Minerva anestesiologica
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Minerva anestesiologica · Mar 2011
Randomized Controlled Trial Comparative StudyAuricular acupuncture for postoperative pain after gynecological surgery: a randomized controlled trail.
Acupuncture for postoperative pain remains controversial. Potential sources of bias are failures in patient-blinding and therapist-patient interactions. Our study investigates the effects of electrical auricular acupuncture (AA) on postoperative pain in patients undergoing laparoscopy with an emphasis on patient-blinding and the exclusion of therapist-patient interactions. ⋯ Our study shows no reduction in postoperative pain or an opioid sparing effect of auricular acupuncture in women undergoing laparoscopic procedures. Because we emphasized blinding of the patients and the exclusion of therapist-patient interactions, our study suggests that electrical auricular acupuncture has no effect on postoperative pain.
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Minerva anestesiologica · Mar 2011
Randomized Controlled Trial Comparative StudyInflammatory response in patients undergoing colorectal cancer surgery: the effect of two different anesthetic techniques.
Anesthesia during surgery often induces an inflammatory response. The aim of this study was to establish and compare differences in inflammatory response among colorectal cancer surgery patients receiving either total intravenous anesthesia (TIVA) with propofol and remifentanil or inhalational anesthesia (INHAL) with sevoflurane and fentanyl. ⋯ TIVA with propofol and remifentanil and INHAL with sevoflurane and fentanyl induced similar inflammatory responses during colorectal cancer surgery. We found that IL-17 cytokine levels were higher in patients anesthetized with sevoflurane and fentanyl.
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Minerva anestesiologica · Mar 2011
Randomized Controlled Trial Comparative StudyA randomized clinical comparison of the Intersurgical i-gel and LMA Unique in non-obese adults during general surgery.
The i-gel is a cuffless, single-use supralaryngeal airway device designed to provide a more effective seal than the laryngeal mask airway (LMA). Although the superiority of the i-gel compared to the LMA Classic was determined in a previous study, no studies have been performed that compare it to the disposable LMA Unique. The aim of this study was to compare the Intersurgical i-gelTM against the LMA UniqueTM (uLMA) in terms of ease of placement, time of insertion, and adequacy of placement through a randomized, controlled clinical trial. ⋯ Although the i-gel had a faster insertion time in comparison to the uLMA, there was a greater need for repeat insertions. The weight criteria established by the manufacturer may need to be readjusted to recommend a larger size device in some patients less than 90 kg because all of the repeat insertions were in patients weighing more than 80 kg. In all other aspects of its use, the i-gel performed similarly to the uLMA.
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Minerva anestesiologica · Mar 2011
ReviewWhat is the role of biomarker measurement after cardiac surgery?
Measurements of cardiac troponin (cTn) and natriuretic peptides can predict outcomes after cardiac surgery and may thus assist in decision making about diagnostic and therapeutic steps in this setting. Not every cardiac surgical procedure is associated with the same degree of cTn or natriuretic peptide elevation; the factors known to affect concentrations of these markers include the severity of preoperative coronary artery disease as well as presenting syndrome, while forms of cardioprotection and anesthesia may affect postoperative concentrations of biomarkers. ⋯ Natriuretic peptide release may occur through both states of irreversible dysfunction as well as more reversible states, such as postoperative shock. Indeed, both cTn and natriuretic peptides are unequivocally prognostic for delayed recovery, intensive care unit utilization, as well as short- and longer-term mortalities following cardiac surgery.
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Minerva anestesiologica · Mar 2011
ReviewAlternative approaches to ventilator-associated pneumonia prevention.
Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. ⋯ Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.