112 research outputs found
Open questions in the treatment of cancer pain: time for a strong evidence-based approach?
No full textPain affects patients with cancer at any stage of their disease. Yet, it is not adequately treated in a significant percentage of cases. In 1986, the WHO proposed a three-step approach for the treatment of pain in cancer patients (from nonopioids to weak opioids to strong opioids, according to pain intensity) following the recommendations of an international group of experts. The application of the WHO strategy demonstrated that a clear and simple approach is of educational value and ensured worldwide dissemination. However, there is little evidence that the WHO approach is the best, and there are still several points to debate on the treatment of cancer pain
Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis?
No full textThe challenge of perioperative pain management in opioid-tolerant patients
No full textFlaminia Coluzzi,1 Francesca Bifulco,2 Arturo Cuomo,2 Mario Dauri,3 Claudio Leonardi,4 Rita Maria Melotti,5 Silvia Natoli,3 Patrizia Romualdi,6 Gennaro Savoia,7 Antonio Corcione8 1Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesia, Intensive Care and Pain Medicine, Sapienza University of Rome, Polo Pontino, Latina, 2National Cancer Institute “G Pascale” Foundation, Unit of Anaesthesia, Intensive Care and Pain Medicine, Naples, 3Department of Clinical Science and Translational Medicine, Tor Vergata University of Rome, 4Addiction Disease Department, Local Health Unit (ASL) Rome 2, Rome, 5Department of Medical and Surgical Sciences, 6Department of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, 7Department Anesthesia, Fatebenefratelli Hospital, Naples, 8Unit of Anaesthesia and Intensive Care, Dei Colli Hospital, V. Monaldi, Naples, Italy Abstract: The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone. Keywords: opioids, postoperative pain, addiction, abusers, buprenorphine, methadone 
Diagnostic Accuracy of Procalcitonin in Bacterial Infections of the CNS: An Updated Systematic Review, Meta-Analysis, and Meta-Regression
No full textObjectives: To evaluate diagnostic accuracy of serum and cerebrospinal fluid (CSF) procalcitonin for diagnosing CNS bacterial infections. Data sources: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and International Web of Science databases from January 1, 2016, to September 30, 2022. Study selection: Randomized controlled trials and observational studies, either prospective or retrospective, focusing on procalcitonin as a biomarker for CNS infections. Data extraction: We screened and extracted studies independently and in duplicate. We assessed risk of bias using the revised Quality Assessment for Studies of Diagnostic Accuracy tool. Data for diagnostic sensitivity and specificity were pooled using the bivariate or hierarchical model, as appropriate. Data synthesis: Of 5,347 citations identified, 23 studies were included. Overall, CSF procalcitonin showed slightly higher pooled sensitivity, specificity, and positive likelihood ratio compared with serum procalcitonin. In adults, pooled sensitivity of CSF procalcitonin was 0.89 (95% CI, 0.71-0.96), specificity 0.81 (95% CI, 0.66-0.91); pooled sensitivity of serum procalcitonin was 0.82 (95% CI, 0.58-0.94), specificity 0.77 (95% CI, 0.60-0.89). In children, pooled sensitivity of CSF procalcitonin was 0.96 (95% CI, 0.88-0.99), specificity 0.91 (95% CI, 0.72-0.97); pooled sensitivity of serum procalcitonin was 0.90 (95% CI, 0.75-0.97), specificity 0.83 (95% CI, 0.67-0.92). In post-neurosurgical patients, pooled sensitivity of CSF procalcitonin was 0.82 (95% CI, 0.53-0.95), specificity 0.81 (95% CI, 0.63-0.91); pooled sensitivity of serum procalcitonin was 0.65 (95% CI, 0.33-0.88), specificity 0.61 (95% CI, 0.41-0.78). Logistic regression revealed between-study heterogeneity higher for serum than CSF procalcitonin. For the latter, threshold variability was found as source of heterogeneity. Conclusions: In children and critical post-neurosurgical patients, CSF procalcitonin gains superior sensitivity and specificity compared with serum procalcitonin. Overall, CSF procalcitonin appears to have a higher pooled positive likelihood ratio compared with serum procalcitonin
TIVA (Total intravenous anaesthesia) per interventi ORL in regime di day-surgery
No full textSono stati sottoposti a microlaringoscopia e a settoplastica in regime di day-surgery 150 pazienti ASA I-II. In tutti i pazienti è stata realizzata un'anestesia totalmeente endovenosa (TIVA) secondo il seguente schema: Propofol in modalità TCI con target plasmatico di 4-6 mcg/ml, remifentanil in infusione per un minuto alla dose di 0,4 mcg/kg/ min, seguito da infusionee continua di 0,25 mcg/kg/min. La miorisoluzione è garantita dalla somministrazione di Vecuronio 0,06 mg/kg oppure Atracurio 0,4 mg/kg. Dopo l'intubazione il target plasmatico del Propofol è ridotto a 3 mcg/ml, la VMC è realizzata con O2 e aria (2 l/min), mantenendo la normocapnia (EtCO2=30 mmHg). L'infusione del Propofolo viene interrotta secondo i tempi di interruzione del farmaco (tempo di risveglio previsto). Il Remifentanil viene sospeso al termine dell'intervento. L'anestesia totalemnte endovenosa ha garantito in tutti i casi una buona stabilità dei parametri emodinamici, con campo operator io sufficientemente esangue, una buona qualità del risveglio, brevi tempi di estubazione, assenza di nausea o vomito post-operatori, dolore postoperatorio (VAS) 0-2 per le microlaringoscopie, 1-3 per le settoplastiche. La TIVA in modalità TCI si conferma una tecnica anestesiologica particolarmente idonea ai requisiti della chirurgia ORL in day-surgery. Infatti permette di ottomizzare in consumo di Propofol modulando il livello di anestesia in relazione alle esigenze chirurgiche, con risveglio pronto e completo, dimissibilità del paziente lo stesso giorno dell'intervento, con conseguente riduzione dei cost
- …
