Minerva anestesiologica
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Minerva anestesiologica · Nov 2017
Safety aspects of desflurane anesthesia and laryngeal mask airway.
Laryngeal mask (LM) and inhaled anesthesia combination is often deemed unsuitable. Actually the evolution of surgical procedures towards minimal invasiveness, the search of improved productivity, and the contemporary need for patient safety and faster recovery, push the anesthetists to get interested in their use in the daily practice. ⋯ Main operative steps have been defined, which, if appropriately implemented, would successfully achieve safety objectives. Two aspects are considered crucial, first the educational role of Universities and Medical Schools to structure a systematic approach to the theoretical and practical teaching of the use of LM with desflurane; second an appropriate training for improving the skills in the use of LM also for more complicated patients.
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Labor epidural failure is a challenging situation for the obstetric anesthetist, especially when associated to high risk of caesarean delivery, obesity, and difficult airway predictors. Labor epidural failure is still not standardly defined, consequently its incidence is uncertain: improving the knowledge of risk factors related to failure will increase epidural block success rate. Prolonged labors, previous history of epidural failure, and repeated top-ups needed during labor are recognized risk factors for failure. ⋯ Software-controlled infusion pumps seem to increase epidural analgesia success rate. Among non-technical skills, good communication among medical team members and parturient women is another pivotal point to achieve a satisfactory analgesia for labor. Clear algorithms should be promoted where epidural failure during labor or caesarean delivery may occur.
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Minerva anestesiologica · Nov 2017
Scalp block for glioblastoma surgery is associated with lower inflammatory scores and improved survival.
Regional anesthesia has anti-inflammatory effects. Recent studies suggest that regional anesthesia might improve the survival of patients with cancer. We hypothesized that the use of a scalp block (SB) during craniotomy for glioblastoma (GB) decreases the postoperative systemic and local inflammatory response and extend their survival. ⋯ This retrospective study supports the hypothesis that in patients with GB undergoing craniotomy, the use of SB is associated with lower levels of systemic and local inflammation, and longer survival.
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Minerva anestesiologica · Nov 2017
Perioperative stroke: incidence, etiologic factors, and prevention.
Stroke is a devastating complication that is difficult to diagnose in the perioperative setting because of the effects of anesthetic and analgesic agents. Lingering anesthesia effects hinder clinicians in identifying stroke symptoms, frequently resulting in a delay in diagnosis and treatment and in unfavorable outcomes. The authors performed a systematic search in PubMed and the Cochrane Central Register. ⋯ Preoperative optimization for preexisting risk factors may reduce the rate of perioperative stroke. Prompt, early management can improve patient outcomes. Recognition of the incidence, risk factors, and causes of perioperative stroke may lead to prevention and proper management.
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Minerva anestesiologica · Nov 2017
Editorial CommentIs sedation for endoscopy as safe as you think?