Minerva anestesiologica
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Direct costs of critical care are increasing more than in other health care sectors. Tools are needed to evaluate adequacy of ICU admission in order to have a proper allocation of ICU resources. ⋯ Despite the difficulties imposed by he rigid nurses' work organization in Italy, a daily data collection about level of care, severity of illness, workload utilization could provide, together with standard administrative indexes, the necessary framework to assess and to improve adequacy of ICU admission.
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Minerva anestesiologica · Apr 2002
Guideline[The SIAARTI document in preparation: recommendations on admission and discharge from intensive care units and on limits of treatments in intensive care].
The document in progress is intended to help the health care professionals in bioethical decision-making process in ICU. It will be probably written as Recommendations because it is a conceptual framework for making decision about intensive care, consensually derived from an Ad Hoc Sub-Committee of SIAARTI Ethics Committee. ⋯ These guidelines do not relieve health care professionals involved from their personal responsibility for decisions and action taken in individual cases. These guidelines are in line with the general ethical principles for the care of critically ill patients as formulated, as examples, in the following declarations and deontological codes: Declaration of Helsinki, Ethical Principles in Intensive Care (World Federation of Society of Intensive and Critical Care Medicine), Italian Medical Association's Deontological Code (3/10/98), European Convention of Bioethics Oviedo and in many others international consensus statements and guidelines.
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Since acupuncture provides analgesia it might be expected to reduce the need for conventional anaesthetic drugs during general anaesthesia. In this review we discuss four double blind, placebo controlled studies evaluating acupunture's ability to reduce analgesic or anesthetic requirement. Three studies (from Greif et al., Morioka et al. and Taguchi et al.) examined whether transcutaneous electrical stimulation of some acupuncture points reduces anaesthetic requirement. Kotani et al. tested the hypothesis that preoperative insertion of intradermal needles in the bladder meridian reduces postoperative pain and oppioid requirement. ⋯ none of the first three studies showed that the stimulation of the acupoints produces clinically important reductions in anaesthetic requirement. In contrast, Kotani et al. showed that at least some acupuncture techniques provide substantial postoperative analgesia and significantly reduce opioid requirement.
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In Italy (130,000 new strokes in the general population per year) ischemic stroke is the third cause of death, after cardiovascular disease and neoplastic disease with a prevalence of 6.5%. Different physicians are involved in the emergent evaluation and treatment of the acute ischemic stroke. As other acute events, the initial evaluation must be addressed to assess the patient's airway and breath-ing and cardiocirculatory conditions. ⋯ The goal is to achieve and to maintain an adequate cerebral perfusion by lowering the intracranial pressure (treating the cerebral oedema) and by increasing the mean arterial pressure, with an appropriate volemic expansion and/or with inotropic or vasopressor drugs. The thrombolytic therapy with intravenous recombinant tessutal plasminogen activator (r-TPA) when not specifically contraindicated, is recommended within 3 hours of onset of ischemic stroke. The benefit of intravenous r-TPA for acute ischemic stroke beyond 3 hours from the onset has never been proved.
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Over the past 15 years, there have been dramatic changes in the management of blunt hepatic trauma, specifically in the imaging techniques, and in the non-operative management. Actually, in more than 80% of blunt hepatic trauma, non operative management is used. In the last 20% the surgical option has to be taken without delay, sometimes in extreme emergency, using the adapted surgical techniques. In this article the author describes the nonoperative management of blunt hepatic trauma: classification, presentation, initial decision, treatment, possible complications and results.