Minerva anestesiologica
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Minerva anestesiologica · Oct 2020
Regional intratidal gas distribution in acute lung injury and acute respiratory distress syndrome--assessed by electric impedance tomography.
Regional tidal volume distribution and end-expiratory lung volume (EELV) distribution in patients with acute lung injury and acute respiratory distress syndrome (ALI, ARDS) have previously been investigated using computed tomograpy and electric impedance tomography (EIT). In the present study, we utilized the high temporal resolution of EIT to assess intratidal gas distribution. ⋯ On-line intratidal gas distribution monitoring offers additional information on recruitability and optimal PEEP.
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Minerva anestesiologica · Oct 2020
Multicenter Study Meta AnalysisEffect of volatile anesthetics on mortality and clinical outcomes in patients undergoing coronary artery bypass grafting: a meta-analysis of randomized clinical trials.
For patients undergoing coronary artery bypass grafting there is no mortality difference between volatile anaesthesia and TIVA.
pearl -
Minerva anestesiologica · Oct 2020
ReviewAnesthesia for patients with psychiatric illnesses: a narrative review with emphasis on preoperative assessment and postoperative recovery and pain.
The physical and psychological fragility of patients with psychiatric illness poses critical importance in the preoperative assessment, evaluation, and choice of premedication, which includes regular therapy, as well as concerns about polypharmacy with possible interactions of anesthetics, analgesics, and psychiatric medications. A considerable effort is to reduce risks for exacerbations or relapses of imminent illness in the postoperative period. In this narrative review, the goal was also set towards the use of proper tools for the preoperative assessment of anxiety and management of postoperative pain. ⋯ Psychiatrist involvement is necessary throughout the perioperative period, starting preoperatively and continuing after discharge. Clinical pharmacologists should be part of the team during the management of critically ill patients when polypharmacy can cause undesirable effects. Psychosocial wellbeing of surgical patients with psychiatric co-morbidity depends deeply on the collaboration of medical staff, family, and friends and international guidelines aim to establish standards, including but not limited to postoperative management.
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Minerva anestesiologica · Oct 2020
ReviewA practical approach to the use of targeted temperature management after cardiac arrest.
Among comatose survivors after cardiac arrest, target temperature management (TTM) is considered the most effective treatment to reduce the consequences of postanoxic brain injury. Several international guidelines have thus incorporated TTM in the management of the postresuscitation phase. ⋯ There is indeed still relatively large uncertainty concerning some practical aspects related to TTM application, such as: A) how to select patients who will benefit the most from TTM; B) the optimal time to initiate TTM; C) the best target temperature; D) the most effective methods to provide TTM; E) the length of the cooling phase; and F) the optimal rewarming rate and fever control strategies. The purpose of this manuscript is to review and discuss the most recent advances in TTM use after cardiac arrest and to give some proposals on how to deal with all these relevant practical questions.