Minerva anestesiologica
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Minerva anestesiologica · Jan 2016
How to advance prediction of postoperative delirium? A secondary analysis comparing three methods for very early assessment of elderly patients after surgery and early prediction of delirium.
Postoperative impairment of the cerebral function can appear immediately after general anesthesia and may be predictive for a postoperative delirium. We compared three tools assessing patients on recovery room admission in order to detect early signs of postoperative brain dysfunction: the Postanesthetic Recovery Score (PARS), the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). ⋯ The RASS and Nu-DESC were independent predictors for a delirium within seven postoperative days. Very early assessment of the cerebral function may help to advance detection, prevention and treatment of postoperative delirium in elderly patients.
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Minerva anestesiologica · Jan 2016
Early vascular complications after percutaneous cannulation for Extracorporeal Membrane Oxygenation for cardiac assist.
Extracorporeal membrane oxygenation (VA ECMO) demonstrated an advantage in survival and neurological outcome in patients with cardiogenic shock and, in selected population, in victims of refractory cardiac arrest. The incidence of vascular complications ranges in recent series from 10 to 70% including both early and late complications. The aim of the present study was to determine the incidence of early vascular complications and the effectiveness of the prevention of limb ischemia by the insertion of a catheter for distal perfusion. ⋯ The majority of ischemic episodes were resolved with the insertion of a distal perfusion catheter. We did not observe any mortal vascular complication, nor any of the observed complications was related to increased mortality.
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Minerva anestesiologica · Jan 2016
Review Meta AnalysisBedside predictors of difficult intubation: a systematic review.
Unanticipated difficult intubation is associated with unwanted patient outcomes. The capability of predicting difficult airways may contribute to patient safety, efficient patient flow and rational use of limited resources. We evaluated current literature on performance of bedside airway tests in predicting difficult tracheal intubation. ⋯ Current bedside tests have limited and inconsistent capacity to discriminate between patients with difficult and easy airways. Most studies are characterized by high risk of bias and concerns of applicability. Reliable bedside criteria to predict difficult intubation remain elusive.
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Minerva anestesiologica · Jan 2016
ReviewShort Hospitalization System: a new way of interpreting day surgery care.
Today's poorer income on the one hand and the more and more unbearable costs on the other, call for solutions to maintain public health through proper and collective care. We need to think of a new dimension of health, to found a modern and innovative approach, which can combine the respect of healthcare rights with the optimization of resources. Worldwide, franchises serving millions of people every year succeed in limiting operating costs and still offer a service and a quality equal to single businesses. ⋯ The Short Hospitalization System (SHS) is the proposed project, which is not only a type of hospitalization which is different from the ordinary, but also an innovative clinical-organizational model, with an important economic impact, where the management and maximization of the different hospital flows (care, professional, logistical, information), as well as the ability to implement strategies to anticipate them are crucial. The expected benefits are both clinically and socially relevant. Among them: 1) best practice build up; 2) lower impact on daily habits and increased patient satisfaction; 3) reduction of social and health expenditure.