Minerva anestesiologica
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Minerva anestesiologica · Sep 2020
Meta AnalysisEffects 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 · Sep 2020
Meta AnalysisEffects 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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Bowel dysfunction, especially ileus, has been increasingly recognized in critically ill patients. Ileus is commonly associated to constipation, however abnormal motility can also concern the upper digestive tract, therefore impaired gastrointestinal transit (IGT) seems to be a more appropriate term. IGT, especially constipation, is common among patients under mechanical ventilation, occurring in up to 80% of the patients during the first week, and has been associated with worse outcome in intensive care unit (ICU). ⋯ However, cholinesterase inhibitors seem safe and could probably be used in case of constipation but remains poorly prescribed. Prevention with bowel management protocol using osmotic laxatives appears to be safe but did not demonstrate its effectiveness. For patients treated with high posology of opioids during sedation, enteral opioid antagonists may be a promising strategy.
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Minerva anestesiologica · Sep 2020
Abdominal aortic aneurysm patients remain at risk for delirium on the surgical ward after intensive care unit dismissal.
The incidence of delirium following open abdominal aortic aneurysm (AAA) surgery is significant, with incidence rates ranging from 12% to 33%. However, it remains unclear on what level of care a delirium develops in AAA patients. The aim of this study was to investigate the incidence of delirium in the ICU and on the surgical ward after AAA surgery. ⋯ Delirium frequently occurs in patients who undergo AAA surgery. This study demonstrated that patients on the surgical ward remain at risk of developing a delirium after ICU dismissal. Patients with ICU delirium differ in clinical characteristics and outcomes from patients with a delirium on the surgical ward.