Minerva anestesiologica
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Minerva anestesiologica · Dec 2024
A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block.
Locoregional anesthesia is commonly used in orthopedic trauma surgery, particularly in elderly patients. We conducted a prospective, monocentric, randomized controlled trial to evaluate the anesthetic and analgesic efficacy of pericapsular nerve group (PENG) block in patients on antithrombotic drugs undergoing hip fracture surgery, comparing it with femoral and obturator nerve block (FNB+ONB). ⋯ Our results suggest that PENG block is not inferior to FNB + ONB as anesthetic and analgesic technique in patients on antithrombotic drugs undergoing hip fracture surgery.
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Minerva anestesiologica · Dec 2024
Awake veno-venous extracorporeal membrane oxygenation: practical aspects and considerations.
Veno-venous extracorporeal membrane oxygenation (ECMO) is a life-saving technique in the armamentarium of critical care medicine. It involves extracorporeal blood circulation outside the body, providing temporary respiratory support while allowing the lungs to heal. ⋯ The "awake ECMO" concept emerged as a promising strategy to mitigate sedation-related complications and facilitate early mobilization in critically ill patients. In this article, we describe the potential advantages of awake ECMO and its role in preserving respiratory muscle function, enhancing rehabilitation prospects, and improving patient outcomes.
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Minerva anestesiologica · Dec 2024
Comparison of two approaches to quadratus lumborum block for postoperative analgesia in radical cystectomy: a randomized clinical trial.
The aim of this study was to evaluate the analgesic effects following radical cystectomy using two ultrasound guided QLB techniques: anterior and intramuscular. ⋯ Compared with QLBi, bilateral ultrasound guided QLBa provided a longer time to the first analgesic request, less postoperative opioid consumption, lower NRS at rest and on movement, and higher patients' satisfaction after radical cystectomy under general anesthesia.
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Airway management is often a life-saving procedure for patients. However, during airway management, difficult ventilation and difficult intubation are not always predictable. Preoxygenation, a crucial technique to improve oxygen reserves, plays a vital role in preventing hypoxemia during anesthesia induction. Preoxygenation technology and equipment are not monolithic. With the development of preoxygenation equipment and technology, the effect of preoxygenation has been improved, and it can be applied to different clinical settings. ⋯ Preoxygenation is really effective, and different preoxygenation equipment and technology can be applied in different clinical settings to improve the oxygen reserve of patients, thereby ensuring patient safety and improving patient outcome.
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Minerva anestesiologica · Dec 2024
New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.
The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. ⋯ The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.