Minerva anestesiologica
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Minerva anestesiologica · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyAutonomic cardiovascular modulation with three different anesthetic strategies during neurosurgical procedures.
Autonomic cardiovascular modulation during surgery might be affected by different anesthetic strategies. Aim of the present study was to assess autonomic control during three different anesthetic strategies in the course of neurosurgical procedures by the linear and non-linear analysis of two cardiovascular signals. ⋯ Despite an important reduction of cardiovascular signal variability, the analysis of RR and SAP signals were capable to detect information about autonomic control during anesthesia. Symbolic analysis (non-linear) seems to be able to highlight the differences of both the sympathetic (slow) and vagal (fast) modulation among anesthetics, while spectral analysis (linear) underlines the same differences but only in terms of balance between the two neural control systems.
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Minerva anestesiologica · Jan 2015
ReviewCoagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding.
Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. ⋯ Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII.
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Minerva anestesiologica · Jan 2015
Randomized Controlled TrialValidity and fidelity of the upper airway in two high-fidelity patient simulators.
Human patient simulators are frequently used for airway management training and research. However, little is known about their fidelity and validity. The use of these simulators as a benchmark model remains highly questionable. The objective of this study was to evaluate the validity and fidelity of two patient simulators (compared to actual patients) for anaesthesia residents performing three airway management techniques. ⋯ Patient simulators are not a valid alternative to human patients for conducting scientific evaluations of supraglottic airway management techniques. HAL and SimMan do have adequate validity for endotracheal intubation, but the fidelity and validity are low when a laryngeal mask is used or if mask ventilation is performed. Therefore, previous simulation-based airway device evaluation studies must be interpreted with great caution.
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Surgical site infections (SSIs) are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these infections, although Gram-negative organisms are also frequently involved. The risk of developing a SSI is associated with a number of factors, including aspects of the operative procedure itself, such as wound classification, and patient-related variables, such as preexisting medical conditions. ⋯ Broad spectrum antibiotics should be avoided due to the risk of promoting bacterial resistance. Cephalosporins are the most commonly used antibiotics in surgical prophylaxis; specifically, cefazolin or cefuroxime are mainly used in the prophylaxis regimens for cardio-thoracic surgery, vascular surgery, hip or knee arthroplasty surgery, neurosurgical procedures and gynecologic and obstetric procedures. A review of the prophylactic regimens regarding the main surgical procedures is presented.
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Minerva anestesiologica · Jan 2015
Factors of tidal volume variation during augmented spontaneous ventilation in patients on extracorporeal carbon dioxide removal - a multivariate analysis.
Extracorporeal carbon dioxide removal (ECCO2-R) allows lung protective ventilation using lower tidal volumes (VT) in patients with acute respiratory failure. The dynamics of spontaneous ventilation under ECCO2-R has not been described previously. This retrospective multivariable analysis examines VT patterns and investigates the factors that influence VT, in particular sweep gas flow and blood flow through the artificial membrane. ⋯ Higher sweep gas flow is associated with low VT in patients on extracorporeal lung assist and augmented spontaneous ventilation. Such a technique can be used for prolonged lung protective ventilation even in the patient's recovery period.