Minerva anestesiologica
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Minerva anestesiologica · May 2018
ReviewCommitted to be fit. The value of preoperative care in the perioperative medicine era.
In the era of perioperative medicine, important advances have been made in the perioperative care of patients, usually within those known as enhanced recovery after surgery (ERAS) protocols. These have led to a decrease in postoperative complications and the duration of hospital stays; however, there is still a lack of preoperative care, which could make perioperative medicine more prominent. Elderly patients, malnourished, anemic and ones with a low physical function before surgery are likely to have sub-optimal recovery from surgery. ⋯ Prehabilitation consists of exercise training and nutritional and psychological support, which increases the physiological reserve before surgical stress. The integration of exercise, adequate nutrition, anemia correction and psycho-social components, with multi-modal optimization in the preoperative period leads to an improvement in the functional capacity of the patients undergoing surgery, with the consequent improvement in terms of outcomes. The present article discusses specific aspects of preoperative care which are not well defined in the ERAS protocols and which represent fundamental shifts in surgical practice, including preoperative nutrition, management of preoperative anemia and prehabilitation.
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Minerva anestesiologica · May 2018
Randomized Controlled TrialThe analgesic potency dose of remifentanil to minimise stress response induced by intubation and measurement uncertainty of surgical pleth index.
The aim of this study was to evaluate the analgesic potency dose of remifentanil to maintain Surgical Pleth Index (SPI) values at less than 50 after intubation in patients undergoing general anesthesia with target-controlled infusion of propofol and remifentanil. ⋯ The analgesic potency dose of remifentanil to maintain SPI values at less than 50 after intubation was 135.0 µg.
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Minerva anestesiologica · May 2018
ReviewPhysiology, intervention, and outcome: three critical questions about cerebral tissue oxygen saturation monitoring.
The balance between cerebral tissue oxygen consumption and supply can be continuously assessed by cerebral tissue oxygen saturation (SctO2) monitor. A construct consisting of three sequential questions, targeting the physiology monitored, the intervention implemented, and the outcomes affected, is proposed to critically appraise this monitor. The impact of the SctO2-guided care on patient outcome was examined through a systematic literature search and meta-analysis. ⋯ However, its effects on other neurocognitive outcomes remain unclear. These results need to be interpreted with caution due to the high risks of bias. Quality RCTs based on improved intervention protocols and standardized outcome assessment are warranted in the future.
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Minerva anestesiologica · May 2018
Randomized Controlled TrialThe addition of continuous wound infusion of local anaesthetics to local infiltration in the management of postoperative pain and rehabilitation after total hip arthroplasty: a double-blind randomized controlled trial.
Total hip arthroplasty is one of the most common procedures in orthopedic surgery. We hypothesized that local infiltration of analgesia and continuous wound infusion of anesthetics in the first 72 hours after surgery could provide more effective postoperative analgesia with better rehabilitation. ⋯ The addition of continuous wound infusion of anesthetics to local infiltration analgesia provided an extended analgesic effect associated with good rehabilitation performance.
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Minerva anestesiologica · May 2018
Randomized Controlled TrialGabapentin given before laparoscopic sleeve gastrectomy reduces postoperative oxycodone consumption in obese patients. A randomized double-blind placebo-controlled trial.
Postoperative pain can be prevented. Gabapentin may be effective in this role. Our primary objective was to test the hypothesis that a prophylactic administration of gabapentin in obese patients before surgery has an opioid-sparing effect and reduces postoperative oxycodone consumption more efficiently than placebo. ⋯ The demand for oxycodone was delayed in the gabapentin group; also, the total 12-hour dose requirement of oxycodone was lower in the gabapentin group.