Ultrasound guided regional anesthesia: What we know, what we think we know, what we don't know yet: Running title USGRA: Overview about facts and questions: An educational narrative review of literature

The introduction of ultrasound guidance over the last two decades brought progress, new blocks and new challenges to Regional Anesthesia. This narrative review addresses and discusses facts, frequent questions, beliefs, controversies, unsolved issues, open safety questions and existing knowledge gaps related to efficacy and safety of ultrasound guided regional anesthesia (USGRA), based on the available literature. We discuss evidence-based advantages and limitations of ultrasound guidance, as well as unresolved questions, with respect to successful anesthesia, undesired side effects and patient safety, like nerve injury and local anesthetic systemic toxicity (LAST). In an educational approach we also emphasize some practical aspects of our everyday experience as well as necessary structural requirements

Avoiding pitfalls in antibiotic therapy: the antibiotic stewardship approach

The aim of this reflection is to determine the effectiveness and safety of ABS interventions. A strong correlation between antibiotic overuse and the growing worldwide resistance, but also with individual side effects is well established and should open the door to a more personalized approach to anti-infective therapies. Antibiotic resistance is a global public health challenge and is recognized as a global threat to human health by national healthcare agencies, governments, medical societies and the World Health Organization (WHO). The anticipated clinical scenario of Pan- Drug – Resistant (PDR) bacteria is accelerated by antibiotic overuse. In fact, multi- drug – resistance (MDR) is already the cause of severe infections, complications, longer hospital stay and increased mortality in most of the countries. Herein, the techniques of an Antibiotic Stewardship Approach and their stepwise implementation are summarized and highlighted. There is often a general lack of understanding on how to choose the right antibiotic at the right time and in the right dose. This article discusses general principles like the best choice and use of different antibiotic classes, a better use of beta- lactams according to principles of pharmacokinetics, avoidance or limitation of unnecessary combination therapies, shorter courses of therapy without any disadvantage in infection control and the value of PCT monitoring. We hope to contribute to the promotion and implementation of these important therapeutical principles, aiming at the reduction of unnecessary or wrong antibiotic therapies and, so, at the decrease of side effects, mortality and further resistance.