Minerva anestesiologica
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Over the last 20 years, an increasing number of patients with multimorbidity and polypharmacy underwent different types of elective non-cardiac and cardiac surgery. Despite surgery is safer today than in the past, rate of perioperative major adverse cardiovascular events is still attracting significant attention from both clinicians and researchers. The perioperative myocardial infarction (PMI), a permanent damage of the heart, is a major cause of short- and long-term morbidity and mortality in current surgical populations. ⋯ These findings challenge our view of what may be feasible in terms of perioperative cardioprotection, despite technological limitations. Here, we will first analyze recent large-scale trials regarding current cardioprotective aids in non-cardiac and cardiac surgery. Finally, we will review novel cardioprotective targets translatable to surgical patients.
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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 · Oct 2020
Regional intratidal gas distribution in acute lung injury and acute respiratory distress syndrome--assessed by electric impedance tomography.
Regional tidal volume distribution and end-expiratory lung volume (EELV) distribution in patients with acute lung injury and acute respiratory distress syndrome (ALI, ARDS) have previously been investigated using computed tomograpy and electric impedance tomography (EIT). In the present study, we utilized the high temporal resolution of EIT to assess intratidal gas distribution. ⋯ On-line intratidal gas distribution monitoring offers additional information on recruitability and optimal PEEP.
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Minerva anestesiologica · Jul 2020
Review Meta AnalysisDrugs for anaesthesia and analgesia in the preterm infant.
There is largely an absence of validated evidence-based therapies in term- and preterm newborn infants, due to a lack of pharmacological clinical trials. As a consequence, the drugs and doses used in clinical practice are extrapolated from dose-ranging trials performed in older patients. Drugs administered to the preterm infant are invariably off-label. The aim of this current review is to identify commonly used anesthetic and analgesic agents in this patient population, assess the existing evidence base, in terms of safety, efficacy, pharmacokinetics and pharmacodynamics, current indications and doses. ⋯ Preterm infants are characterized by remarkable metabolic and developmental differences when compared with adults. It is not possible to derive guidelines or clinical recommendations based on the existing evidence.
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Minerva anestesiologica · Jun 2020
Review Meta AnalysisValue of new ST-Segment / T-Wave changes for prediction of major adverse cardiac events after vascular surgery: a meta-analysis.
The aim of this review is to examine current evidence on value of new ST-segment or T-wave changes for prediction of major adverse cardiac events (MACE) after vascular surgery. ⋯ Current evidence suggests that in the setting of vascular surgery, new ST-segment/T-wave changes could serve as predictor of MACE with reasonable accuracy. Heterogeneity across studies, possibility of publication bias and paucity of eligible studies are potential limitations to these conclusions.