Masui. The Japanese journal of anesthesiology
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Hyperglycemia is common in critically ill patients with approximately 90% of patients treated in an intensive care unit (ICU) developing blood glucose concentrations greater than 110 mg x dl(-1). Recently the international multicentre NICE-SUGAR study reported increased mortality with adopting intensive glucose control for critically ill patients and recent meta-analyses do not support this approach. ⋯ Unresolved issues include whether increased blood glucose variability is inherently harmful and whether even moderate hypoglycemia can be tolerated in the quest for tighter blood glucose control. Until another level I evidence will be available, clinicians would be well advised to hasten slowly and abide by the age-old adage to "first, do no harm".
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Bad anesthesia management easily causes mal-temperature situation. Main consequence of it is hypothermia as defined core temperature less than 36 degrees C and the other one is hyperthermia. ⋯ Other than that, hypothermia may provoke many complications after surgery including higher rate of wound infection, longer duration of hospitalization, more morbid cardiac events, prolongation of drug effects, more postoperative shivering, and delayed post anesthetic recovery. This review article discusses the mal-temperature management during surgery.
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To prevent catheter-related bloodstream infections (CRBSI), the use of maximal sterile barrier precautions (MSBP) during central venous catheter insertion, using a cap, mask, sterile gown, sterile gloves, and a large sterile sheet, was recommended in the Centers for Disease Control and Prevention Guidelines. However, this recommendation is based on the evidence obtained by only one randomized controlled trial (RCT) in which the subject patients were outpatients for chemotherapy. Nevertheless, the recommendation is applied to any kind of clinical settings. ⋯ There were 5 out of 211 cases (2.4%) of CRBSI in the MSBP group and 6 out of 213 cases (2.8%) in the SSBP group (P = 0.77). These results suggest that further RCTs should be necessary in many clinical settings to reach a conclusion on this issue. We also address other evidences regarding prevention of CRBSI in this review.
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Recently, rigid indirect laryngoscopes with integrated tube guidance such as Pentax-AWS (AWS) and Airtraq (ATQ) are clinically available. They are known to improve the laryngeal view and facilitate intubation compared to the Macintosh laryngoscope (MAC). However, whether these new devices are easy to learn for novice laryngoscopists is not well understood. We surveyed medical students regarding their usefulness in intubation procedure on mannequin. ⋯ With minimal instruction including practice, the AWS seemed to achieve safer intubation with better laryngeal view for novice laryngoscopists.
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Acute Respiratory Distress Syndrome (ARDS) is a life threatening condition. There are several randomized placebo controlled trials (RCT) that tested ventilated and non-ventilated patient managements. Among them, only ARMA trial that compared mortality and ventilator free-days between low tidal volume ventilation and conventional ventilation (6 and 12 ml x kg(-1) predicted body weight, respectively) showed differences (31.0% vs., 39.8%, P = 0.007 and 12 +/- 11 vs. 10 +/- 11 days, P = 0.007, respectively). ⋯ Methylprednisolone iv administration starting between 7 and 13 days of the onset of ARDS increased the number of ventilator-free days and shock-free days; whereas, methylprednisolone treatment starting more than two weeks after the onset of ARDS increased the risk of death. There are no RCTs that positively showed the improvement in mortality by using any therapeutic agent. Based on basic science studies, molecules that enhance epithelial and endothelial cell proliferation and the therapies targeting on septic pathophysiology would be the target for future strategies.