Minerva anestesiologica
-
Minerva anestesiologica · Jan 2020
ReviewHyperoxia and oxidative stress in anesthesia and critical care medicine.
Oxygen administration is particularly relevant in patients undergoing surgery under general anesthesia and in those who suffer from acute or critical illness. Nevertheless, excess O2, or hyperoxia, is also known to be harmful. Toxicity arises from the enhanced formation of reactive oxygen species (ROS) that, exceeding the antioxidant defense, may generate oxidative stress. ⋯ To this purpose, we searched the PubMed database according to the following combination of key words: ("hyperoxia" OR "FiO2" OR "oxygen therapy") AND ("oxidative stress" OR "ROS" OR "RNS" OR "lipid peroxidation") AND ("anesthesia" OR "surgery" OR "intensive care"). We focused in the results from the past 20 years. Available evidence points toward a conservative monitoring and use of oxygen, unless there is solid proof of its efficacy.
-
Minerva anestesiologica · Dec 2019
ReviewClinical guidelines for perioperative hemodynamic management of non cardiac surgical adult patients.
Perioperative hemodynamic management, through monitoring and intervention on physiological parameters to improve cardiac output and oxygen delivery (goal-directed therapy, GDT), may improve outcome. However, an Italian survey has revealed that hemodynamic protocols are applied by only 29.1% of anesthesiologists. Aim of this paper is to provide clinical guidelines for a rationale use of perioperative hemodynamic management in non cardiac surgical adult patients, oriented for Italy and updated with most recent studies. ⋯ Fluid strategy should aim to a near zero balance in normovolemic patients at the beginning of surgery, and a slight positive fluid balance may be allowed to protect renal function. Drugs such as inotropes, vasocostrictors, and vasodilatator should be used only when fluids alone are not sufficient to optimize hemodynamics. Perioperative GDT protocols are associated with a reduction in costs, although no economic study has been performed in Italy.
-
Minerva anestesiologica · Dec 2019
ReviewIntranasal dexmedetomidine in pediatrics: update of current knowledge.
Intranasal dexmedetomidine, although still off-label, recently boasted an increasing consensus for different uses, namely, in diagnostic non-painful procedures, in painful procedures and in surgical premedication. However, at present, there is no consensus regarding indications, dosage and timing for administration. ⋯ In summary, available pediatric evidence confirms efficacy and safety of dexmedetomidine for intranasal administration. Pharmacological profile for the various pediatric ages and procedures still needs quality studies and pharmacokinetic in-depth analysis.
-
Minerva anestesiologica · Dec 2019
Review Comparative StudyComparison between thromboelastography and thromboelastometry.
Two of the most commonly used viscoelastic hemostatic assays, thromboelastometry (ROTEM) and thrombelastography (TEG), have proven to decrease allogenic blood transfusions with cost reduction and possibly decrease mortality and morbidity in cardiac, trauma, and other bleeding patients. This article compares the two devices to provide guidance on the selection and use of these monitoring systems. Their second-generation assays, TEG 6S and ROTEM Sigma, are also discussed.
-
Minerva anestesiologica · Nov 2019
Meta AnalysisSystematic review and meta-analysis of single injection fascia iliaca blocks in the peri-operative management of patients with hip fractures.
The aim of the study was to determine the analgesic efficacy and safety profile of single injection fascia iliaca compartment block (FICB) performed peri-operatively for isolated hip fractures. ⋯ FICB is effective in controlling acute peri-operative pain in adult patients with traumatic hip fractures. The benefit is more evident during mobilization of the limb when compared to patients at rest.