1,721,276 research outputs found
Short acting insulin analogues in intensive care unit patients
No full textBlood glucose control in intensive care unit (ICU) pa- tients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an ad-
equate calories load and, when necessary, to continu-
ously infuse insulin titrated to patients needs: intensive insulin therapy (IIT). Short acting insulin analogues (SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter on- set and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a
Bilotta F, Guerra C, Badenes R, Lolli S, Rosa G. Short acting insulin analogues in intensive care unit patients. World J Dia- betes 2014; 5(3): 000-000 Available from: URL: http://www.
wjgnet.com/1948-9358/full/v5/i3/000.htm DOI: http://dx.doi. org/10.4239/wjd.v5.i3.000
more limited risk of inducing episodes of iatrogenic hy-
poglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and research- ers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients (i.e. , sedation and treatment of arterial hypertension) and we also de- scribe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia relate
Perioperative hyperglycemia and neurocognitive outcome after surgery: a systematic review
No full texta B
introDUction: Preliminary evidence suggest a possible relationship between perioperative
hyperglycemia, postop- erative delirium (PoD) or cognitive dysfunction (PocD). We aim to present
the available clinical evidence related to chronic (i.e. diabetes mellitus) or acute perioperative
hyperglycemia as risk factors for PoD/PocD.
eviDence acQUisition: a literature search of eMBase (via ovid, 1974-present) online medical
database and MeDline (via PubMed or ovid, 1946-present) was performed. all types of clinical
studies including randomized con- trolled trials, prospective, as well as retrospective cohort
studies were screened. clinical studies that reported original information on the relationship
between diabetes mellitus (DM) and/or acute perioperative abnormal glucose levels and PoD or PocD
were selected. reviews and editorials (i.e. articles not presenting original preclinical or
clinical research) were excluded and case-reports were not considered for analysis.
eviDence sYntHesis: our search resulted in 2356 papers for screening, from which we selected 29
studies that met our inclusion criteria. DM was investigated in 24 observational papers, acute
perioperative hyperglycemia in six obser- vational studies and two randomized controlled trials
examined the effect of perioperative glucose lowering on PoD/ PocD. Diabetes was associated with
PoD or PocD in 18/24 observational studies and 6/6 of the included observational studies found that
perioperative hyperglycemia was associated with PoD/PocD, independent of diabetes. the two ran-
domized controlled trials had a different trial design and reported conflicting results.
conclUsions: according to the available evidence, DM and acute perioperative hyperglycemia may be
associated with an increased risk for PoD/PocD. these conclusions are based mostly on observational
studies and deserve more and dedicated research. this systematic review may direct the design of
future studies.
(Cite this article as: Hermanides J, Qeva e, Preckel B, Bilotta F. Perioperative hyperglycemia and
neurocognitive outcome after surgery: a systematic review. Minerva anestesiol 2018;84:1178-88. Doi:
10.23736/s0375-9393.18.12400-X)
Key words: Hyperglycemia - cognitive dysfunction - Delirium - Diabetes mellitus - Postoperative
complications
Neuroanesthesiology: the ineludible path toward super-specialty
No full textIn the anesthesiological and critical care community,
the need for professionalism dedicated to periopera tive management of patients with neurosurgical dis eases has continuously evolved [1] since the initial
recognition, that started in the late years of the 1950.
Neuroanesthesiologist is the definition of the com petences associated with this professional
Perioperative Hydroxyethyl Starch: A Potential Threat to Patient Safety
No full textPagel et al1
surprisingly do not report that the 2013
restrictive rules for hydroxyethyl starch (HES) pre scription by the US and European regulatory agen cies (Food and Drug Administration and European Medical
Agency) are being violated to such an extent that in October
17, 2017, the European Medical Agency began an ongoing
scrutiny of HES use.2
New data provided by Pagel et al1
were collected in
patients at “low risk” for acute kidney injury and do not rule
out toxic effects of HES on renal function. They can only say
that the effect, if present, was not sufficient to require post operative renal replacement therapy. In addition, their data
provide strong and alarming evidence that the use of HES
in the perioperative setting is associated with a significant
increase in blood loss, red blood cell transfusion, intraop erative noradrenaline administration, and length of hospital
stay. All of these conditions raise substantial concerns for
patient safet
LGBTIQ People
No full textLGBTIQ is an acronym for lesbian, gay, bisexual, transsexual, intersex and queer/questioning people. Being an LGBTIQ person is not the prerequisite for acquiring a legal status, because it no longer assigns rights or new duties to those who carry these characteristics. For LGBTIQ people, the law creates the conditions to overcome the obstacles to gaining access to the rights and duties that are normally connected to the status that everyone can acquire. LGBTIQ people are taken into consideration in different ways by European law with the aim of pressuring all the EU Member States to provide more protection for them
Propofol versus thiopental use in patients undergoing craniotomy
No full textnesthesiologists have long searched for the optimal anesthetic technique for patients undergoing craniotomy.1, 2 Thiopental was considered to be beneficial for neurosurgical patients because it preserves autoregulation of cerebral blood flow (CBF) and decreases in- tracranial pressure (ICP) by reducing cerebral metabolic oxygen consumption and CBF.3 Newer hypnotic agents like propofol have similar effects on CBF and ICP and a shorter context-sensitive half-life and, have largely re- placed the use of thiopental despite a lack of
clinical comparative studies.
Inhaled sedation in acute brain injury patients
No full textEditor—Thanks for the chance to respond to the letter by
Badenes and Bilotta. We appreciate their interest in our article1
and fully agree that tight management of the arterial partial pres sure of carbon dioxide ðPaCO2 Þ is crucial for avoiding increases in
intracerebral pressure (ICP) resulting from hypercapnic vasodila tory effects. However, in our study increases in ICP have occurred
not only in response to PaCO2 increases, but also independently,
and at times these were fairly delayed after switching to the
anaesthetic conserving device (ACD).1 Prompt increases in ICP
are usually not expected after a more gradual increase in PaCO2 ,
but rather after sudden increases of PaCO2 , which might indeed
occur directly after switching to the ACD in the absence of com pensatory mechanism
MAGNESIUM SULFATE AND NEUROPROTECTION
No full textWe read with great interest the article from Wilkes et al. (1) report- ing that correcting ionized plasma magnesium during cardiopul- monary bypass in patients undergoing coronary artery bypass graft- ing (CABG) reduces the risk of postoperative cardiac arrhythmia. In their article, Wilkes and colleagues mention some of the systemic effects of magnesium sulfate administration and the underlying cellular mechanisms. But they fail to mention its neuroprotective effects
Is dexmedetomidine a favorable agent for cerebral hemodynamics?
No full textHemodynamic stability, with special attention to arterial
pressure in order to warrant an adequate cerebral perfusion,
is a cornerstone of neuroanesthesia (NA) and neurocritical
care (NCC) management. An abrupt elevation of arterial
blood pressure can aggravate cerebral edema or induce
cerebral hematoma, resulting in a prolonged NCC unit
stay. On the other hand, hypotension is associated with an
increased risk for cerebral ischemia that is more pronounced
when autoregulation of cerebral blood flow (CBF) is
impaired, and there is a compromised cerebral compliance.
[1,2] However, NCC encompasses subgroups of patients such
as traumatic brain injury (TBI), subarachnoid hemorrhage
(SAH), and intracerebral hemorrhage ones in whom there
is the unique need to maintain supranormal blood pressure
values with a view to ensure adequate cerebral perfusion
and to optimize outcome.[1-3] Moreover, any derangement
of cerebrovascular hemodynamics may contribute to
intracranial pressure (ICP) elevation with concomitant
cerebral perfusion pressure (CPP) deterioration, which can
further exacerbate ischemic damage.[3
- …
