Minerva anestesiologica
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Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. ⋯ In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data.
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Postoperative urinary retention (POUR) occurs after lower joint arthroplasty with an incidence between 0% and 75%. This vast range reflects the differences in diagnosis and management of POUR. At present, clinical practice includes either preoperative insertion of an indwelling catheter to be removed after 24-48 postoperative hours or postoperative intermittent in-and-out catheterization performed either at scheduled times (every 6-8 hours) or as necessary. ⋯ The purpose of the present article is to review the published data on the effects of analgesia techniques on the development of POUR after hip and knee arthroplasty. General and regional anesthesia are implicated in the etiology of POUR; however, type and duration do not correlate with its incidence. Of the different postoperative analgesic techniques currently used, continuous peripheral nerve block has the least impact on POUR.
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Minerva anestesiologica · Feb 2010
Case ReportsSuccessful emergent reintubation using the Aintree intubation catheter and a laryngeal mask airway.
Tracheal extubation can be potentially catastrophic, especially in patients with difficult airways. This article describes a case where planned extubation in a patient with a large tongue lesion led to complete airway obstruction and subsequent cardiac arrest. Reintubation was facilitated using a laryngeal mask airway and an Aintree intubation catheter.
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Minerva anestesiologica · Feb 2010
Open intensive care units: a regional survey about the beliefs and attitudes of healthcare professionals.
We aimed at assessing the opinion and degree of acceptance of physicians and nurses in Intensive Care Units (ICUs) toward an open ICU as our regional ethical committee has advised that ICU visitation policies be reformed using such a new approach. ⋯ This study points out that, in our region, physicians are more liberal and able than nurses to "customize" their wards to the specific psychosocial and emotional needs of patients and visitors.
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Postoperative pulmonary complications (PPC) account for a substantial portion of the risks related to surgery and anesthesia and are a source of postoperative morbidity, mortality and longer hospital stays. The current basis for our understanding of the nature of PPC is weak; only a small number of high-quality studies are available, a uniform definition has not emerged, and studies have focused on specific patients and kinds of surgeries. ⋯ Age, general co-morbidity, pre-existing respiratory and cardiac diseases, the use of general anesthesia and the overall surgical insult. are the most significant factors associated with complications. Election of anesthetic technique, postoperative analgesia and physical therapy seem to be the preventive measures that are best supported by evidence.