499 research outputs found
Studio sperimentale di fase IV monocentrico randomizzato in doppio cieco di confronto tra ketamina e remifentanil per l'analgosedazione di pazienti ventilati invasivamente in terapia intensiva
No full textAlthough in the literature there are many studies comparing the efficacy of different regimens of analgo-sedation in the Intensive Care Unit (ICU), more studies are needed to directly compare ketamine versus remifentanil in terms of its ability to effectively sedate and control pain in mechanically ventilated critically-ill patients. Remifentanil, which belongs to the opioid family of drugs, is routinely used in continuous infusion in the operating room (OR) and ICU. Ketamine, a NMDA-receptor antagonist, is used more often in the OR to provide pain relief while its use is not widespread in the ICU setting as remifentanil. Ketamine is mainly given as a bolus injection, while there are no data focusing on ketamine in continuous infusion/Targeted Controlled Infusion (TCI).It does not belong to the opioid family of drugs and thus does not act mainly on the mu-receptors, its action is free of many undesired effects that are typical of prolonged opioid administration, such as: cardiovascular depression, intestinal paralysis, nausea, pruritus, tolerance and withdrawal syndromes. Moreover ketamine may have a role in decreasing the incidence of delirium and depression after long periods of ICU stay. These are the reasons why we would like to investigate the effectiveness of ketamine in continuous infusion to provide at least the same quality level of analgosedation as another routinely used analgo-sedative drug - remifentanil - in mechanically ventilated critically ill patients. We expect ketamine not to be inferior to remifentanil in providing adequate sedation and analgesia. At the same time, we hope to show a decreased incidence of cardiovascular depression with a subsequent reduced need for use of cathecolamines, lower rates of intestinal paralysis, nausea, pruritus, tolerance, withdrawal syndromes, delirium and depression in patients treated with ketamine in comparison to patients treated with remifentanil.
To avoid adverse emergence reactions such as psychomotor agitation and visual and tactile disturbances when ketamine or remifentanil are discontinued in our protocol we made sure that the administration of both drugs is simultaneous with that of propofol in continuous infusion at any time
Le parole in cucina. Storia di parole e gastronomia
No full textPare quasi infinito il numero dei termini che caratterizzano una sfera fondamentale dell’essere umano come l’alimentazione. Pratica certo utile e necessaria, di recente sempre più ai confini col dilettevole. Un vocabolario immenso e in continua evoluzione non solo per l’affacciarsi di cibi e piatti esotici, ma anche per la riscoperta di parole rimaste a lungo confinate in cucine locali, o addirittura in ambito familiare nella nostra lunga tradizione alimentare che pesca talora oltre l’antica Grecia.
Molti sono i nomi legati al cibo che portano con sé un’antica storia, costellata da diversificazioni, specializzazioni e contaminazioni. Ripercorrerne la nascita e lo sviluppo ci aiuta a meglio comprendere la direzione di una parte dell’agire umano nel tempo, e a scoprire che alcune di queste parole sono indelebilmente scritte in un altro vocabolario, quello di un lessico familiare che attiene più alla sfera emotiva personale che a un vocabolario gastronomico
Multidrug-resistant organisms in lung transplant: a narrative review
No full textPurpose of review: The purpose of this narrative review is presenting the current knowledge of multidrug-resistant (MDR) pathogens in lung transplant recipients, considering both Gram-positive and Gram-negative bacteria. Recent findings: Overall prevalence of Gram-negative pathogens has increased remarkably (4.33/1000 recipient-days) in solid organ transplant recipients, while the prevalence of Gram-positive bacteria seems to be decreasing (0.20 cases/100 transplant-years). In lung transplant, the prevalence of postoperative infections due to MDR-GN bacteria has been assessed between 31 and 57%, and the incidence of carbapenem-resistant Enterobacterales is between 0.4 and 20%, with a related mortality up to 70%. MDR Pseudomonas aeruginosa is common in lung transplant recipients with cystic fibrosis and may contribute to bronchiolitis obliterans syndrome. The prevalence of MDR Gram-positive bacteria is around 30% (predominantly Methicillin-resistant Staphylococcus aureus and Coagulase-negative staphylococcus). Summary: Survival after lung transplant, although lower than in other SOT, is increasing and currently at 60% at 5 years. This review highlights the potential clinical and social burden of postoperative infections in lung transplant recipients, and confirmed that a PI due to MDR bacteria negatively affects survival. A prompt diagnosis, prevention and management of these MDR pathogens should remain the cornerstone for higher goals of care
The impact of psychophysiological well being on executive functions among anaesthesia residents
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Methodological Standards for Conducting High-Quality Systematic Reviews
No full textSystematic reviews are a cornerstone of evidence-based research, providing comprehensive summaries of existing studies to answer specific research questions. This article offers a detailed guide to conducting high-quality systematic reviews in biology, health and social sciences. It outlines key steps, including developing and registering a protocol, designing comprehensive search strategies, and selecting studies through a screening process. The article emphasizes the importance of accurate data extraction and the use of validated tools to assess the risk of bias across different study designs. Both meta-analysis (quantitative approach) and narrative synthesis (qualitative approach) are discussed in detail. The guide also highlights the use of frameworks, such as GRADE, to assess the certainty of evidence and provides recommendations for clear and transparent reporting in line with the PRISMA 2020 guidelines. This paper aims to adapt and translate evidence-based review principles, commonly applied in clinical research, into the context of biological sciences. By highlighting domain-specific methodologies, challenges, and resources, we provide tailored guidance for researchers in ecology, molecular biology, evolutionary biology, and related fields in order to conduct transparent and reproducible evidence syntheses
Benchmarking Scientific Productivity in Anesthesia: A Career-Adjusted Nomogram of the H-Index
No full textHigh-frequency percussive ventilation: a new strategy for separation from extracorporeal membrane oxygenation
No full textStretching stenoses of the external auditory canal: a report of four cases and brief review of the literature
No full textAcquired stenosis of the external auditory canal may be caused by a variety of insults, all sharing a common pathogenesis, namely a cascade of inflammatory changes leading to medial canal fibrosis. Previous surgery (canaloplasty or meatoplasty) and radiotherapy, especially if associated with a history of parotid surgery extended to the external auditory canal, have been implicated as possible causes. The literature offers advice on the management of stenosis consequent to otosurgery for congenital and acquired defects, but nothing on forms secondary to radiotherapy to the head and neck region. The proposed solutions are often cumbersome and difficult to fabricate, and therefore expensive. The aim of this paper, in which the cases of four patients are reported, is to present a new technique initially used for the most severe form - i.e. external auditory canal stenosis after surgery and radiotherapy - and then extended to forms due to different causes. This new technique involves the use of a series of surgical steel tubes of increasing dimension commonly used for tissue expansion in a body piercing practice called stretching and known as ear stretching tunnels or ear stretchers. This innovative approach proved effective in solving external auditory canal stenosis in our patients, with the least discomfort for the patient and the lowest cost. We consider this new solution to be feasible and practical and are convinced that it provides a new approach to an old problem. Further studies are needed to increase the number of clinical cases to verify how long the ear stretcher should be kept in place for the stenosis to stabilise, and to establish whether surgery is always necessary after ear stretcher application and, if so, the best timing for surgery
Authorship trends in systematic reviews: a 30-year analysis in anaesthesia and pain medicine
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