Minerva anestesiologica
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Minerva anestesiologica · May 2011
ReviewGoal-directed therapy in anesthesia: any clinical impact or just a fashion?
Goal-directed therapy (GDT) describes the protocolized use of cardiac output and related parameters as end-points for fluid and/or inotropic therapy administration. Identifying the patient who will benefit from it has implications throughout perioperative management. The fundamental principle behind GDT is optimizing tissue perfusion by manipulating heart rate, stroke volume, hemoglobin and arterial oxygen saturation to improve oxygen delivery by using fluids, inotropes, red blood cells and supplementary oxygen. ⋯ To date, the quantity and the type of fluids to administer during major elective surgery remain an object of continuing debate. In conclusion, in terms of evidence-based medicine, GDT during anesthesia has a clinical impact when performed using an FTc-based fluids algorithm protocol. In contrast, GDT can be considered unreliable if confusing targets such as SvO2 or ScvO2 higher than 70% during anesthesia are followed.
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Hypoxemia is considered to be the most important challenge during one-lung ventilation (OLV). Recent studies, however, have shown that one-lung ventilation can involve some lung damage and can therefore be per se a cause of hypoxemia. OLV can be associated to an injury: but the techniques used to improve oxygenation may also damage the lung. A new ventilator approach should be used and applied with regards to what is so far known in terms of "lung protection" also during OLV.
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Minerva anestesiologica · May 2011
HLA-DR and B7-2 (CD86) monocyte expressions after major cancer surgery: profile in sepsis.
HLA-DR monocyte expression may be affected by major surgery. A potential mechanism for monocyte activation is the engagement of costimulatory receptors (B7-2 or CD-86). The aim of the present study was to determine the possible role of monocyte HLA-DR and B7-2 molecules in the occurrence of postoperative sepsis after major cancer surgery. ⋯ Results suggest a key role for costimulatory molecules in modulating inflammatory response in the context of subsequent postoperative sepsis after major cancer surgery. These molecules may be involved, in association with HLA-DR, in postoperative monocyte dysfunction.