Minerva anestesiologica
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Minerva anestesiologica · Apr 2002
Principles, protocols and patients: the practical management of a limit in ICU.
The definition and management of a limit is a common but sometimes extremely complex problem in the Intensive Care Unit (ICU). Guidelines and consensus documents have been published in order to help clinicians. ⋯ In this sense, the practical management of a limit in ICU is usually run by a dual normativity: an external one, which derives from the cultural, moral and legal values of the society, and an internal one, which depends on the particular clinical and human situation, namely the values of everybody involved in (the patient, his/her relatives, the health staff) and the relationships among these people. The considerable freedom left for the decision by an open communication is a great and favourable potential which must be used in the interest of the patient's and of his/her family.
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The new OxiMax Pulse Oximetry System includes the Nellcor N-595 Pulse Oximeter and a new line of OxiMax sensor. The main feature of this platform is the digital memory chip inserted within each OxiMax sensor that contains all the calibration and operating characteristics for that individual sensor. It allows an information exchange between the sensor and the monitor improving monitoring performance during difficult acquisition periods. We reviewed several studies showing that the more centrally placed forehead sensor can offer significant advantage over finger sensor when monitoring patient with low pulse perfusion, especially in situation where rapid detection of hypoxemia is critical.
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Percutaneous radial artery catheterization for blood gas monitoring and continuous arterial pressure recording has become a common procedure in the management of patient undergoing cardiac surgery operations. Since radial artery pressure does not accurately reflect central aortic pressure, in the immediate post bypass period and in low cardiac output states, specially during catecholamine infusion, a long arterial line is necessary. The author has been using several techniques of central arterial cannulation from 1980 to 2002 in 6303 procedures using central radial artery, including 734 patients with Length of Stay (LOS) >96 h, and 1880 patients with Seldinger Technique, using polyurethane Arrow catheter 16 G 50 cm. The use of long radial catheter has been recently associated, for the control pulse analysis, with Picco technology successfully in 74 patients undergoing cardiac and vascular surgery operations, having no complication. The author referred on the clinical aspect connected with the use of central radial catheter with special emphasis on safety of the procedure. a) Large retrospective review on the use of long arterial catheter (6303), including prospective (50 patients) Trial of consecutive unrandomized patients. b) ⋯ Cardiac surgery end vascular department in a large over 1000 beds and 4 Hospitals Administration (the study has been limited to cardiac surgery unit).
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Minerva anestesiologica · Mar 2002
Review Comparative StudyNew antidepressants in the treatment of neuropathic pain. A review.
Before 1980s, tricyclics (TCAs) were considered, between antidepressants, the standard in the treatment of different kinds of neuropathic pain, for their action on noradrenergic and serotoninergic pathways, thought the high incidence of side effects. In 1980s a new class of antidepressants has been introduced, the selective serotonin reuptake inhibitors (SSRI). We reviewed some publications, including trials comparing SSRIs with TCAs in pain management. ⋯ The other new antidepressants have been less extensively studied, thus only anecdotal therapeutic results and experimental works have been found and reported. Existing data are surely insufficient to conclude which of these new classes of drugs has the best clinical profile and can be more effective in the treatment of neuropathic pain, but the lower incidence of side effects should be considered. Further evidence-based research in the safety and efficacy of these promising agents in pain relief, is warranted.