Minerva anestesiologica
-
Minerva anestesiologica · Feb 2018
ReviewMachine perfusion in liver transplantation - an essential treatment or just an expensive toy?
This review focuses on recent developments in preservation techniques in liver transplantation. First, we discuss mechanisms of organ injury when using high-risk organs, including donation after circulatory death and steatotic grafts and we summarize pathways of ischemia reperfusion injury together with their link to the immune response. Second, we report on improvement strategies of marginal liver grafts by different machine perfusion concepts and summarize perfusion approaches with recent clinical implementation.
-
Minerva anestesiologica · Feb 2018
ReviewBispectral index (BIS) and non-BIS anesthetic protocols on postoperative recovery outcomes: a systematic review and meta-analysis.
The study aimed to compare Bispectral Index (BIS) and non-BIS anesthetic protocols on postoperative recovery outcomes. ⋯ The use of BIS-monitoring is superior to non-BIS monitored anesthesia in terms of shorter time to eye-opening, extubation, and orientation. BIS monitor may be considered a safe and effective method for monitoring depth of anesthesia during surgery.
-
Minerva anestesiologica · Jan 2018
Review Comparative StudySuperiority of ultrasound guided Shamrock lumbar plexus block.
Ultrasound-guided lumbar plexus block (LPB) performed with the Shamrock approach has received much interest since the technique was first described in 2013. The technique is believed to be faster and easier to perform and possibly safer in regards to potential complications compared with other LPBs. In order to outline some favorable characteristics of the Shamrock LPB, we performed an exhaustive search of the current literature; even though it is rather limited. ⋯ The needle trajectory and needle tip location just lateral to the lumbar plexus probably reduces the risk of adverse effects and complications. Ultrasound guided lumbar plexus blockade is an expert technique. The Shamrock technique improves but does not eliminate all the challenges of ultrasound-guided LPB technique.
-
Minerva anestesiologica · Jan 2018
ReviewRobotic-assisted thoracoscopic lung surgery: anesthetic impact and perioperative experience.
Anesthesiologists and the perioperative team have a tremendous impact upon clinical outcomes in robotic-assisted thoracoscopic surgery. As anesthesiology is developing its role outside the operating room, the patient population benefits from an expanded focus on perioperative critical care and pain management. This article focuses upon the preoperative optimization, unique intraoperative considerations for surgeons and anesthesiologists, and postoperative management of patients undergoing robotic-assisted thoracoscopic surgery.
-
Minerva anestesiologica · Jan 2018
ReviewMucosal and cutaneous capnometry for the assessment of tissue hypoperfusion.
In critically ill patients, tissue hypoperfusion is an important cause leading to multi-organ dysfunction and death, and it cannot always be detected by measuring standard global hemodynamic and oxygen-derived parameters. Gastric intramucosal partial pressure of carbon dioxide (PCO2) as measured by gastric tonometry has been recognized to be of clinical value as a prognostic factor, in assessing the effects of particular therapeutic interventions, and as an end-point of resuscitation. However, this technique has several limitations that have hampered its implementation in clinical practice. ⋯ Clinical studies have established that high PslCO2 values and, more especially, high PslCO2 gap (PslCO2 - arterial PCO2) values are correlated with impaired microcirculatory blood flow and a poor outcome in critically ill patients. Sublingual capnography seems to be the ideal noninvasive monitoring tool to evaluate the severity of shock states and the adequacy of tissue perfusion. However, clinical studies are needed to determine the clinical utility of PslCO2 gap monitoring as end-point target to guide resuscitation in critically ill patients.