Minerva anestesiologica
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Minerva anestesiologica · Dec 2024
New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.
The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. ⋯ The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.
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Minerva anestesiologica · Dec 2024
Centralized monitored anesthesia care by nurse anesthetist for cataract and glaucoma surgery in a 1:3 ratio: a non-inferiority study.
Minor Ophthalmic Procedures (MOP), especially cataract or glaucoma surgery, are considered low risk. However, in France, anesthesia must be monitored continuously and carried out by an anesthetist or a nurse anesthetist (NA). The aim was to assess whether an externalized monitored anesthesia care (MAC) would be non-inferior to an individual MAC inside the OR regarding the incidence of severe hypertension, bradycardia, hypoxemia, and surgeon satisfaction. ⋯ Among patients undergoing MOP with topical or locoregional anesthesia, an externalized MAC strategy with a 1:3 NA-to-patient ratio were non-inferior to an inside monitoring on the incidence of severe hypertension, bradycardia, hypoxemia and surgeon satisfaction regarding patient safety.
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Minerva anestesiologica · Dec 2024
Analgesic effect of lateral femoral cutaneous nerve block to the pericapsular nerve group (PENG) block in primary total hip arthroplasty: a randomized clinical trial.
Adequate hip joint and surgical incision analgesia represent a challenge in the postoperative period of primary total hip arthroplasty (THA). This study aimed to evaluate whether the combination of the lateral femoral cutaneous nerve block (LFCN block) and the pericapsular nerve group block (PENG block) influences postoperative analgesia and rescue opioids, in primary THA surgeries. ⋯ The combination of the LFCN block and the PENG block, compared to the sole PENG block, results in better analgesia at rest and on movement up to 24 h and a reduction in the total consumption of opioids up to 48 h after THA.
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Minerva anestesiologica · Dec 2024
Observational StudyRenal resistive index assessment by intraoperative transesophageal echocardiography is associated with acute kidney injury after cardiac surgery: a prospective observational study.
Acute kidney injury (AKI) is a major health burden after cardiac surgery. Renal vasoconstriction and venous congestion can be assessed via transesophageal echocardiography (TEE). The primary objective is to determine feasibility of measuring intraoperative Renal resistive index (RRI) and portal vein pulsatility fraction (PF) by TEE. The secondary objectives are to determine the association between RRI and/or PF and postoperative AKI, Intensive Care Unit (ICU) length of stay, hospital length of stay, and 30-day mortality. ⋯ This study demonstrates high feasibility for obtaining intraoperative TEE measurement of RRI and PF and significant correlation between postoperative AKI with pre CPB RRI, post chest closure RRI, and the combination of RRI at the three timepoints.