Minerva anestesiologica
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Minerva anestesiologica · Apr 2018
Clinical ethics: what the anaesthesiologist and the intensivist need to know.
Clinical ethics if often perceived as an intuitive understanding of what is right versus wrong. This is insufficient for healthcare workers in general, but particularly for anesthesiologists and intensivists, who often must weigh up complex and emergent life or death decisions and subsequently justify these decisions to their team and patients, as well as patient's families. ⋯ The most important concept is that interventions offered should be both clinically appropriate and ethically proportionate, desirable by both the patient and the medical team, and offering a meaningful benefit to the patient within the context of his or her own life narrative. This puts an emphasis on understanding, from the patient or his/her proxies, not just who the patient is biologically but also biographically: that is what gives meaning to his/her life subjectively, and what quality of life would be compatible with this level of functioning, as well as when he/she would wish life sustaining therapy to be withheld or withdrawn.
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Minerva anestesiologica · Apr 2018
Randomized Controlled TrialPreventative effect of ketamine on post-surgical hyperalgesia induced at a body part remote from the surgical site: a randomized controlled trial.
It is known that pain hypersensitivity can be induced at a body part remote from a surgical site (tertiary hyperalgesia), leading to patient discomfort. Nevertheless, no reported study to date has investigated methods to attenuate such tertiary hyperalgesia. Ketamine is known to modulate hyperalgesia induced by central sensitization. Thus, we investigated whether intraoperative administration of ketamine could decrease post-surgical tertiary hyperalgesia in patients undergoing a laparoscopic hysterectomy. ⋯ These results suggest that the intraoperative administration of ketamine may decrease post-surgical hyperalgesia developing at a region remote from the surgical site.
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Minerva anestesiologica · Apr 2018
Perioperative pain management in cardiac surgery: a systematic review.
Every year, more than 1.5 million patients, who undergo cardiac surgery worldwide, are exposed to a series of factors that can trigger acute postoperative pain associated with hemodynamic instability, respiratory complications, and psychological disorders. Through an evaluation of literature data about postoperative pain in cardiac surgery we define unmet needs and potential objectives for future research on this often-underestimated problem. ⋯ Over the past 17 years, opioids are still the most extensively used therapy, whereas we found only few trials investigating other drugs (e.g. paracetamol). Regional anesthesia techniques, especially thoracic epidural analgesia and intrathecal morphine administration, can effectively treat pain, but have not yet showed any significant impact on major clinical outcomes, with several concerns related to their potential complications. To date multimodal analgesia with implementation of regional analgesia seems to be the best choice. In the future, better-designed studies should consider other drugs stratifying groups according to comorbidities and risk factors, as well as using standardized units of measurement.
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Minerva anestesiologica · Apr 2018
Randomized Controlled TrialRepeated alveolar recruitment maneuvers with and without positive end-expiratory pressure during bariatric surgery: a randomized trial.
Positive end-expiratory pressure (PEEP) is considered essential in protective ventilation, while it may lead to hemodynamic impairment. In the present study, we investigated the effect of repeated alveolar recruitment maneuvers (ARMs) with or without additional PEEP on the arterial oxygenation of obese patients who were undergoing bariatric surgery. ⋯ Repeated ARMs, either with or without PEEP, improve early postoperative oxygenation and shorten time to extubation. ARMs without PEEP result in lower airway pressure and less hemodynamic impairment in patients who were undergoing bariatric surgery.
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Minerva anestesiologica · Apr 2018
Randomized Controlled Trial Comparative StudyAirway management with fastrach laryngeal mask versus spritztube: a prospective randomised manikin-based study.
A new promising device, the Spritztube (ST), was developed combining the ability to perform both supraglottic ventilation and orotracheal fibreoptic intubation using the same device, allowing an easy passage from supraglottic ventilation to tracheal ventilation avoiding apnea. The present study aims to compare the speed and the subjective ease of insertion of the novel tracheal tube (Spritztube®) compared to the intubating laryngeal mask airway Fastrach™ (FT-LMA) in a simulation environment. ⋯ In a manikin simulation setting, insertion and intubation with and ST was performed 11 s slower than with use of a FT-LMA.