Minerva anestesiologica
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Minerva anestesiologica · Feb 2017
Randomized Controlled Trial Comparative StudyComparison of three different doses sugammadex based on ideal body weight for reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery.
The majority of authors and the literature recommend sugammadex dose to be calculated according to RBW without taking fat content into consideration. Our aim was to compare the efficacy and safety of sugammadex at doses of 1.5, 2, and 4 mg/kg, calculated according to ideal body weight basis, for the reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery. ⋯ A dose of sugammadex of 1.5 mg/kg calculated according to IBW successfully reversed moderate rocuronium-induced NMB in laparoscopic bariatric surgeries.
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Minerva anestesiologica · Feb 2017
ReviewBurnout syndrome and wellbeing in anaesthesiologists: the importance of emotion regulation strategies.
Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. ⋯ New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.
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Minerva anestesiologica · Feb 2017
Prevention of Respiratory Insufficiency after Surgical Management (PRISM) trial: report of the protocol for a pragmatic randomised controlled trial of Continuous Positive Airway Pressure (CPAP) to prevent respiratory complications and improve survival following major abdominal surgery.
Over 300 million patients undergo surgery worldwide each year. Postoperative morbidity - particularly respiratory complications - are most frequent and severe among high-risk patients undergoing major abdominal surgery. However, standard treatments, like physiotherapy or supplemental oxygen, often fail to prevent these. Preliminary research suggests that prophylactic continuous positive airways pressure (CPAP) can reduce the risk of postoperative respiratory complications. However, without evidence from a large clinical effectiveness trial, CPAP has not become routine care. This trial aims to determine whether early postoperative CPAP reduces the incidence of respiratory complications and improves one-year survival following major intra-peritoneal surgery. ⋯ This is the first proposed clinical effectiveness trial of postoperative CPAP to prevent respiratory complications of which we are aware. The large sample size and multicenter international design will make the result generalizable to a variety of healthcare settings.
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Minerva anestesiologica · Feb 2017
Preoperative functional assessment and optimization in surgical patient. Changing the paradigm.
Functional capacity has been shown to be a major determinant of surgical outcome since it is related to postoperative complications, activity and daily function, level of independence and quality of life. Anesthesiologists as "perioperative physicians", can identify those scoring systems that assess functional capacity, whether from the basic physical history and walk test to the most complex such as cardiopulmonary exercise testing, and formulate intraoperative and postoperative interventions (rehabilitation) to minimize the impact of surgery on the recovery process. Nevertheless, the preoperative period can be used as an opportune time to increase functional reserve in anticipation of surgery, thus enabling the patient to better withstand the metabolic cost of surgical stress (prehabilitation). There is a compelling evidence that prehabilitation programs, including physical exercise, nutritional optimization and relaxation strategies, can enhance preoperative physiological reserve, however further studies are needed to identify the most appropriate protocols for those patients at risk, and assess the impact of such programs on clinically meaningful surgical outcomes.