Minerva anestesiologica
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Minerva anestesiologica · Sep 2017
Severe perioperative hyperglycemia attenuates postoperative monocytic function, basophil count and T cell activation.
Hyperglycemia in hospitalized patients is associated with increased morbidity and mortality. Postoperative infections are particularly common in the setting of perioperative hyperglycemia; however, the relationship between perioperative glucose levels and the innate immune system remains unclear. ⋯ Severe perioperative hyperglycemia attenuated postoperative basophil count, T cell activation and monocytic function. These patients were also at preoperative higher immune activation.
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Minerva anestesiologica · Sep 2017
ReviewThrombolysis for non-traumatic intra-ventricular hemorrhage in adults: a critical reappraisal.
Intra-ventricular hemorrhage (IVH) is a critical condition with high rate of morbidity and mortality due to acute hydrocephalus and secondary brain injury. Mechanisms underlying the clinical deterioration are not only related to the appearance of an acute hydrocephalus but also to blood-clot mass effect and the inflammatory effects of blood break-down products which impede local blood flow and exert a direct toxic effect on the peri-ventricular structures leading to chronic hydrocephalus. An effective treatment strategy should aim at IVH fast removal and reduction of blood-clot mass effect. ⋯ Protocol-based use of alteplase with extra-ventricular drain seemed safe, therefore such approach may be a potential option in individual cases. Currently no consensus has been reached and extrapolation of data from the literature does not permit to identify a uniform therapeutic approach but merely to outline some rational procedural modalities. Further research and studies are needed to compare the efficacy of the different fibrinolytic agents and protocols on functional outcome.
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Minerva anestesiologica · Sep 2017
The safety and efficacy of the use of the flexible laryngeal mask airway with positive pressure ventilation in elective ENT surgery: a 15-year retrospective single-center study.
The use of flexible laryngeal mask airway (FLMA) in elective ear, nose and throat (ENT) surgery offers significant advantages, but is frequently considered inferior to tracheal intubation (TI) for ventilation and airway protection. We investigated the safety and success rate of intraoperative FLMA use with positive pressure ventilation (PPV), and the factors responsible for FLMA failure. ⋯ The results suggest an acceptably low failure rate of use of FLMA with PPV in selected ENT surgical procedures. True intraoperative FLMA failure is uncommon. We advocate observing strict criteria for adequacy of FLMA placement, and close monitoring of FLMA function intraoperatively at all times.
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Minerva anestesiologica · Sep 2017
Letter Historical ArticleThe last sigh and the death knell: a view on lung hyperinflation from a millennium ago.
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Minerva anestesiologica · Sep 2017
Randomized Controlled TrialOpioid-sparing effect of nefopam in combination with paracetamol after major abdominal surgery: a randomized double-blind study.
Because nefopam's morphine-sparing is debated when combined with paracetamol, this study aimed to assess pain relief by IV nefopam in combination with paracetamol after major abdominal surgery. ⋯ This prospective randomized study suggested that nefopam in combination with paracetamol has no benefit after open abdominal surgery.