Articles: operative.
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Paediatric anaesthesia · Aug 2020
The predictive value of the Pleth Variability Index on fluid responsiveness in spontaneously breathing anaesthetized children - a prospective observational study.
In children the preoperative hydration status is an important part of the overall clinical assessment. The assumed preoperative fluid deficit is often routinely replaced during induction without knowing the child's actual fluid status. ⋯ The Pleth Variability Index may be of additional value topredict fluid responsiveness in spontaneously breathing anesthetized children. A significant overlap in baseline Pleth Variability Index values between fluid responsive and non fluid responsive patients does not allow a reliable recommendation as to acut-off value.
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Paediatric anaesthesia · Aug 2020
Case ReportsAnesthetic Implications of a Pediatric Patient with Stiff Skin Syndrome: A Case Report.
Stiff Skin Syndrome (SSS) is a rare genetic syndrome characterized by rock-hard, indurated skin and joint contractures that worsen with age. Difficulties with mask ventilation should be expected due to the restrictive effect of the skin overlying the chest and abdomen, especially after muscle relaxation. ⋯ SSS patients may experience diffuse entrapment peripheral neuropathy at contracted joints increasing the vulnerability to intraoperative nerve damage. Oral psoralens can cause nausea so antiemetic prophylaxis should be considered for SSS patients on PUVA therapy.
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Minerva anestesiologica · Aug 2020
Opioid free anesthesia: evidence for short and long-term outcome.
The introduction of synthetic opioids in clinical practice played a major role in the history of anesthesiology. For years, anesthesiologists have been thinking that opioids are needed for intraoperative anesthesia. However, we now know that opioids (especially synthetic short-acting molecules) are definitely not ideal analgesics and may even be counterproductive, increasing postoperative pain. ⋯ OFA may also increase patient-reported outcomes; despite it is difficult to specifically rule out the effect of intraoperative opioids. Finally, few data are available on long-term outcomes (persistent pain and opioid abuse, cancer outcome). New studies and data are required to elaborate the optimal approach for each patient/surgery, but interest and publication are increasing and may open the road to the wider adoption of OFA.
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Minerva anestesiologica · Aug 2020
Postoperative fatigue after day surgery: prevalence and risk factors. A prospective observational study.
Postoperative fatigue (POF) is a major cause of rehabilitation failure after surgery. POF is a complication that could negatively affect outpatients but to date no study has specifically investigated POF at home after day surgery. The objective of this study was to assess early and late POF and risk factors for POF after day surgery. ⋯ This work suggests that early and late POF are common after day surgery but that severe POF is rare. Postoperative pain is the main risk factors for the early POF. The optimized management of postoperative pain could probably decrease the prevalence of POF after day surgery.