Minerva anestesiologica
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Minerva anestesiologica · Oct 2020
ReviewA practical approach to the use of targeted temperature management after cardiac arrest.
Among comatose survivors after cardiac arrest, target temperature management (TTM) is considered the most effective treatment to reduce the consequences of postanoxic brain injury. Several international guidelines have thus incorporated TTM in the management of the postresuscitation phase. ⋯ There is indeed still relatively large uncertainty concerning some practical aspects related to TTM application, such as: A) how to select patients who will benefit the most from TTM; B) the optimal time to initiate TTM; C) the best target temperature; D) the most effective methods to provide TTM; E) the length of the cooling phase; and F) the optimal rewarming rate and fever control strategies. The purpose of this manuscript is to review and discuss the most recent advances in TTM use after cardiac arrest and to give some proposals on how to deal with all these relevant practical questions.
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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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Minerva anestesiologica · Aug 2020
Meta AnalysisS100β as a potential biomarker of incident delirium: a systematic review and meta-analysis.
Delirium is an acute and fluctuating change in cognition, attention and consciousness, defined as an acute neuropsychiatric syndrome, but mechanism is extremely complex and still not well understood. Recently, the S100 calcium-binding protein B protein (S100β) has received attention in the biomarker research area of delirium. This meta-analysis was designed to investigate the relationship between S100β levels and delirium. ⋯ This meta-analysis provides evidence that serum S100β seems to be of limited value as a biomarker of delirium, but CSF S100β elevation may be more meaningful.
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Minerva anestesiologica · Aug 2020
ReviewNew techniques and recommendations in the management of free flap surgery for head and neck defects in cancer patients.
Free flap surgery is the gold standard surgical treatment for head and neck defects in cancer patients. Outcomes have improved considerably, probably due to recent advances in surgical techniques. In this article, we review improvements in the parameters traditionally used to optimize hematocrit levels and body temperature and to prevent vasoconstriction, and describe the use of cardiac output-guided fluid management, a technique that has proved useful in other procedures. Finally, we review other parameters used in free flap surgery, such as clotting/platelet management and nutritional optimization.