Minerva anestesiologica
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Minerva anestesiologica · Dec 2024
Randomized Controlled TrialPrehabilitation for Chilean frail elderly people - pre-surgical conditioning protocol - to reduce the length of stay: randomized control trial.
Frail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery. ⋯ The PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.
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Minerva anestesiologica · Dec 2024
ReviewUnderstanding the anatomy of pelvic fascia: implications for regional anesthesia.
The fascia, a continuous structure around the whole body across various anatomical locations, remains underexplored in regional anesthesia. The pelvic fascia is a particularly controversial and complicated anatomical structure. It holds significant relevance not only for surgeons but also in the realms of regional anesthesia and pain management. ⋯ A thorough understanding of pelvic fascia anatomy is crucial for understanding the potential pathways and barriers for spread of local anesthetics, enhancing analgesia, and minimizing side effects. Currently, a systematic discussion of pelvic fascia from the perspective of regional anesthesia and pain therapy is notably absent. This narrative review aims to consolidate knowledge on the anatomy of pelvic fascia pertinent to regional anesthesia and pain management, detailing relevant pelvic nerves, and associated peripheral nerve blocking techniques.
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Minerva anestesiologica · Dec 2024
ReviewAssessment of the organ function as the primary intention of clinical reasoning applied to the critically ill patient.
This article examines how clinical reasoning about the critical patient is currently treated and draws attention to some critical issues already often highlighted in the literature. Traditional approaches to clinical reasoning, even when applied to critical patients, prioritize identifying structured diseases. In contrast, the critical care setting demands an alternative approach that aligns with the intensivist's goal of supporting or substituting vital organ functions. ⋯ This discourse emphasizes a deep understanding of physiology and pathophysiology as foundational for practical clinical reasoning in critical care. Finally, we propose a structured assessment method that prioritizes pinpointing the compromised organ function, elucidating the pathophysiological mechanism responsible, hypothesizing potential causes, and testing these hypotheses to guide therapeutic interventions. This approach aligns clinical reasoning with the intensivist's goal: supporting and restoring vital functions in the critically ill patient.
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Minerva anestesiologica · Dec 2024
Randomized Controlled TrialUltrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study.
Living donor hepatectomy is a procedure associated with notable postoperative pain, impacting patient recovery and satisfaction. Addressing this challenge, we aimed to examine the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) in postoperative analgesia management of patients undergoing living donor hepatectomy for liver transplantation. ⋯ ESPB displayed promise in effectively managing post-living donor hepatectomy pain, resulting in decreased opioid consumption, improved pain relief, and reduced rescue analgesia requirements. This technique holds potential to enhance recovery and patient satisfaction following donor hepatectomy.