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Mădălina Duţu, Robert Ivascu, Darius Morlova, Alina Stanca, Dan Corneci and Silvius Negoita

Abstract

Sedation and analgesia may be need­ed for many interventional or diagnostic proce­dures, whose number has grown exponentially lately. The American Society of Anesthesiolo­gists introduced the term “procedural sedation and analgesia” (PSA) and clarified the termi­nology, moderate sedation and Monitored An­esthesia Care. This review tries to present a nondissociative sedation classification, follow­ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, pa­tient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.

Open access

Tiberiu Bratu, Anca Dinu, Mihai Sandesc, Sonia Elena Popovici, Razvan Gabriel Dragoi, Amaricai Elena and Dorel Sandesc

Abstract

With time, medical and pharmaceutical research has advanced significantly. However, one of the major issues is how to administer the active substance. Among these, it counts over- or under-dosage of the active substance, low re­sponse to treatment, or increased clinical risk of the patient. An innovative method able to avoid these obstacles is represented by controlled release systems for active substances. The interest for these systems came with allowing encapsulation in the antibiotic release matrices, local anesthetics, protein or other substances. Moreover, a number of such vehicles are now available to release controlled substances used predominantly in the anesthesia and intensive care unit.

Open access

Alida Moise

Abstract

Vitamin D - „the sunshine vitamin” is essential for the good functioning of the human body. The most important forms of the vitamin D are the vitamin D2 and the vitamin D3, both biologically inactived. Vitamin D can come from: diet or nutritiv suplimentts and skin. The activation of vitamin D is effect in two steps to the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D]. The biological actions of Vitamin D involve regulation of gene expression at the transcriptional level and are mediated through binding to a Vitamin D Receptor (VDR). Vitamin D has multiple roles: hormonale/ nonhormonale, skeletale/nonscheletale, genomice/nongenomice. Interesting is inversely corelation between Vitamin D and total body fat (BMI) and correlation between Vitamin D and cognitive impairment, especially Alzheimer Disease or delirium during hospitalisation. The curent recomandations regarding the supplying with Vitamin D are different for regions of the globe, also differ depending on the baseline serum Vitamin D and on the desired effect. So, potential nonskeletal effects occur at levels >30ng/ml, above 50-75ng/ml, serum level who should become the target of the supplementation. The loading dose should be considered perioperatively for rapid effects. In conclusion, Vitamin D is more than just a vitamin. It is a substance with multiple roles in body’s economy, and in recent years there has been an interest in the relation be tween vitamin D deficiency and obesity or cognitive impairment. The majority of the data supports association, not causation, of low vitamin D levels. In other words, much of data does not clearly support the idea that vitamin D supplementation in a patient with low vitamin D levels reduces the risk of these diseases. But, the supplimentation is very easy and no harm might be done.

Open access

Emanuel Moisă, Silvius Negoiţă and Dan Corneci

Abstract

Erythrocyte rheology is of interest in understanding microcirculation and oxygen delivery and consumption alterations induced by sepsis and septic shock. Several mechanisms are proposed: (i) direct or indirect RBC membrane alterations, (ii) abnormal intraerythrocytic homeostasis, (iii) RBCs interaction with other cells and extracellular molecules, (iiii) increased reactive species production and altered redox homeostasis. In this review, we describe in part these mechanisms and what’s the impact of these hemorheological disturbances on the outcome and mortality rate. Also, we outline the possible therapeutic interventions and further perspectives regarding sepsis and septic shock management.

Open access

Ioana M. Ciuca and Elena Margau

Open access

Ioana Mihaiela Ciuca, Liviu Laurentiu Pop, Alexandru Florin Rogobete, Monica Marc, Liviu Athos Tamas and Florin George Horhat

Abstract

Background: Pulmonary infectious inflammation is a major cause of decline in lung function in patients with cystic fibrosis (CF) marked by exacerbations, consequently, slowing evolution of lung disease is a primary aim in CF management. The objective of the study was to analyze the microbiological spectrum from epidemiological point of view in our patients. Methods: An observational, cross-sectional transversal study including fifty-seven patients evaluated the prevalence of CF-related microbes in the study group and their pulmonary status. Results: The most frequent microorganism found in our group, regardless age, was Staphyloccocus aureus, closely followed by Pseudomonas aeruginosa. Bacillus tuberculosis was a rare germ, despite the important frequency in our country. The microbes frequency was different with age groups, thus 3.5% of 1-3 years old children had the methicillin sen sitive Staphylococcus aureus (MSSA) strain, while for the 6-12 years group, Pseudomonas aeruginosa was found in an equal percentage of 14% with MSSA. Pseudomonas prevalence was found in 14.0% of adults and the combined infections were diagnosed in about a fifth of our patients. Conclusions: We concluded that the percentage of respiratory infections with redoubtable microbes is relatively moderate. The presence of underweight among CF patients with severe mutations are risk factor for a worse outcome and measures should be instituted.

Open access

María Bermúdez López, Álvaro Gasalla Cadórniga, José Manuel López González, Enrique Domínguez Suárez, Carlos López Carballo and Francisco Pardo Sobrino

Abstract

The erector spinae plane block is a novel ultrasound-guided technique that has recently been described for the management of acute and chronic thoracic pain. Currently an increasingly number of indications for the ESP block have been published. Nevertheless, the anatomy, mechanism of action, doses and volume of local anesthetic needed are still unclear. The aim of this narrative review is study this new block with base on the updated medical literature.