Minerva anestesiologica
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Minerva anestesiologica · Dec 2020
ReviewContextualizing cardiac dysfunction in critically ill patients with COVID-19.
Acute cardiac injury incidence in COVID-19 is about 13 times higher in the Intensive Care Unit (ICU)/severely ill than in less critical patients. Patients with cardiovascular comorbidities seem to be more prone to develop higher acuity of the infection, and myocardial injury has been reported amongst them in up to 15% of those hospitalized and up to 30% of ICU-admitted ones. The symptoms of over ischemia/heart failure may be challenging to distinguish as dyspnea and chest discomfort overlap with those due to COVID-19. ⋯ Moreover, the hyper-inflammation with endothelial dysfunction is likely be responsible of both pulmonary in-situ platelet aggregation and deep thrombosis potentially leading to severe pulmonary embolism and right ventricular failure. Besides the customary antithrombotic prophylaxis for critical patients, D-dimer levels and tighter coagulation monitoring are recommended and should guide the choice for anticoagulation treatment. We summarize the current knowledge regarding cardiovascular involvement in patient with COVID-19.
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Minerva anestesiologica · Dec 2020
Observational StudyLabour outcomes with epidural analgesia: an observational before-and-after cohort study comparing continuous infusion versus programmed intermittent bolus plus patient-controlled analgesia.
Scientific evidence shows that programmed intermittent epidural bolus (PIEB) for labor analgesia achieves good obstetric outcomes. After implementing our institutional standard for epidural analgesia, we compared PIEB + patient-controlled epidural analgesia (PCEA) versus continuous epidural infusion (CEI). ⋯ PIEB+PCEA offers obstetric and analgesic advantages over CEI in daily clinical practice.
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Minerva anestesiologica · Dec 2020
ReviewHow do i manage cerebral vasospasm and delayed cerebral ischemia?
Delayed cerebral ischemia (DCI) is the leading cause of mortality and disability in patients who survived the initial bleed of subarachnoid hemorrhage. Currently available guidelines are based on expert opinions derived from small observational studies due to the lack of randomized controlled trials. In this review, we will review some of the available literature and describe our local protocols for prophylaxis, risk stratification, monitoring in patients at risk, including multimodal invasive monitoring, and interventions measures in patients with DCI. These protocols are largely in line with the current guidelines but are deemed to evolve as ongoing and future trials provide stronger evidence to support interventions.
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Minerva anestesiologica · Dec 2020
Observational StudyPostoperative fatigue after day surgery: prevalence and risk factors. A prospective observational study.
Postoperative fatigue (POF) is a major cause of rehabilitation failure after surgery. POF is a complication that could negatively affect outpatients but to date no study has specifically investigated POF at home after day surgery. The objective of this study was to assess early and late POF and risk factors for POF after day surgery. ⋯ This work suggests that early and late POF are common after day surgery but that severe POF is rare. Postoperative pain is the main risk factors for the early POF. The optimized management of postoperative pain could probably decrease the prevalence of POF after day surgery.
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Minerva anestesiologica · Dec 2020
Can goal-directed fluid therapy decrease the use of blood and hemoderivates in surgical patients?
The purpose of goal-directed therapy (GDT) is to improve patient outcome by the optimization of hemodynamic status, as it is considered that many perioperative complications are related to microcirculatory disturbance due to an imbalance between oxygen delivery and consumption. The application of GDT protocols incorporating the assessment and optimization of patients' intravascular status should theoretically lead to a reduction in perioperative bleeding and transfusion requirements, as both hypervolemia and hypovolemia and their consequences such as dilutional coagulopathy, anemia and inadequate oxygen delivery to the tissues are avoided. ⋯ In the future, the GDT protocols should include not only the prediction of fluid responsiveness and optimization of hemodynamic status, but also the assessment of microcirculation and measures to improve tissue oxygenation, parameters which can also guide the decision for blood product transfusion. A better standardization of GDT algorithms is also required in order to perform a more accurate assessment of the effects of applying GDT on the consumption of blood products.