Minerva anestesiologica
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Minerva anestesiologica · May 2020
ReviewVasopressors to treat refractory septic shock: a narrative review.
Norepinephrine is the first line vasopressor used in patients with septic shock. However, norepinephrine doses above 1 µg/kg/min are associated with mortality rates of over 80%, suggesting a need to implement adjunctive strategies prior to reaching this dosage. The present study therefore sought to review the existing and emergent vasopressor agents for patients with refractory septic shock. ⋯ Angiotensin II is another emerging option that uses a different signaling pathway. However, nitric oxide synthase inhibitors and methylene blue do not appear to be appropriate in the management of patients with refractory septic shock. In conclusion, the use of different adjunctive agents in combination with the use of norepinephrine may be useful in patients with refractory septic shock, but care must be taken to avoid excessive vasoconstriction.
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Minerva anestesiologica · May 2020
Meta AnalysisEffectiveness of quadratus lumborum block for postoperative pain: a systematic review and meta-analysis.
This study aimed to evaluate the effect of quadratus lumborum (QL) block on pain after surgeries under general or spinal anesthesia. ⋯ QL block may be a good multimodal analgesic approach for pain after abdominal surgeries.
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Minerva anestesiologica · May 2020
Randomized Controlled TrialChanges in plasma volume before and after major abdominal surgery following stroke volume variation-guided fluid therapy: a randomized controlled trial.
The aim of intraoperative fluid therapy is to avoid both hypovolemia and hypervolemia; however, the patient's exact volume status is difficult to determine during surgery. Fluid optimization guided by stroke volume variation (SVV) has been widely used in patients undergoing major open abdominal surgery. The aim of this study was to evaluate the changes in plasma volume before and after surgery following SVV-guided fluid therapy. ⋯ Fluid administration during surgery to maintain SVV below 13% was effective for maintaining the preoperative plasma volume until the end of surgery in patients undergoing major open stomach or colorectal surgery. This result supports the validity of SVV-guided fluid therapy, which maintains the SVV value below 13%, in terms of maintaining patient volume status.