Minerva anestesiologica
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Minerva anestesiologica · Apr 2020
Effects of deep neuromuscular block on surgical workspace conditions in laparoscopic bariatric surgery: a systematic review and meta-analysis of randomized controlled trials.
Deep neuromuscular blockade For laparoscopic bariatric surgery improves surgical conditions but does not shorten surgical duration.
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Minerva anestesiologica · Apr 2020
Pediatric pain review: what has happened since the First World Congress on Pediatric Pain in 1988? The past, the present and the future.
The present text summarizes the development within the field of pediatric pain during the last 30 years, with a special focus on pediatric postoperative pain. Insights concerning pain ontogeny, how pain influences the neuro-endocrine stress response and the induction of a "pain memory" is discussed as well as established and new options with regards to treatment of postoperative pain. Lastly, some aspects concerning future development within this field is discussed. ⋯ The use of regional anesthetic techniques should be used whenever possible and combined with appropriate systemic options, thereby producing multi-modal analgesia. However, new concepts and drugs are unfortunately few and, thus, progress often lies in using established drugs in more efficient ways. The concept of Enhanced Recovery After Surgery (ERAS) also provides a framework where high-quality postoperative pain relief is of essence for the best possible outcome after both minor and major surgery.
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Minerva anestesiologica · Apr 2020
Effects of anesthesia depth on postoperative cognitive function and inflammation: a systematic review and meta-analysis.
Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are common postoperative complications in elderly patients. The effect of anesthesia depth on cognitive function remains unknown. We aimed to assess the correlations between anesthesia depth, cognitive function, and inflammation. ⋯ Light anesthesia was associated with a decrease in POD and may promote better neurocognitive function postoperatively in comparison with deep anesthesia.
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Minerva anestesiologica · Apr 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, anaemia 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.
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Minerva anestesiologica · Apr 2020
Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study.
We aimed to analyze anesthesia timing and perioperative respiratory adverse event (PRAE) risk factors in children undergoing therapeutic cardiac catheterization after upper respiratory tract infection (URI). ⋯ If treatment is not urgent, a pediatric patient at a high risk of PRAEs will be benefit from the postponement of an interventional operation by at least two weeks after URI.