Minerva anestesiologica
-
Minerva anestesiologica · Jun 2015
Multicenter StudyRelationship of ECMO duration with outcomes after pediatric cardiac surgery: a multi-institutional analysis.
There are very sparse data on the outcomes of children receiving prolonged extracorporeal membrane oxygenation (ECMO) after cardiac surgery. This study was aimed to evaluate the association of ECMO duration with outcomes in children undergoing surgery for congenital heart disease using the Pediatric Health Information System (PHIS) database. ⋯ Data from this large multicenter database suggest that longer duration of ECMO support after pediatric cardiac surgery is associated with worsening outcomes.
-
Acute kidney injury (AKI) represents 18-47% of all causes of hospital-acquired AKI and it is associated with a high incidence of morbidity and mortality especially in patients requiring dialysis. Only recently, with the application of new AKI classifications and guidelines (RIFLE, AKIN and KDIGO), a more accurate evaluation of the real incidence of kidney dysfunction in patients undergoing surgery has been detailed. In patients undergoing non-cardiac, non-vascular and non-thoracic surgery several independent preoperative and intraoperative predictors of AKI have been identified. ⋯ Multi-hit mechanisms (ischemia, inflammation, toxins) co-act on patients' predisposition (susceptibility). A multi-step approach is probably necessary to limit the incidence and the severity of postsurgery AKI patients, such as careful risk stratification, adoption of preventive measures and goal directed intraoperative algorithms. The present review will summarize the current literature about the epidemiology of postoperative AKI focusing on patient-related and technical-related risk factors, outcome and prevention strategies in different groups of surgeries.
-
Minerva anestesiologica · Jun 2015
Ondansetron attenuates the decrease in blood pressure due to spinal anaesthesia in the elderly - a double blind, placebo-controlled study.
Ondansetron was effectively used to prevent spinal anesthesia-induced hypotension in the general population and women anesthetised for cesarean section. The aim of this study was to test the hypothesis that blocking type 3 serotonin receptors with intravenous ondansetron administration reduces hypotension and bradycardia induced by spinal anesthesia in elderly patients. ⋯ Administration of intravenous ondansetron prior to spinal anesthesia in geriatric patients attenuates the drop in the diastolic and mean arterial pressure without substantially affecting the systolic blood pressure.
-
Minerva anestesiologica · Jun 2015
Deaths with acute cerebral lesions in ICU: Does the number of potential organ donors depend on predictable factors ?
As the potentiality of deceased organ donation mostly depends on the number of brain deaths (BDs), the aim of this study is to quantify rates and probabilities of BD declaration in Italy. ⋯ Predictable factors associated with BD declaration can be identified in ACLD management. Positive factors leading to the identification of potential organ donors, i.e., the capacity of declaring BD in all the patients fulfilling BD criteria irrespective of age and etiology, could be captured in the best performing regions and reproduced throughout the Country. The implementation of simple indicators based on prospective ACLD monitoring, i.e. the declared BDs to ACLDs in ICU ratio, may be helpful in achieving efficiency targets and reliable comparisons of outcomes in the identification of BD potential organ donors.