Minerva anestesiologica
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Minerva anestesiologica · Jul 2022
ReviewOut-of-hospital and in-hospital cardiac arrest during the COVID-19 pandemic: changes in demographics, outcomes and management.
During the COVID-19 pandemic, prehospital and hospital services were put under great stress because of limited resources and increased workloads. One expected effect was the increased number of out-of-hospital (OHCA) and in-hospital (IHCA) cardiac arrests that occurred during 2020 compared to previous years. Both direct and indirect mechanisms were involved. ⋯ In the latter case, the strain on hospitals, changes in treatment protocols, governments' actions to limit the spread of the disease and fear of the contagion naturally affected treatment efficacy and disrupted the CA chain of survival; as expected in OHCA, only a small proportion of patients were positive to COVID-19, and yet reported outcomes were worse during the pandemic. CA patient characteristics were reported, along with modifications in patient management. In this review, we summarize the evidence to date regarding OHCA and IHCA epidemiology and management during the COVID-19 pandemic.
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Minerva anestesiologica · Jul 2022
Prediction of platelet counts with ROTEM-sigma in cardiac surgery.
Excessive bleeding is common after cardiac surgery. According to transfusion algorithms based on ROTEM results (TEM International Inc., Munich, Germany), platelet transfusion is recommended when FIBTEM amplitude is normal and EXTEM amplitude is reduced. The aim of this study was to evaluate whether ROTEM (TEM International Inc.) parameters may predict accurately platelet counts in cardiac surgery patients, and to determine which of these parameters is the most useful for predicting platelet counts. ⋯ This study demonstrates the reliability of considering early ROTEM (TEM International Inc.) results and the feasibility of using PLTEM A5 to predict platelet counts and so, improve our ability to decide the need of platelet transfusion in cardiac surgery patients.
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Minerva anestesiologica · Jul 2022
Point of care coagulation management in anesthesiology and critical care.
Point of care (POC) devices are increasingly used in the ICU and in anesthesia. Besides POC-devices for blood gas analysis, several devices are available for coagulation measurements. Although basic principles for thromboelastographic measurements are not novel, some promising developments were made during the last decade improving both user-friendliness and measurement reliability. ⋯ On the other hand, benefits of POC-devices need to be balanced against limitations, which include technical restrictions and operator related errors, mainly affecting reproducibility and interpretation of results. Therefore, it is recommendable to consider results of POC-coagulation testing in comparison to standard laboratory tests (SLT). Nevertheless, in urgent or emergency situations POC results enable fast decision making to optimize patient care.
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Minerva anestesiologica · Jul 2022
Observational StudyUse of an intraoperative veno-venous bypass during liver transplantation: an observational, single center, cohort study.
As previous studies demonstrated conflicting results, we investigated the hemodynamic and renal outcomes of the intra-operative use of a veno-venous bypass during liver transplantation. ⋯ Our data suggest that the use of a veno-venous bypass fails to release the increased renal venous backflow from inferior vena cava clamping resulting in renal congestion with reduced renal perfusion pressure.
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Minerva anestesiologica · Jul 2022
Ultrasound-guided epidural anesthesia and sedation for open transvesical Cohen ureteric reimplantation surgery in 20 consecutive children: a prospective case series and proof-of-concept study.
Epidural anesthesia is usually combined with general anesthesia (GA) for children undergoing sub-umbilical surgery and GA in children is associated with a potential for respiratory events. Aiming to reduce airway manipulation and the use of GA drugs, we designed a study of transvesical Cohen ureteteric reimplantion under epidural anesthesia in sedated, spontaneously breathing children. ⋯ Sedation and epidural anesthesia emerged as a useful alternative to GA from our consecutive case series.