯ Maximal sterile barrier proved to be an effective and recommended practice. However surveillance skin cultures revealed the common and changing nature of colonization of skin at the insertion site.
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Minerva anestesiologica · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialDesflurane and sevoflurane in elderly patients during general anesthesia: a double blind comparison.
To investigate pulmonary wash-out of sevoflurane and desflurane and the quality of recovery from anesthesia in elderly patients. ⋯ Patients receiving desflurane reported faster recovery from anesthesia but an earlier and more intense perception of pain after surgery.