Minerva anestesiologica
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Minerva anestesiologica · Feb 2020
ReviewImmunomodulatory effects of anesthetic agents in perioperative medicine.
Anesthetics comprise a heterogeneous group of drugs with multiple functions and mechanisms of action, which are not yet fully elucidated. In the clinical setting, it is difficult to isolate the effects of anesthetic agents from those of surgical stress itself or of other individual covariates. For this reason, several methods involving human immune cells and animal models have been used to study the effects of anesthetic agents on the immune system. ⋯ The immunomodulatory consequences of general anesthesia are complex. Immunosuppression can lead to beneficial effects, reducing systemic and local inflammation, or negative effects, which result in increased risk of infection. Anesthesiologists should choose the most appropriate agents based on the immune status of each patient.
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Minerva anestesiologica · Feb 2020
Meta AnalysisContinuous nerve block versus single-shot nerve block for total knee arthroplasty: a meta-analysis from randomised controlled trials.
This meta-analysis aims to determine whether continuous nerve block (CNB) provides better pain relief and functional recovery than single-shot nerve block (SSNB) after total knee arthroplasty (TKA). ⋯ CNB and SSNB have similar effects on pain relief, complications and functional recovery in patients receiving TKA. The optimal analgesic regimen for patients after TKA needs further identification.
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Minerva anestesiologica · Feb 2020
ReviewUncontrolled donation after circulatory death and liver transplantation: evidence and unresolved issues.
This review aimed at summarizing the available evidence on liver transplantation from uncontrolled donation after circulatory death (uDCD) on differences in protocols, donor management, in and ex vivo perfusion techniques from center to center. Uncontrolled DCDs represent a unique, complex model of ischemia-reperfusion injury, so far not completely understood. Nevertheless, results on liver transplantation from uDCDs are promising in terms of long-term graft survival. ⋯ Values and kinetics of transaminanes during normothermic regional perfusion (nRP) should not considered absolute contraindication at least for ex vivo perfusion. Intraoperative evaluation at organ recovery remains pivotal since macroscopic alterations (i.e. hepatic rupture, an abnormal appearance of gall bladder and choledocus) still represent contraindications for organ retrieval. Concerning ex vivo perfusion, the debate is still open, since the choice of type of machine perfusion (mainly hypothermic vs. normothermic) varies from center to center, mainly relying to the single center experience (especially in controlled DCD), surgeons' believes and/or criteria translated from animal models.
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Minerva anestesiologica · Jan 2020
Meta AnalysisHemodynamic stability of closed-loop anesthesia systems: a systematic review.
This systematic review investigates the effect of closed-loop anesthesia delivery on the maintenance of cardiovascular parameters. The specific challenges arise from the fact that many physiological variables used for the control of anesthetic delivery and maintenance of hemodynamic stability are regulated by the autonomic nervous system, which is subject to high inter-individual variability. ⋯ The findings support the use of closed-loop systems for anesthetic delivery. Interpretation should take into account limitations, such as the large variations in the selected studies in the type of parameters used to measure outcomes. In summary, this review provides evidence supporting the importance of considering cardiovascular variables in the design of automated anesthetic delivery systems.
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Fever represents a frequent and dangerous secondary insult for the injured brain and is often associated with worsened neurological outcomes. The identification of fever in the Neuro-Intensive Care Unit requires careful monitoring and rapid and effective treatment. The main objective of this article was to provide practical information regarding temperature monitoring, triggers for intervention and fever management in brain injured patients.