Minerva anestesiologica
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Minerva anestesiologica · May 2022
ReviewPerioperative management in complex spine surgery: a narrative review.
The last two decades have seen a significant increase in the number of spine surgical procedures performed worldwide. This type of surgery includes a wide variety of procedures, from mini-invasive discectomies to multilevel spinal arthrodesis and osteotomies. ⋯ We will discuss preoperative concerns, intraoperative management including airway management, choice of maintenance, intraoperative neuromonitoring and anesthetic effect, blood management and the dynamic topic of anesthetic and analgesic techniques. Finally, we will briefly address the issue of perioperative complications as they relate specifically to spine surgery.
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Minerva anestesiologica · Apr 2022
ReviewOpioid use, misuse, and abuse: a narrative review about interventions to reduce opioid consumption and related adverse events in the perioperative setting.
Opioids remain the most potent and predictable drug available for perioperative analgesia and moderate-to-severe cancer-related pain. However, their efficacy has been questioned in other clinical settings. ⋯ Thus, there has been a significant effort to develop strategies to curtail their unnecessary prescription. Here, we summarize the history, current trends, and new directions in perioperative opioid prescription in an unbiased manner.
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The aim of this study was to revise the etiologic features about Tapia's Syndrome (TS), a condition to particularly consider in the era of the COVID-19 pandemic. ⋯ TS is a rare syndrome that has been related to a combined cranial nerve palsy; while TS due to central causes is very rare, it is mainly related to peripheral causes. A particular attention to TS should be given during the SARS-CoV-2 pandemic, either since the correlation between Tapia's syndrome, airway management and anesthetic procedures, since the possible implication of the viral infection itself.
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Minerva anestesiologica · Mar 2022
Meta AnalysisBenefits of dexmedetomidine on postoperative analgesia after bariatric surgery: a systematic review and meta-analysis.
Anesthetic management of morbidly obese patients is challenging, particularly in those undergoing bariatric surgery. Dexmedetomidine is a α
2 -adrenergic receptor agonist that is increasingly used in the perioperative setting for its beneficial properties including sedation, anxiolysis, analgesia with opioid-sparing effects, and minimal impact on respiration. The objective of this study was to evaluate the effect of dexmedetomidine on postoperative analgesia and recovery-related outcomes among patients undergoing bariatric surgery. ⋯ Dexmedetomidine is an efficacious anesthesia adjunct in patients undergoing bariatric surgery. These benefits of dexmedetomidine may be considered in the multi-modal analgesic management and enhanced recovery pathways in this high-risk population. -
Factor XIII (FXIII) is the final factor in the coagulation cascade. It converts soluble fibrin monomers into a stable fibrin clot, prevents premature degradation of fibrin, participates in wound healing, and helps prevent the loss of the endothelial barrier function. FXIII deficiency is believed to be rare, and this may explain why clinicians do not routinely take it into consideration. ⋯ Acquired forms have been described in patients with decreased hepatic or bone marrow synthesis, overconsumption and increased degradation by autoantibodies. This review offers guidance on how to suspect and diagnose FXIII deficiency in both the preoperative consultation and different surgical settings. We also analyze current scientific evidence in order to clarify when and why this clinical situation should be suspected, and how it may be treated.