Minerva anestesiologica
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Minerva anestesiologica · May 2017
ReviewUltrasonography for neuraxial blocks: a review of the evidence.
This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) pertaining to the use of adjunctive ultrasonography (US) for neuraxial blocks. ⋯ Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US for neuraxial blocks. Further well-designed RCTs are warranted.
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Owing to their immune modulatory, anti-inflammatory, antioxidant, antithrombotic, and endothelial action, statins are widely used in the critical care setting in several disease scenarios. The present review focuses on the evidence supporting an even wider utilization of statins in intensive care practice for diverse indications. A search of the literature was carried out in PubMed, Cochrane and EMBASE databases up to January 2016. ⋯ References were also searched for other potentially useful articles. It was concluded that beneficial effects of statins are observed in cardiac surgery; however, no robust evidence supports their effectiveness in diverse critical care settings. The decision to discontinue statins in native users should be taken in consideration of particular clinical circumstances.
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Minerva anestesiologica · May 2017
Randomized Controlled TrialReal-time ultrasound guided spinal anesthesia in patients with predicted difficult anatomy.
There are limited reports of lumbar neuraxial blocks using real-time US in patients with predicted difficulties. We compared the number of attempts to perform spinal anesthesia using real-time US guidance versus landmark technique in patients meeting predefined criteria for difficult spinal anesthesia. We also compared procedure time, block success, patient satisfaction and difficulty scores between groups. ⋯ This trial suggests that real-time US guidance for spinal anesthesia in challenging patients in comparison to the controlled group was completed in longer time, with lower needle insertion attempts, and higher patient satisfaction scores but without statistically significant differences.
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Minerva anestesiologica · May 2017
European implementation of the "2014 ESC/ESA guideline on non-cardiac surgery: cardiovascular assessment and management".
Substandard implementation of a guideline is a major factor contributing to poor guideline adherence and has the potential to result in preventable patient harm. This study aims to quantify the uptake of the European guideline on non-cardiac surgery by European anesthetists. ⋯ Current implementation and knowledge of the guideline on non-cardiac surgery in Europe needs to be improved.
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Minerva anestesiologica · May 2017
Accuracy of non-invasive hemoglobin monitoring by pulse co-oximeter during liver transplantation.
Hemoglobin level monitoring is essential during liver transplantation (LT) due to substantial blood loss. We evaluated the accuracy of non-invasive and continuous hemoglobin monitoring (SpHb) obtained by a transcutaneous spectrophotometry-based technology (Masimo Corporation, Irvine, CA) compared with conventional laboratory Hb measurement (HbL) during LT. Additionally, we made subgroup analyses for distinct surgical phases that have special features and hemodynamic problems and thus may affect the accuracy of SpHb. ⋯ SpHb was demonstrated to have a clinically acceptable accuracy of hemoglobin measurement in comparison with a standard laboratory device when used during LT. This technology can be useful as a trend monitor during all surgical phases of LT and can supplement HbL to optimize transfusion decisions or to detect occult bleeding.