Minerva anestesiologica
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Minerva anestesiologica · Jan 2003
ReviewCritical points for sepsis management at the patient bedside.
Following an interpretative philosophy, dyna-mic and faithful to the complexity theory, a clinical pathway is outlined close to the reality, at the patient bedside, that is comprehensive of the diagnostic process in its temporal dynamism, of the therapeutic process in its specificity (antibiotic therapy, surgical souce control), in the use of organs supportive therapy (haemodynamic, respiratory, renal, etc.) and in the use of adjunctive and immunomodulatory therapies (APC, AT, etc.). The importance of the contextual activation of microbiological, immunological and coagulative monitorings is underlined. Through a critical review of the more recent literature, a strict relationship, in sepsis and septic shock, between inflammation and coagulation is described, that allowed the activated protein C (drotrecogin alpha activated) success, in terms of reduction of the absolute and relative mortality. ⋯ Once systemic inflammation is complicated by organ failure, there are few options. Treatment with activated protein C lowers the risk of death but is associated with an increased risk of bleeding and is likely to be expensive. The strategies described by the groups of Rivers and Annane offer the opportunity for good therapeutic results, by preventing the progression or even the development of sepsis and its complications: septic shock and multiple organ dysfunction.
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Minerva anestesiologica · Jan 2003
Comparative Study Clinical TrialRelationship between MPQ and VAS in 962 patients. A rationale for their use.
1) To analyse the information provided both by the Visual Analogue Scale (VAS) and by the McGill Pain Questionnaire (MPQ) in a cross-sectional study with patients affected by different kinds of pain and to study the relationship between VAS and MPQ scores in the same patient sample. ⋯ Several differences emerged among the pain groups. VAS and MPQ resulted to address pain aspects only partially overlapping. In some clinical conditions (headache and cancer) the MPQ can provide more detailed and clinically useful information about patients' pain experience.
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Minerva anestesiologica · Dec 2002
ReviewShould disclosure of the danger of awareness during general anesthesia be a part of preanesthesia consent?
Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a series of untoward effects, among them symptoms compatible with the posttraumatic stress syndrome (PTSS). Incidence of AGA ranges between 0.1% and 0.7%, most of the reports indicating a 0.2% rate of all general anesthesias. Nevertheless, some patients are considered to be in a higher than usual risk for developing this incident. ⋯ This paper rises the question of the indication to discuss the AGA matter, as part of the informed consent, with any patient who is prone develop it in a significant higher percentage than the general population. The topic can be discussed by the primary care physician or by the surgeon, but this represents the obvious task of the anesthesiologist during his/her first contact with the patient before anesthesia and surgery. It is the authors belief that a preoperative discussion on AGA might substantially reduce the magnitude of repercussions of AGA among high-risk patients to develop this anesthetic complication.
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This study examines the quality of patients' informed consent in patients undergoing minor surgical procedure. Information provided on risks and complications inherent in anaesthesia-care and patients' awareness of specific risks involved in anaesthesia were recorded, and the influence of a questionnaire-form was evaluated. ⋯ Our results indicate that most patients are glad to be informed, even if they are unaware of the risks and complications of anaesthesia. The questionnaire form seems to be an important tool for patient education. Ethical questions are proposed.