Minerva anestesiologica
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Minerva anestesiologica · Apr 2020
A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the airtest score.
Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs. ⋯ The simple, non-invasive and inexpensive bedside air-test score, evaluating pre- and postoperatively SpO2 measured on room-air, helps to predict the risk for PPCs.
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Advantages of propofol use in children may include less airway complications, less emergence agitation, and less postoperative behavioral changes. However, needle phobia and the complexity of total intravenous anesthesia set-up, as well as the pharmacokinetic and pharmacodynamic restrictions may limit the wide use of propofol-based anesthesia in the form of total intravenous anesthesia. ⋯ Propofol has earned its place as a valuable choice in pediatric anesthesia. In addition, propofol and inhalation anesthesia should not be looked at as mutually exclusive; a combination of both may sometimes be the best approach to complex clinical dilemmas.
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Moral distress is a major concern among healthcare professionals (HCPs). In the Intensive Care Unit (ICU), moral distress can result from: 1) disagreements within the ICU team regarding life-sustaining treatments; 2) critical illnesses that result in tragic choices regarding treatment planning; 3) circumstances that require rapid decisions and actions without adequate consideration of all morally meaningful concerns; 4) tensions with administrators; and 5) legal standards that define the decisional authority that should be held by patients and families or which forms of end-of-life care are permissible. An impressive body of research literature has highlighted the prevalence of moral distress among HCPs (including ICU HCPs), health impacts of moral distress, as well as personal and contextual factors that are strong predictors of moral distress. ⋯ This article outlines strategies that could be used to help diminish moral distress, drawing on the available literature. These strategies include: 1) Listen attentively to your colleagues' moral distress; 2) shift the focus from moral distress to moral agency; 3) promote ethically-attuned discussion and education (drawing on discussion models that can help reconcile diverse ethical viewpoints or disagreements); and 4) provide personal supports for HCPs. Research is urgently needed to further examine which strategies are most effective for addressing moral distress in ICU settings as well as other clinical contexts.
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Over the last 20 years, an increasing number of patients with multimorbidity and polypharmacy underwent different types of elective non-cardiac and cardiac surgery. Despite surgery is safer today than in the past, rate of perioperative major adverse cardiovascular events is still attracting significant attention from both clinicians and researchers. The perioperative myocardial infarction (PMI), a permanent damage of the heart, is a major cause of short- and long-term morbidity and mortality in current surgical populations. ⋯ These findings challenge our view of what may be feasible in terms of perioperative cardioprotection, despite technological limitations. Here, we will first analyze recent large-scale trials regarding current cardioprotective aids in non-cardiac and cardiac surgery. Finally, we will review novel cardioprotective targets translatable to surgical patients.