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
Comparative Study Observational StudyLMA protector versus traditional LMA for performing endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA), a retrospective analysis.
The aim of this study was to evaluate the use of laryngeal mask airway (LMA)® Protector™ by comparison with traditional LMA for performing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). ⋯ EBUS-TBNA conducted with LMA Protector is a useful strategy that reduced the procedural time and in theory ensured the comfort of patients. Our results should be confirmed by larger, prospective, randomized studies.
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Minerva anestesiologica · Jul 2019
Discrimination and calibration properties of the hypotension probability indicator during cardiac and vascular surgery.
Hypotension during surgery is linked to postoperative complications. Recently, a new hemodynamic algorithm intended to predict hypotensive events (hypotension probability indicator [HPI]) has been developed. The aim of the present study is to test the discrimination and calibration properties of the HPI. ⋯ The HPI5-7 may offer some useful insights. Values ≤85% carry a clinically acceptable NPV for hypotensive events at the observed prevalence and may represent a "safe zone" during surgery. Values >85% do not carry enough PPV to trigger hemodynamic interventions, but represent a warning signal. Values >98% are highly suggesting a hypotensive event after 5-7 minutes. Further studies exploring the predictive ability of the HPI at different times are needed.
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Minerva anestesiologica · Jul 2019
Clinical TrialPerfusion index and ultrasonography in the evaluation of infraclavicular block.
It has been reported that noninvasive, objective tests are needed for determining the success of peripheral nerve blocks because conventional methods necessitate the cooperation of the patient. It is also known that the brachial plexus block causes vasodilatation and an increase in blood flow due to its sympathectomy effect. Our study aimed to determine whether Perfusion Index (PI) and measured regional hemodynamic changes using ultrasound were reliable parameters in evaluating the early success of an infraclavicular block. ⋯ Changes in EDV, especially RI and PI, provide more effective and objective results for the assessment of early regional block success.