Minerva anestesiologica
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Minerva anestesiologica · Jul 2016
Randomized Controlled TrialHow can postoperative delirium be predicted in advance? A secondary analysis comparing three methods of early assessment in elderly patients.
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 · Jul 2016
Observational StudyProspective study of residual neuromuscular block and postoperative respiratory complications in patients reverted with neostigmine versus sugammadex.
Postoperative residual curarization (PORC) is an important complication of neuromuscular blocking drug (NMBD) use. This study evaluates the incidence of PORC in the Postanesthesia Care Unit (PACU), its relation to the type of muscle relaxant and reversal agent used, and its implication in the development of postoperative respiratory complications. ⋯ PORC in the PACU is associated to a greater incidence of major and minor respiratory complications. The use of rocuronium-sugammadex significantly reduces the incidence of PORC in the PACU.
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Minerva anestesiologica · Jul 2016
Paediatric anaesthesia and neurotoxicity: can we translate findings from animals to humans?
Many studies have demonstrated a neurodegenerative effect of anesthetic drugs in cubs and young animals, raising the concern that similar effects can happen in children, and that the administration of anesthesia in young children undergoing surgical or diagnostic procedures may cause long-term neurocognitive impairment. Thus, several epidemiological studies have been performed with the aim to find a possible association between early anesthesia exposure and poor long-term outcome, like learning disabilities or worse school grading and two prospective trials are currently running, the GAS and the PANDA study. ⋯ Nonetheless, studies in animals are necessary to better understand the effects of anesthetics and the mechanistic of potential anesthesia-related neurotoxicity. Studies in humans must run in parallel in order to determine whether similar effects may occur in young patients.
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Minerva anestesiologica · Jul 2016
ReviewMortality as an endpoint in studies in critically ill patients: a reappraisal of definitions.
The recent literature was critically reviewed reporting heterogeneous mortality endpoints in studies involving critically ill patients. Both location- and duration-dependent definitions are used, more or less arbitrarily and sometimes with contradictory results. ⋯ There is no consensus on how mortality should be evaluated in the critically ill. It is argued that trialists should aim at uniformity in outcome evaluation of critical care, in order to allow comparison of studies, and that 28-day mortality should remain the primary endpoint for intervention studies.