Minerva anestesiologica
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Non invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic respiratory failure, has also found a wide application in the postoperative period. The expanding indications to the transcatheter treatment of diseased left heart valves have led to an increase in cardiac interventional and diagnostic procedures in severely fragile cardiac patients. As an essential part of post cardiac surgery care is ventilatory support, NIV use has expanded to cardiosurgical patients. ⋯ The knowledge and the real time assessment of the possible effects of positive pressure ventilation on cardiopulmonary interactions in the clinical scenario of cardiac surgery will prompt the intensivists to tailor the respiratory support by non invasive ventilation to the individual patient. The influence on the cardiovascular system of positive pressure and volume delivered through the airways, which can be highly favorable on the impaired left heart and less favorable on the diseased right heart, should be considered when applying NIV in a cardio-surgical patient. As a consequence, the application of NIV in this setting requires an expertly skilled team, continuous hemodynamic monitoring and echocardiographic assessment.
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Minerva anestesiologica · Jul 2011
Epidural analgesia and liver resection: postoperative coagulation disorders and epidural catheter removal.
The aim of this study was to quantify the duration and severity of postoperative coagulopathy in order to establish the optimal time for epidural catheter removal. ⋯ Despite this, no epidural or spinal haematoma was recorded.
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Minerva anestesiologica · Jul 2011
Effects on cardiac function of a novel low viscosity plasma expander based on polyethylene glycol conjugated albumin.
Plasma expanders have become increasingly advantageous when compared to blood transfusion, due to their long shelf-life and cost-effectiveness. A new generation of plasma expander based on polyethylene glycol (PEG) conjugated to human serum albumin (PEG-HSA) has shown positive microvascular effects during extreme hemodilution and fluid resuscitation from severe hemorrhagic shock. PEG conjugation increases uniformly albumin molecular weight (MW) and colloidal osmotic pressure, with minor effects on viscosity. ⋯ PEG-HSA, a low viscosity plasma expander, had beneficial effects on cardiac function when compared to conventional colloidal plasma expanders with higher viscosities. Maintenance of homeostasis during hemodilution and resuscitation from hemorrhagic shock using PEG-HSA will lead to a significant decrease of the use of blood, thus alleviating in part, forecasted blood shortages, and significantly reducing morbidity and mortality associated with the use of blood in transfusion medicine.