Minerva anestesiologica
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Minerva anestesiologica · Aug 2021
Observational StudyCirculating leptin, soluble leptin receptor and free leptin index in critically ill patients with sepsis: a prospective observational study.
Leptin, the prototype adipokine, exerts immunomodulatory actions being implicated in inflammatory responses during sepsis. Clinical evidence regarding its role in sepsis has been contradictory, while free leptin has not been studied. The aim of this study was to jointly investigate circulating total leptin, its soluble receptor (sOB-R), and free leptin, as well as their kinetics in critically ill patients with sepsis regarding their diagnostic and prognostic value. ⋯ Higher circulating total leptin and its higher kinetics during the first week from sepsis onset independently predict 28-day survival in critically ill patients. Free leptin did not present any additional diagnostic and prognostic value in sepsis.
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Minerva anestesiologica · Aug 2021
Meta AnalysisThe opioid sparing effect of erector spinae plane block for various surgeries: a meta-analysis of randomized-controlled trials.
The erector spinae plane block (ESPB) is a newer fascial plane block which has been broadly applied for postoperative analgesia after various surgeries, but the effectiveness in these populations is not well established. ⋯ ESPB may be a useful addition to the multimodal analgesic regimen for a variety of surgeries especially when the alternative is no block. Unanswered questions include determining of the mechanism of action, refining of the EPSB technique, and establishing recommended local anesthetic dose and volume.
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Children with symptoms of hypotonia (reduction of postural tone of lower limbs and trunk with or without changes in phasic tone) are frequently anesthetized for diagnostic and therapeutic interventions. This review outlines the underlying causes and classifications, and the anesthesiologic pre- and peri-operative management of hypotonic children. Hypotonia may have a large range of etiologies that are categorized into central and peripheral hypotonia. ⋯ Adequate postoperative pain treatment is essential to limit stress and metabolic alteration. Preferably a locoregional technique is used to reduce the increased risk of respiratory depression. A multidisciplinary preoperative approach taking into account the differential diagnosis of the underlying disease of the floppy child is recommended.
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Minerva anestesiologica · Aug 2021
Meta AnalysisVolatile anesthetics versus intravenous anesthetics for noncardiac thoracic surgery: a systematic review and meta-analysis.
We performed this meta-analysis of randomized controlled trials (RCTs) to investigate two types of anesthetics for noncardiac thoracic surgery regarding their effects on clinical outcomes and the inflammatory response. ⋯ In lung surgery, but not esophagectomy, volatile anesthetics may be a better choice than intravenous anesthetics, possibly because volatile anesthetics reduce airway inflammation.