Minerva anestesiologica
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Minerva anestesiologica · Apr 2013
ReviewPatient-ventilator dyssynchrony during assisted invasive mechanical ventilation.
Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. ⋯ To date, technological complexity has made it impossible to evaluate patient-ventilator synchrony throughout the course of mechanical ventilation. Studies have shown that a high index of dyssynchrony may increase the duration of mechanical ventilation. Better training, better ventilatory modes, and/or computerized systems that permit better synchronization of patients' demands and ventilator outputs are necessary to improve patient-ventilator synchrony.
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Fluid management is a crucial issue in patients with acute respiratory distress syndrome (ARDS). Assessment of preload responsiveness should help to define the best fluid strategy. Arterial pulse pressure variation (PPV), which represents the amplitude of the respiratory changes in arterial pulse pressure, is considered as a marker of preload responsiveness in patients mechanically ventilated and fully adapted to their ventilator. ⋯ Although a PPV >10-12% still keeps its good predictive value, a lower PPV (<10%) is far to guarantee fluid unresponsiveness since many false-negative cases can be encountered in this setting. Thus, performance of alternative preload responsiveness tests such as passive leg raising or end-expiratory occlusion tests, is necessary when low PPV values are measured. This review addresses the meaning of PPV, its conditions of use and its limits in ARDS patients.
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Minerva anestesiologica · Apr 2013
Role of anhepatic time in endothelial-related coagulation in liver transplantation.
Disturbances in coagulation homeostasis are common in patients undergoing orthotopic liver transplantation (OLT) and anhepatic period is one of the important factors related to the coagulation abnormalities. The endothelium can regulate hemostasisby producing substances such as thrombomodulin (TM). The primary aim was to evaluate the effect of an hepatic time on the thrombomodulin-protein C system in patients undergoing OLT. ⋯ Patients with prolonged anhepatic time had greater changes in the thrombomodulin-protein C system.
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Minerva anestesiologica · Apr 2013
Evaluation of a new training device to simulate the epidural and subarachnoid spaces for neuraxial anesthesia techniques.
We are introducing a new epidural/spinal simulation unit to be used either as a part-task trainer to teach and learn regional anesthesia techniques or to be inserted in the manikin's back to allow reliable advanced simulation scenarios. The aim of this study was to determine if it may be a useful tool for training novice anesthesiologists in these procedures according to the evaluation performed by experienced anesthetists. ⋯ This device to be inserted in a full scale manikin may be a promising tool for training of neuraxial procedures. It could be also an essential component of more complex high fidelity scenarios when neuraxial anesthesia is one of the major learning goals.
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Minerva anestesiologica · Apr 2013
ReviewRecommendations for anesthesia and perioperative management of patients with neuromuscular disorders.
Patients with neuromuscular disorders are at high risk of intraoperative and postoperative complications. General anesthesia in these patients may exacerbate respiratory and cardiovascular failure due to a marked sensitivity to several anesthetic drugs. Moreover, succinylcholine and halogenated agents can trigger life-threatening reactions, such as malignant hyperthermia, rhabdomyolysis and severe hyperkalemia. ⋯ Anesthesia and perioperative management of patients with neuromuscular disorders are described in this article. To grade the strength of recommendations and the quality of evidence we adopted the GRADE approach. In case of low-quality evidence, these recommendations represent the collective opinion of the expert panel.