Minerva anestesiologica
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Minerva anestesiologica · Apr 2023
Randomized Controlled TrialUse of a curved needle to facilitate four-in-one nerve block performance after total knee arthroplasty in elderly patients: a randomized clinical trial.
Peripheral nerve block is the main analgesic technique for total knee arthroplasty (TKA) in elderly patients. Accurate delivery of the needle tip to the target nerve under ultrasound-guided is a prerequisite for successful nerve block. Failed needle-tip positioning in sciatic nerve (SN) or medial femoral cutaneous nerve (MFCN) block can be due to anatomical structure shadow. The aim of the study was to compare curved and straight needles in regard to the time needed to perform the nerve block for TKA in elderly patients. ⋯ The use of a curved needle can reduce the time required to perform the nerve block, with reduction in the number of attempts and needle redirections. Curved needle also resulted in lesser procedural pain and higher satisfaction compared with the straight needle.
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Minerva anestesiologica · Apr 2023
ReviewPotential nutritional and pharmacological treatment of glycocalyx alterations during sepsis.
During sepsis, a combination of pathophysiological insults disrupts the glycocalyx. The thickness of the glycocalyx is correlated with parameters of disease severity, making it a potential new and independent target for therapeutic strategies in sepsis. The aim of this review was to examine potential beneficial effects of nutritional and pharmacological measures on glycocalyx alterations during sepsis and their timing.
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Minerva anestesiologica · Apr 2023
Observational StudyHydrocortisone may act through the angiotensin II receptor-2 level in patients with catecholamine-resistant septic shock.
This study aimed to compare the serum angiotensin II and its receptor levels (AT1, AT2) in septic patients with catecholamine-responsive or resistant. The effect of hydrocortisone treatment on angiotensin II levels in the catecholamine-resistant septic patients was evaluated. ⋯ It was concluded that angiotensin II and AT1 can be used as a biomarker of refractory septic shock and hydrocortisone may provide their blood pressure correcting effect by reducing AT2 level in these patients. AT2 can be a therapeutic target in the catecholamine-resistant septic shock patients.
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Minerva anestesiologica · Apr 2023
Implementation of a spontaneous awakening/spontaneous breathing trial protocol in a surgical intensive care unit: a before and after study.
Prolonged invasive mechanical ventilation (IMV) influences patient outcome in multiple ways. In this regard the early weaning from IMV is a major goal to be achieved in the treatment of ICU patients. Adopting a weaning protocol that incorporates a Spontaneous Awakening Trial (SAT) and a Spontaneous Breathing Trial (SBT) seems to be essential to reach this goal. Most studies investigating the effectiveness of SAT/SBT protocols in ICU patients' outcomes have focused mainly on medical or mixed (medical and surgical), but not on exclusively surgical patient populations. Surgical patients usually experience more complications and often undergo revision surgeries, therefore needing longer sedation periods and adequate analgo-sedation therapy. Moreover, the longer IMV times make the weaning process more arduous. ⋯ We conclude that even for an exclusively surgical patient population, the implementation of a SAT/SBT protocol could result in a higher rate of successful extubation.
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Minerva anestesiologica · Apr 2023
Dexmedetomidine versus remifentanil for sedation under monitored anesthetic care in complex endovascular aortic aneurysm repair: a single center experience with mid-term follow-up.
Sedation protocols in patients undergoing complex endovascular aortic aneurysm repair are not fully investigated. The aim of this study was to compare a dexmedetomidine (DEX) based sedation protocol with a remifentanil-based sedation protocol. ⋯ In this setting remifentanil provides reliable sedation with higher patient's satisfaction and less hemodynamic effect than DEX.