Minerva anestesiologica
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Minerva anestesiologica · Jan 2017
ReviewThe link between anesthesiology and neurology: a mindful cooperation to improve brain protection.
Preventing neurological injury is mandatory during the perioperative period of any kind of surgery and in the care of critically ill patients in the intensive care unit. During daily practice, both anesthesiologists and neurologists focus on brain protection as an integral part of systemic homeostasis maintenance. This article highlights the intriguing overlap between anesthesiology and neurology in clinical practice along with its potential implications for outcome. ⋯ Clinical vigilance and the use of shared monitoring and diagnostic technology could allow early recognition and treatment of cerebral dysfunction occurring in the perioperative period or in the critical care setting, thus reducing morbidity and mortality. In order to improve patient safety and outcome, neurologists and anesthesiologists should more closely and successfully collaborate, using shared monitoring tools and integrating traditional areas of expertise. Daily activity, education, research and training programs in anesthesia and neurology could benefit from a stronger relationship with each other.
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Minerva anestesiologica · Dec 2016
ReviewPerioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI consensus.
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. ⋯ The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein.
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Minerva anestesiologica · Dec 2016
ReviewThe aging digestive tract. What should we anesthesiologists know about it?
At present, elderly individuals represent approximately 18.5% of the European population and account for about 23% of surgical procedures performed. This patient population is at a higher risk for perioperative complications and adverse postoperative outcome. This narrative review highlights our current knowledge about physiological changes in the aging gut and the implications for anesthesiologists. ⋯ Healthy aging appears to be associated with modest slowing of gastric emptying, but this does not demand prolonged preoperative fasting. The physiological changes associated with polypharmacy also make elderly patients a risk group for pulmonary aspiration during anesthesia. Further research is needed to determine the effects of commonly used anesthetic agents on the pharyngo-gastrointestinal tract in elderly patients.
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Minerva anestesiologica · Nov 2016
ReviewFailure of statins in ARDS: the quest for the "Holy Grail" continues.
Experimental and clinical observational studies have shown potential benefits of statin administration in the acute respiratory distress syndrome (ARDS) by modulating inflammation and preventing worsening respiratory function. More recently, two randomized clinical trials failed to demonstrate an improved survival of ARDS patients treated with statins. In the first study, conducted by the ARDS Network, 745 patients with sepsis‑associated ARDS were randomized within 48-hours of onset to receive either rosuvastatin or placebo. ⋯ There was no significant difference between the study groups for number of ventilator‑free days (primary outcome, 13±10 in the simvastatin vs. 12±10 in the placebo group, P=0.21) or 28-day mortality (22% vs. 27%, respectively; P=0.23). No significant difference in serious adverse events was reported between groups. Herein, we discuss the main reasons for these negative findings and consider where there could be a role for statins in ARDS patients.