Minerva anestesiologica
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Minerva anestesiologica · Jul 2019
ReviewAcute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations.
Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with regional anesthesia techniques constituting an integral part of it. ⋯ In this review, we set out to provide several examples of injuries, to elucidate the precise anatomy of fractured bones (osteotomes), and to elaborate on certain peripheral nerve blocks employed in pain management of trauma patients. Controversies/special considerations pertaining to peripheral nerve blocks also dictate thorough analysis: as such, acute compartment syndrome, acute peripheral nerve injuries, regional anesthesia in awake or anesthetized patients, continuous peripheral nerve blocks, positioning limitations and, finally, ultrasound imaging versus neurostimulation techniques are extensively reviewed.
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Minerva anestesiologica · Jul 2019
Randomized Controlled Trial Comparative StudyHemadsorption during cardiopulmonary bypass reduces interleukin 8 and tumor necrosis factor α serum levels in cardiac surgery: a randomized controlled trial.
Surgical trauma and cardiopulmonary bypass (CPB) are associated with the liberation of pro-inflammatory cytokines. With hemadsorption (Cytosorb®) during CPB, pro-inflammatory cytokines may be reduced and the inflammatory response may be decreased. ⋯ This prospective study shows a significant reduction in pro-inflammatory cytokine levels of Il-8 and TNFα with hemadsorption in on-pump cardiac surgery whilst also demonstrating safety in its applications. However, the differences in cytokine levels and CI between patients treated with hemadsorption and those without were minor and of short duration.
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Minerva anestesiologica · Jul 2019
Out-of-hospital cardiac arrest at place of residence is associated with worse outcomes in patients admitted to intensive care: a post-hoc analysis of the Targeted Temperature Management trial.
The majority of out-of-hospital cardiac arrests (OHCAs) occur at place of residence, which is associated with worse outcomes in unselected prehospital populations. Our aim was to investigate whether location of arrest was associated with outcome in a selected group of initial survivors admitted to intensive care. ⋯ Half of all initial survivors after OHCA admitted to intensive care had an arrest at place of residence which was independently associated with poor outcomes. Actions to improve outcomes after OHCA at place of residence should be addressed in future trials.
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Minerva anestesiologica · Jul 2019
Postoperative pain (POP) after vitreo-retinal surgery is influenced by duration of surgery and anaesthesia conduction; opioids are not necessary for its management.
The control of postoperative pain (POP) is a key component of perioperative care. POP after vitreo-retinal surgery (VRS) has been under-investigated, and its incidence remains elusive. ⋯ The incidence of POP after VRS is low but not absent, especially for long procedures, it does not require postoperative opioids and can be modified by anesthesiologic choices.
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Minerva anestesiologica · Jul 2019
ReviewDeath by neurologic criteria: pathophysiology, definition, diagnostic criteria and tests.
Death by neurologic criteria is an irreversible sequence of events culminating in permanent cessation of cerebral functions. In this context, there are no responses arising from the brain, no cranial nerve reflexes nor motor responses to pain stimuli, and no respiratory drive. ⋯ The diagnosis, confirmation, and certification of death are core skills for medical practitioners. The aim of this review is to discuss the pathophysiology and definition of death by neurological criteria, describing the clinical assessment, and the use of ancillary tests for the diagnosis of brainstem death.