Minerva anestesiologica
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Minerva anestesiologica · Jul 2018
Novel applications of bedside monitoring to plumb patient hemodynamic state and response to therapy.
Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognize patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive. ⋯ More recently, pathophysiological and echocardiographic-based approaches have been introduced to investigate ventriculo-arterial coupling, the relationship between both left and right heart and the relative circulatory bed. Such techniques allowed establishing that in many critically ill scenarios, coupling between the heart and the circulation is inefficient and probably that is the reason why in this case hemodynamic restoration cannot be achieved by standard approaches. Combining echocardiography to better understand and treat in real-time pathophysiological determinants of altered hemodynamic states with functional approaches seems to be the key to plumb hemodynamic states although it remains to be demonstrated if this tailored approach will improve patient outcome.
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Minerva anestesiologica · Jul 2018
Comparative Study Observational StudyImmobilisation during anaesthesia for vitrectomy using a laryngeal mask without neuromuscular blockade versus endotracheal intubation and neuromuscular blockade.
For intraocular surgery, most authors recommend general anesthesia including intubation and neuromuscular blockade to avoid complications by patient movements. However, anesthesia using a laryngeal mask and avoidance of muscle relaxants is common clinical practice. Purpose of this prospective observational study was to compare the incidence of eye movement and deviation of the eye axis during general anesthesia adjusted to minimal alveolar concentration (MAC) for pars plana-vitrectomy (PPV) using a laryngeal mask without neuromuscular blockade (LM) versus endotracheal intubation and neuromuscular blockade (INT). ⋯ For PPV, MAC adjusted balanced anesthesia using a laryngeal mask without neuromuscular blockade was associated with more, but clinically irrelevant upward eye deviations and may be an alternative to intubation with neuromuscular blockade. However, adequate depth of anesthesia must be assured to avoid unwanted injuries during surgery.