Minerva anestesiologica
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Minerva anestesiologica · Mar 2020
Multicenter Study Observational StudyPediatric anesthesia practice in Italy: a multicenter national prospective observational study derived from the Apricot trial.
Pediatric anesthesia nowadays requires specific knowledge and expertise. The Anesthesia PRactice In Children Observational Trial (APRICOT) was a European multicenter study designed for the identification of perioperative severe critical events and management. We aimed at analyzing the Italian database in an attempt to determine the practice of anesthesia and the incidence of severe critical events in Italy. ⋯ This secondary analysis demonstrates that the incidence of severe critical incidence was lower in Italy in comparison to that reported for Europe. This low rate of critical events may be related to the high expertise and experience of the anesthesiologists in charge of the children in the Italian centres that participated to APRICOT.
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Minerva anestesiologica · Mar 2020
Meta AnalysisPredictive parameters of difficult intubation in thyroid surgery: a meta-analysis.
Airway management is a fundamental goal for the anesthesiologist. The rate of difficult laryngoscopy in patients undergoing thyroid surgery ranges from 6.8% to 9.6%. An accurate and detailed preoperative evaluation of the airway seems to be a promising tool to predict a potentially difficult airway management. We aimed to identify possible risk factors and physical findings that predict difficult intubation in thyroid surgery. ⋯ In thyroid patients, the presence of high Mallampati Score, shorter thyromental distance, interincisor gap, tracheal deviation (the unique thyroid pathology linked parameter), obesity and male gender were risk factors for difficult intubation. However, all these significant parameters should be used in preoperative assessment to anticipate difficult intubation in thyroid surgery.
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Minerva anestesiologica · Mar 2020
ReviewBenefits and boundaries of processed electroencephalography (pEEG) monitors when they do not concur with standard anesthetic clinical monitoring. Light and shadow.
Numerous clinical conditions that have a direct effect on electroencephalography (EEG) cerebral function could also directly influence brain function monitors (BFM) indices. There is no conventional comparator technology for BFM assessment. The conventional comparator technology used as a benchmark for assessing BFMs technologies chosen by the UK National Institute for Health and Care Excellence (NICE) to reflect the currently used standards in the National Health Service (NHS), was demarcated as "standard anesthetic clinical monitoring" and precisely defined as "the combination of routine clinical observation and electronic monitoring used in clinical practice to assess the adequacy of anesthesia." Because BFMs are EEG-derived parameters, all conditions that can "alter" the raw EEG signal would subsequently change BFM indices to reflect other unrelated EEG events of patient-dependent pathophysiologic perturbations. ⋯ Changes in BFM indices during acute cerebral pathology would be highly beneficial to trained informed clinicians as it alerts to something they would not otherwise be aware was happening. This fact-based, citation-supported, narrative review article provides better understanding of BFMs' limitations through examining various published reports of all values that did not coincide with a "standard anesthetic clinical monitoring" whether arising from an underlying alteration of patients' own EEG or those due to shortcomings in the BFM design or performance. The notion of just "riding the numbers" seems to be not a good anesthesia practice; rather we should interpret these BFM indices within context and limitations.
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Minerva anestesiologica · Mar 2020
Observational StudyElevation in optic nerve sheath diameter due to the pneumoperitoneum and Trendelenburg is associated to postoperative nausea, vomiting and headache in patients undergoing laparoscopic hysterectomy.
Optic nerve sheath diameter (ONSD) measurement with ultrasound has emerged as a simple, non-invasive and reliable surrogate of invasive intracranial pressure (ICP) measurement. Increase in ICP might lead to postoperative nausea and vomiting (PONV) and postoperative headache. Here, we aimed to evaluate the extent of change in ONSD, resulting from pneumoperitoneum (PP) and Trendelenburg (TP) position during the laparoscopic hysterectomy (LH), by using ultrasonographic ONSD measurement. We also aimed to investigate the relation of ONSD with PONV and postoperative headache. ⋯ Combination of PP and TP leads to a significant increase in ONSD during LH. The extent of the increase in ONSD during the procedure is significantly correlated with PONV and headache occurring within the first three hours of recovery.
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Minerva anestesiologica · Mar 2020
The effects of topical chlorhexidine-benzydamine spray on laryngeal mask airway application.
Laryngeal mask airway (LMA) use is very common during anesthesia practice. Sore throat, earache, hoarseness and swallowing difficulties may occur on LMA insertion. The primary aim of this study was to describe the effects of topical application of a spray formula of chlorhexidine gluconate and benzydamine hydrochloride (Kloroben® oral spray, 30 mL) on postoperative sore throat due to LMA use. The secondary aims were to evaluate earache, swallowing difficulty, nausea and vomiting and the hemodynamic responses due to LMA insertion and the incidence of coughing, tooth clenching, desaturation and laryngeal spasms during LMA removal. ⋯ Preemptive topical benzydamine hydrochloride and chlorhexidine gluconate in a spray formula may decrease the incidence of sore throat, cough and swallowing difficulties associated with LMA use.