Minerva anestesiologica
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Minerva anestesiologica · Sep 2013
Management of the patient with diabetic peripheral neuropathy presenting for peripheral regional anaesthesia: a European survey and Review of literature.
Diabetic peripheral neuropathy (DPN) is a frequent complication of longstanding diabetes mellitus. There is no evidence-based consensus whether neuropathic patients undergoing peripheral regional anesthesia are at increased risk of neurologic damage. It is unknown whether these controversial results have been incorporated into clinical practice. We conducted a survey to test the hypothesis that the majority of respondents would consider DPN a potential risk factor for nerve damage in regional anesthesia, and would adapt their technique when performing regional anesthesia. In parallel, we sought to summarize the current knowledge-base regarding regional anesthesia and DPN. ⋯ In conclusion, we report the results of the first survey analyzing attitudes and standards of care among European anesthesiologists with regards to regional anesthesia in DPN. While literature is divided on the question whether pre-existing diabetic neuropathy is a risk factor for new neurological deficit after regional anesthesia, most of the responders of this survey take measures to reduce risks, counsel patients on a possible greater risk of neurologic complications, but only a minority of responders would avoid peripheral regional anesthesia altogether.
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Minerva anestesiologica · Sep 2013
ReviewLactate or ScvO2 as an endpoint in resuscitation of shock states?
In the current management of critically ill patients, variables such as blood pressure, urine output or central venous pressure guide resuscitative efforts. Unfortunately, global tissue hypoxia may persist leading to multiple organ failure and death. To address tissue well-being, indices such as central venous oxygen saturation (ScvO2) and Lactatemia are widely used and are strongly linked to outcome. ⋯ Nevertheless, choosing one index over the other remains controversial. Herein, we review the physiology and rationale for ScvO2 and lactate monitoring. Clinical uses, evidence-based outcome implications and limitations are also examined to aid the clinician in daily practice.
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Minerva anestesiologica · Sep 2013
Randomized Controlled Trial Comparative StudyComparison of oxidative stress in ASA physical status I patients scheduled for minimally invasive surgery under balanced or intravenous anesthesia.
The effects of anesthetics on inflammation and oxidative parameters, evaluated in patients without comorbidities undergoing minor surgery, remain unknown. The present study aimed to investigate the inflammatory and oxidative stress status in adult patients undergoing elective minimally invasive surgery, using different anesthetic techniques. ⋯ BAL anesthesia maintained with isoflurane and TIVA maintained with propofol are safe by virtue of not causing oxidative stress status in ASA physical status I patients undergoing minimally invasive surgeries. Moreover, even in minor surgeries, TIVA with propofol produces an antioxidant effect in patients.
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Minerva anestesiologica · Sep 2013
Randomized Controlled TrialHemodynamic changes associated with spinal and general anesthesia for hip fracture surgery in severe ASA III elderly population: a pilot trial.
Patients affected by hip fracture (HF) have high risk of perioperative complications. Despite regional anesthesia is widely used, hypotension is common and increases the risk of myocardial ischemia. The aim of this work was to study hemodynamic changes following spinal (SA) and general (GA) anesthesia in this selected population of patients. ⋯ SA in the elderly population with hip fracture provides a more stable hemodynamic profile requiring less intervention to keep MAP close to baseline value. Hypotension was common in SA and GA after induction and within intraoperative period. A larger randomized clinical study should be performed to confirm these preliminary data.
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Minerva anestesiologica · Sep 2013
Tracheal amylase dosage as a marker for microaspiration: a pilot study.
Devices that limit microaspiration through the cuffs of endotracheal tubes could help prevent ventilator-associated pneumonia (VAP). The amount of tracheal microaspirations could be a relevant study endpoint. The aim of our study was to assess whether amylase measured in tracheal secretions constituted a relevant marker for microaspiration. ⋯ Tracheal amylase was easy to collect, transport, and measure. The T/O amylase ratio is a first step towards quantifying oropharyngeal to tracheal microaspiration in mechanically-ventilated patients.