Minerva anestesiologica
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Minerva anestesiologica · Aug 2017
Randomized Controlled Trial Comparative StudyComparative study of fiberoptic guided versus intubating laryngeal mask airway assisted awake orotracheal intubation in patients with unstable cervical spine: a randomized controlled trial.
A safe airway technique minimizes intubation-associated cervical-spine movement and consequent neurological injury in patients with unstable cervical spine (UCS). Awake fiberoptic-guided intubation (FGI) is preferred in patients with UCS. Alternatively, intubating laryngeal mask airway assisted intubation (ILMA-AI) can be performed both during elective and emergency, requires less expertise and is cost-effective. This study evaluated cervical-spine movement during FGI and ILMA-AI in patients with UCS. ⋯ Similar degree of angulations was observed at various time-points during awake FGI and awake ILMA-AI at C1/2 and C2/3 spinal levels in patients with UCS. No patient developed new-onset motor deficits. ILMA can serve as a suitable alternative to fiberoptic-scope for awake intubation in cervical-spine instability.
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Minerva anestesiologica · Aug 2017
Low flow veno-venous extracorporeal CO2 removal for acute hypercapnic respiratory failure.
Ventilation with low tidal volume and airway pressure results in a survival benefit in ARDS patients. Previous research suggests that avoiding mechanical ventilation altogether may be beneficial in some cases of respiratory failure. Our hypothesis was that low flow veno-venous extracorporeal CO2 removal (ECCO2R) enables maintenance of a lung protective ventilation strategy or awake spontaneous ventilation despite severe hypercapnic respiratory failure (HRF). ⋯ Our results suggest that in mechanically ventilated patients with HRF, low flow ECCO2R supports the maintenance of lung protective tidal volume and peak ventilator pressure. In selected awake patients with acute HRF, it may be a novel treatment approach to avoid mechanical ventilation, hence preventing ventilator- and sedation-associated morbidity and mortality.
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Minerva anestesiologica · Aug 2017
Meta AnalysisBlood purification with continuous venovenous hemofiltration in patients with sepsis or acute respiratory distress syndrome. A systematic review and meta-analysis of randomized evidence.
Severe inflammatory conditions, as severe sepsis/septic shock and acute respiratory distress syndrome (ARDS), are related to high morbidity and mortality. We performed a meta-analysis of randomized trials to assess if blood purification with continuous veno-venous hemofiltration (CVVH) reduces mortality in these settings. ⋯ Overall, low-quality evidence indicates that blood purification with CVVH might be associated with a significant reduction in mortality when performed in patients with sepsis or ARDS. The evidence is still insufficient to support a definitive conclusion of benefit. Further high-quality randomized controlled trials, adequately powered for mortality, are needed to clarify the impact of CVVH on these conditions.
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Minerva anestesiologica · Aug 2017
Meta AnalysisEffect of remifentanil for general anaesthesia on parturients and newborns undergoing caesarean section: a meta-analysis.
The results presented by studies investigating the effect of remifentanil on both parturients and newborns during cesarean section differed significantly. Therefore, we performed a meta-analysis to estimate the effect of remifentanil on these patients. ⋯ Remifentanil shows potential value of maternal circulation response during general anesthesia, which reduces maternal blood pressure in response to intubation and surgery. However, whether it is beneficial for the neonate is still controversial. More randomized-controlled trials with larger sample size are required to assess the adverse effects of remifentanil.