Minerva anestesiologica
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This review describes the incidence, risk factors, and long-term consequences of cognitive dysfunction after cardiovascular surgery. Postoperative cognitive dysfunction (POCD) is increasingly being recognized as an important complication, especially in the elderly. A highly sensitive neuropsychological test battery must be used to detect POCD and a well-matched control group is very useful for the analysis and interpretation of the test ⋯ POCD seems to have important long-term consequences regarding self-assessed quality of life, survival, and labor market attachment.
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Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. ⋯ Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.
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More and more frequently anaesthetists must be able to provide complete, integrated anaesthetic care outside the traditional environment of the operating room. Providing non-operating room anaesthesia (NORA) has gained widespread popularity. Both the number and the complexity of these therapeutic and diagnostic procedures is increasing. ⋯ From what is available in the literature paediatric patients carry a high risk of complications; monitored anaesthesia care is associated with more complications and substandard care is often present. Despite these potential risks, the mortality and morbidity related to NORA is infrequently studied and poorly described. Most authors agree that improvements in monitoring are essential to decrease the complication rate.
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Minerva anestesiologica · May 2009
Randomized Controlled Trial Comparative StudyRegional anesthesia for carotid endarterectomy: a comparison between ropivacaine and levobupivacaine.
This study compares ropivacaine and levobupivacaine when administered for cervical plexus block. The authors therefore compared the arterial pressure profile and the incidence of hypotension between drugs. ⋯ Levobupivacaine has a greater vasodilatory effect than ropivacaine. Its higher incidence of hypotension, although not statistically significant, suggests ropivacaine as the drug of choice for cervical plexus block.
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Minerva anestesiologica · May 2009
Patients with comorbidities: what shall we do to improve the outcome.
The number of patients submitted to major surgery affected by one or more comorbidities is progressively increasing. Outcome is the final output measured as morbidity, mortality and quality of life, of diagnostic tests, procedures, therapy tools started in the preoperative period and fitted on single patients or groups of patients or typology of surgical acts. ⋯ In conclusion, a patient with comorbidities scheduled for major surgery needs a full anesthetist-intensivist involvement, which broadens the role of the anesthetist in the perioperative medicine. Outcome is the result of many interventions during patient course, including economic costs and the importance of an appropriate treatment.