Minerva anestesiologica
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Minerva anestesiologica · Jul 2013
Postoperative hemoglobin levels and its association with myocardial ischemia in non-cardiac surgical patients.
Background: Low hemoglobin (Hb) levels as well as cardiac complications are common conditions in postoperative surgical patients and both are associated with poor outcome. The aim of this study was to determine the influence of postoperative Hb levels on myocardial ischemia in high-risk patients who underwent non-cardiac surgery. Methods: In this retrospective observational cohort study, we evaluated 3638 consecutive patients admitted to the 24-hour postoperative anesthesia care unit between 2006 and 2010. 273 (8%) high-risk patients, defined as three or more cardiac risk factors, were selected for analyses. ⋯ Results: Postoperative myocardial ischemia was present in 73 (27%) of the 273 patients. After adjustment for significant pre-, intra- and postoperative risk factors, 4 independent risk factors remained for postoperative myocardial ischemia in male patients: age (OR 1.1; 95% CI: 1.0 - 1.1), a history of ischemic heart diseases (OR 4.2; 95% CI: 1.0 - 17.8), renal failure (OR 5.4; 95% CI: 2.1 - 13.9) and postoperative Hb levels: intermediate tertile (10.3-11.6 g/dL) (OR 5.8; 95% CI: 1.6 - 20.9) and lowest tertile (7.9-10.2 g/dL) (OR 12.9; 95% CI: 3.0 - 55.5). Conclusion: Postoperative Hb levels are independently associated with postoperative myocardial ischemia in high-risk patients undergoing non-cardiac surgery.
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Minerva anestesiologica · Jul 2013
Effects of short sustained lung inflations on cerebral blood flow and cerebral tissue oxygenation in the juvenile rabbit.
Sustained lung inflations improve oxygenation but may impair hemodynamics. This study aimed to determine effects of short sustained inflations on cerebral blood flow and cerebral tissue oxygenation in experimental lung injury. ⋯ A series of short sustained lung inflations of 15 seconds duration can impair cerebral blood flow but increase arterial oxygen saturation in this juvenile animal model. The combination of these effects resulted in either a decrease or increase in regional cerebral tissue oxygenation.
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Minerva anestesiologica · Jul 2013
ReviewSleep in the Intensive Care Unit measured by polysomnography.
Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-friendly care and environment. ⋯ Sedation should be kept at a minimum and interrupted once daily. Care interventions should be clustered and noise reduced and/or masked with earplugs. NAVA, proportional assist+ or assist-control ventilation should be preferred to pressure support ventilation and adjusted to allow smaller tidal volumes, thus avoiding central apnoeas.