Minerva anestesiologica
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Minerva anestesiologica · Mar 2018
ReviewRational approach to transfusion in liver transplantation.
For over 50 years patients with liver cirrhosis were considered to be at markedly increased risk of bleeding. This dogma was seemingly supported by abnormalities in standard laboratory tests (SLTs), such as the prothrombin time, that were interpreted as indicating a bleeding diathesis. However, publications from the last decade have revealed SLTs to be poor predictors of bleeding and it is now understood that stable patients with cirrhosis have a rebalanced haemostatic system and preserved thrombin generation. ⋯ Bleeding risk should be assessed in every patient undergoing invasive intervention and must consider markers of disease severity, underlying coagulation incompetence, anaemia and surgical factors. The recognition that bleeding in this patient cohort is predominantly linked to mechanistic factors such as portal hypertension, rather than primary coagulopathy, has led to a paradigm shift in their perioperative management. Cognizant of their detrimental effect, the use of large volumes of fresh frozen plasma to correct derangements in SLTs has given way to more refined haemostatic management with specific factor concentrates guided by VETs, coupled with measures to minimize portal venous pressure and meticulous surgical hemostasis.
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Minerva anestesiologica · Mar 2018
ReviewSupraglottic airway devices: indications, contraindications and management.
Supraglottic airway devices (SADs) have become an essential tool in airway management. Over the past three decades, these devices have been increasingly adopted as an alternative to face mask ventilation and/or endotracheal intubation. The range of proposed uses and features has increased significantly. ⋯ With SADs, serious complications such as aspiration and loss of airway are rare and largely preventable. Adequate operator experience, familiarity with the selected device, attention to details and careful patient selection are fundamental to safety and proficiency. In this review, we explore the increasing proposed uses for SADs and discuss possible complications and the management of these.
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Minerva anestesiologica · Mar 2018
Comparative StudyRole of flexible fiberoptic laryngoscopy in predicting difficult intubation.
The ability to precisely predict which intubations will be difficult during administration of anesthesia is an important part of preoperative preparation. This study's goal is to accurately identify patients who will be difficult to intubate using the number of tracheal rings observed preoperatively by fiberoptic laryngoscopy. ⋯ Fiberoptic laryngoscopy is a more accurate and convenient preoperative method to predict difficult intubation.