Minerva anestesiologica
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Minerva anestesiologica · Sep 2024
Meta Analysis Comparative StudyRemimazolam versus propofol for endoscopy sedation in elderly patients: a systematic review, meta-analysis and trial sequential analysis.
Procedural sedation is crucial in gastrointestinal endoscopy, where propofol is commonly used but may lead to cardiovascular and respiratory side effects. Remimazolam, a new drug, offers advantages such as rapid onset and recovery. The sedation protocols for this population vary, requiring tailored titration of sedatives. The comparative safety of these drugs in elderly patients undergoing procedural sedation remains unclear, as previous studies primarily focus on the general population. We aimed to compare the safety profiles of remimazolam and propofol in this context. in elderly patients undergoing procedural sedation for gastrointestinal endoscopy. ⋯ Our findings suggest that in elderly patients having gastrointestinal endoscopy, remimazolam could be safer than propofol. This population may benefit from remimazolam's lower risk of adverse events, notably hypoxemia and respiratory depression.
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Minerva anestesiologica · Sep 2024
ReviewThe clinical value of nonpharmacological interventions for preventing postoperative delirium: a narrative review.
Postoperative delirium (POD) is a prevalent perioperative complication among elderly individuals and is a cause of significant detrimental consequences for both individuals and society. Pharmacological and nonpharmacological prevention methods/therapies have been proposed to mitigate the risk of POD. Nevertheless, the efficacy of pharmacological interventions is controversial, and some of them cause side effects. ⋯ The former is aimed at increasing cognitive reserve, thus decreasing the incidence rate of POD. Noncognitive interventions, including sensory stimuli (music therapy, odor enrichment), improving sleep disturbances, physical activity, acupuncture and transcranial magnetic/direct current stimulation, are aimed at decreasing the risk factors for POD. This review provides a comprehensive overview of recently reported nonpharmacological mono-component interventions for preventing POD and briefly describes their clinical value.
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Minerva anestesiologica · Sep 2024
ReviewHas the role of troponin as a biomarker of cardiac complications after non-cardiac surgery been fully understood?
Myocardial injury after non-cardiac surgery is a major issue with a rate of almost 20%, as suggested by the literature. Guidelines recommend screening patients undergoing non-cardiac surgery who have at least one cardiovascular risk factor. Clinical trials are characterized by a high degree of heterogeneity. ⋯ Troponin elevation can be a result of patient-related factors and comorbidities, including age, chronic renal failure, and inflammatory status. Currently, there is no effective strategy to prevent perioperative myocardial injury, and there are no therapeutic options that significantly improve the outcome of patients with myocardial injury. We have focused on this topic and on perioperative myocardial injury to highlight the areas of research that remain unexplored.
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Minerva anestesiologica · Sep 2024
Randomized Controlled Trial Comparative StudyA comparative analysis of elevated endotracheal tube cuff pressure incidence in laparoscopic abdominal surgery: saline versus air inflation.
Endotracheal intubation is a frequently performed procedure in anesthesia practice, and ensuring the correct inflation of the cuff is essential for maintaining the airway seal. Overinflation of endotracheal tube (ETT) cuffs can lead to complications, such as postoperative sore throat. This study aimed to compare the incidence of elevated ETT cuff pressure between saline and air inflation in elective laparoscopic abdominal surgery. ⋯ Inflating ETT cuffs with saline instead of air during laparoscopic abdominal surgeries led to a reduced requirement for interventions in maintaining pressure. This indicates that the use of saline inflation may significantly lower the risk of high cuff pressure and related complications.