Minerva chirurgica
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Review Randomized Controlled Trial Multicenter Study Clinical Trial
[Recombinant activated Factor VII (Novo Seven) for uncontrollable hemorrhage in critically ill patients with multiple injuries].
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The possibility of carrying out surgery in day-surgery (DS) conditions is gradually becoming reality in most branches of surgery; in recent years, DS has also found a place in general surgery, with unquestionable advantages for the management of patients, particularly the elderly. The purpose of the present study is to investigate general surgery needs in DS conditions in elderly patients in order to analyse the clinical-administrative feasibility of DS procedure and the level of its acceptability in this group of patients. ⋯ Willingness to undergo DS by elderly patients is mainly influenced by three factors: educational qualification, working activity and possibility to have home assistance from someone in the relational entourage; these parameters can be considered veritable selection criteria for DS in the elderly. The quality improvement in assistance levels and the introduction in the near future of telematic communication system could lead to an extension of DS indications to the elderly.
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Epidural analgesia is one of the most effective regimens for postoperative pain relief after abdominal surgery. The use of epidural analgesia in high risk patients has been associated with significant decrease in surgical stress response, in cardiac and pulmonary morbidity, in recovery of gastrointestinal function and in thromboembolic events. The aim of this paper is to describe pain relief, side effects and recovery of gastrointestinal function during epidural analgesia. ⋯ Continuous epidural analgesia resulted in good pain relief, provided the best balance of analgesia and side effects and improved postoperative outcome.
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Ward nurses have a central role in postoperative pain management. Pain medication is prescribed by anesthetists and surgeons, but it is ward nurses who spend more time with patients and have the responsibility for assessing patient's pain intensity, administering some prescribed analgesic treatments and monitoring their efficacy. ⋯ There is increasing interest in establishing close cooperation and partecipation of ward nurses in day- to- day management of pain. In conclusion the quality of care provided by ward nurses is an important factor for the quality of patients' postoperative care, and nursing staff should be given the support they need to effectively treat pain.
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Patient controlled analgesia (PCA) helps patients to achieve a better comfort both at rest and when dynamic pain is concerned. This aim can be reached by closing the feedback loop in a shorter time. The purpose is to keep drug concentration in the narrow therapeutic range of MEAC (minimal effective analgesic concentration). ⋯ An effective and safe dose delivering and a correct infusion timing is now possible due to recent improvement in technology. The success in PCA depends more by parameters chosen, patient and healthcare personnel compliance, monitoring of S(p)O(2), respiratory rate, pain VAS and Sedation Score than by the drug administered. There is recent evidence that PCA improves patient's comfort, but does not reduce the amount of personnel work, postoperative morbidity, analgesic consumption and costs.