Minerva anestesiologica
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Minerva anestesiologica · Jun 2023
End-tidal carbon dioxide in the early phase of cardiopulmonary exercise testing prior to major colorectal cancer surgery associates with postoperative outcome.
Cardiopulmonary exercise testing (CPET) objectively informs preoperative risk stratification prior to major surgery. CPET facilities are resource intensive and therefore more cost-effective triage methods are desirable for scalability. We tested two dynamic CPET parameters (end-tidal CO
2 (Pet CO2 ) and heart rate (HR)) to early phase exercise and resting diffusion capacity (DLCO) as potential point of care assessments that could be used outside of formal CPET testing facilities. ⋯ Assessment of DLCO at rest and dynamic assessment of Pet CO2 during the early phase of exercise may potentially be developed as inexpensive point-of-care triage tools to scale objective preoperative risk assessment. -
Minerva anestesiologica · Jun 2023
A protocol based on Hypotension probability indicator vs. standard care to prevent intraoperative hypotension during supratentorial brain surgery: a prospective randomized pilot trial.
To test the hypothesis that Hypotension probability indicator (HPI) driven hemodynamic protocol use may decrease the exposition to hypotension (mean arterial pressure below 65 mmHg) during supratentorial intracranial procedures. ⋯ In this pilot trial, the HPI-based protocol decreased the incidence of hypotension during the anesthesia maintenance but non-significant trends among secondary outcomes were also documented. Larger trials are needed to confirm our findings.
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Minerva anestesiologica · Jun 2023
Randomized Controlled TrialUltrasonographic assessment of metoclopramide effect on gastric volume in parturients females undergoing Caesarean section: a randomized double blind study.
The prokinetic effect of metoclopramide promotes gastric emptying and decreases stomach capacity. The aim of the present study was to assess the efficacy of metoclopramide in reducing gastric contents and volume using gastric point-of-care ultrasonography (PoCUS) in parturients females prepared for elective Cesarean section under general anesthesia. ⋯ Metoclopramide decreases gastric volume, reduces postoperative nausea and vomiting, and may lower the risk of aspiration when used as premedication before obstetric surgery. Preoperative gastric PoCUS has utility in objectively assessing stomach volume and contents.
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Minerva anestesiologica · Jun 2023
Randomized Controlled TrialComparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after laparoscopic nephrectomy: a randomized controlled non-inferiority clinical trial.
Thoracic paravertebral block offers effective analgesia after laparoscopic nephrectomy but has potential severe complication risks. Erector spinae plane block has been described for analgesia after abdominal surgery. However, there are no prospective randomized trials determining if ultrasound-guided erector spinae plane block is non-inferior to thoracic paravertebral block in terms of analgesia after abdominal surgeries including laparoscopic nephrectomy. ⋯ This study demonstrates that erector spinae plane block provides non-inferior analgesia for pain at rest within 24 postoperative hours in comparison to thoracic paravertebral block for laparoscopic nephrectomy.
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Minerva anestesiologica · Jun 2023
ReviewPathophysiology of COVID-19 pneumonia and respiratory treatment.
COVID-19 pandemic has seen an unprecedented number of patients presenting with acute respiratory distress syndrome to the intensive care units all over the world. Between August and November 2022, we performed research on PubMed screening all publications on COVID-19 disease and respiratory failure and its treatment. ⋯ The mainstay of the disease is the frequent presence of severe hypoxemia associated - at least at the beginning - to a near normal lung mechanics and PaCO
2 tension. The management of symptomatic patients, progressing through these temporal phases, is not possible without understanding the pathophysiology underlying the respiratory manifestation.