Articles: operative.
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Minerva anestesiologica · Jan 2025
The impact of remimazolam compared to propofol on postoperative delirium: a systematic review and meta-analysis.
The administration of benzodiazepines has been linked to the occurrence of postoperative delirium (POD) among patients undergoing surgery. In this review, we aim to appraise the current controversy regarding the role of remimazolam in POD. ⋯ Based on the available evidence, perioperative remimazolam administration is not associated with a significant rise in the incidence of POD.
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Minerva anestesiologica · Jan 2025
Transesophageal echocardiography monitoring for liver transplantation: where are we now?
Intraoperative hemodynamic monitoring is crucial for managing patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT) due to their complex cardiovascular and pulmonary abnormalities. Traditionally, pulmonary artery catheterization (PAC) has been the standard for hemodynamic monitoring during OLT. However, the use of transesophageal echocardiography (TEE) has increased due to its real-time visualization of cardiac and vascular structures, which aids in managing hemodynamic instability during the three surgical phases of OLT: pre-anhepatic, anhepatic, and neo-hepatic. ⋯ Although TEE in patients with ESLD poses risks, particularly in the presence of esophageal varices, studies show a low incidence of complications when performed by experienced operators. Focused TEE protocols have proven effective in detecting common causes of hemodynamic instability with fewer views. This review summarizes the applications and safety considerations of TEE during OLT.
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Anesthesia and analgesia · Jan 2025
Effects of Variable Ventilation on Gas Exchange in an Experimental Model of Capnoperitoneum: A Randomized Crossover Study.
The rapid advancement of minimally invasive surgical techniques has made laparoscopy a preferred alternative because it reduces postoperative complications. However, inflating the peritoneum with CO2 causes a cranial shift of the diaphragm decreasing lung volume and impairing gas exchange. Additionally, CO2 absorption increases blood CO2 levels, further complicating mechanical ventilation when the lung function is already compromised. Standard interventions such as lung recruitment maneuvers or increasing positive end-expiratory pressures can counteract these effects but also increase lung parenchymal strain and intrathoracic pressure, negatively impacting cardiac output. The application of variability in tidal volume and respiratory rate during mechanical ventilation to mimic natural breathing has shown benefits in various respiratory conditions. Therefore, we aimed to evaluate the short-term benefits of variable ventilation (VV) on gas exchange, respiratory mechanics, and hemodynamics during and after capnoperitoneum, compared to conventional pressure-controlled ventilation (PCV). ⋯ The detrimental effects of capnoperitoneum on gas exchange were more pronounced with VV. However, after the release of capnoperitoneum, VV significantly improved CO2 clearance. Therefore, VV could possibly be considered as an alternative ventilation modality to restore physiological gas exchange after, but not during, capnoperitoneum.