Minerva anestesiologica
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Minerva anestesiologica · Jun 2013
Association of intraoperative blood pressure instability with adverse outcomes after liver transplantation.
Blood pressure derangements are common in orthotopic liver transplantation (OLT), and are potentially associated with adverse outcomes if they are sustained. While this concept is often believed to be true, few have rigorously demonstrated the validity of this claim, especially in likely vulnerable OLT patients. ⋯ Although severe intraoperative hypotension and BP lability during OLT are often observed in current practice as consequences of major surgical manipulations and patient vulnerability, these are likely not benign conditions based on this retrospective analysis. Prospective trials are warranted to investigate the possibility that interventions tailored to avoidance of hypotension and BP lability may improve outcomes.
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Minerva anestesiologica · Jun 2013
Review Meta AnalysisIntrathecal magnesium as analgesic adjuvant for spinal anesthesia: a meta-analysis of randomized trials.
Intrathecal magnesium extends analgesic duration of spinal opioids.
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Minerva anestesiologica · Jun 2013
ReviewTracheal intubation of patients in non-standard positions requires training.
In extreme emergency situations, patients may need to undergo endotracheal intubation, while in a non-supine position. This manuscript offers several options to the anesthesiologist to cope with tracheal intubations in non-standard positions. The authors stress that there is a need for adequate training in an anaesthesia skills lab, whereby classic direct laryngoscopy and indirect videolaryngoscopy should be practiced on manikins, before our trainees actually practice anesthesia on patients in operating theatres. This manuscript is also a plea for developing an algorithm for emergency airway management in the non-supine position.
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Minerva anestesiologica · Jun 2013
The immune response to one-lung-ventilation is not affected by repeated alveolar recruitment manoeuvres in pigs.
Background: Acute lung injury after thoracic surgery relates to alveolar inflammation induced by one-lung ventilation (OLV) and surgical manipulation. However, alveolar recruitment manoeuvres (ARM), conventional ventilation, and airway manipulation may increase alveolar trauma. This study evaluates pulmonary immune effects of these co-factors in a porcine model. ⋯ Expression of interleukin-8-mRNA increased after OLV, but mRNA expression was not modulated by anesthetics. Conclusion: ARM, standard TLV and repetitive BAL do not additionally contribute to lung injury resulting from OLV for thoracic surgery in healthy porcine lungs. OLV induces expression of interleukin-8-mRNA in alveolar cells, which is not modulated by different anesthetic drugs.