Minerva anestesiologica
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Minerva anestesiologica · Sep 2013
ReviewPostoperative delirium: Risk factors, diagnosis and perioperative care.
Postoperative delirium (PD) relates to increased morbidity -associated with prolonged hospital stay, institutionalization and persistent functional and cognitive decline- poor long term outcome and higher perioperative mortality. Aim of this literature review is to identify established risk factors for PD and to categorize them according timing of occurrence (pre, intra and post operative), and clinical impact (Odds ratio [OR], % increase in incidence of PD). ⋯ medical literature databases (medline and embase) were searched for published manuscripts on "postoperative delirium". Predictors and preoperative risk factors for PD were categorized into 4 groups: demographics; co morbidities; surgery and anesthesia-related (age, education, laboratory anomalies, smoking habits, benzodiazepines premedication, cardiac and thoracic surgery, etc). Intra operative risk factors for PD were categorized into 2 groups: surgery and anesthesia-related (anemia, duration and type of surgery, selected opioid, intraoperative hypotension, etc). Post operative risk factors and precipitating factors include various pathophysiological and environmental conditions, (i.e., ICU admission, low cardiac output requiring inotropes infusion; new onset atrial fibrillation; persistent hypoxia or hypercarbia; use of narcotic analgesics, delayed ambulation, inadequate nutritional status; sensory deprivation, etc). In conclusion, the effective identification, prevention and treatment of pre, intra and postoperative risk factors are the cornerstones for the prevention of PD. A dedicated perioperative care path that encompasses a tailored selection of drugs used perioperatively, the appropriate anesthesia strategy, qualified nursing surveillance, systematic use of diagnostic tools and accurate staff communication reduces the incidence and clinical impact of PD.
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Minerva anestesiologica · Sep 2013
Randomized Controlled TrialHemodynamic changes associated with spinal and general anesthesia for hip fracture surgery in severe ASA III elderly population: a pilot trial.
Patients affected by hip fracture (HF) have high risk of perioperative complications. Despite regional anesthesia is widely used, hypotension is common and increases the risk of myocardial ischemia. The aim of this work was to study hemodynamic changes following spinal (SA) and general (GA) anesthesia in this selected population of patients. ⋯ SA in the elderly population with hip fracture provides a more stable hemodynamic profile requiring less intervention to keep MAP close to baseline value. Hypotension was common in SA and GA after induction and within intraoperative period. A larger randomized clinical study should be performed to confirm these preliminary data.
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Minerva anestesiologica · Sep 2013
Tracheal amylase dosage as a marker for microaspiration: a pilot study.
Devices that limit microaspiration through the cuffs of endotracheal tubes could help prevent ventilator-associated pneumonia (VAP). The amount of tracheal microaspirations could be a relevant study endpoint. The aim of our study was to assess whether amylase measured in tracheal secretions constituted a relevant marker for microaspiration. ⋯ Tracheal amylase was easy to collect, transport, and measure. The T/O amylase ratio is a first step towards quantifying oropharyngeal to tracheal microaspiration in mechanically-ventilated patients.
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Minerva anestesiologica · Sep 2013
Management of the patient with diabetic peripheral neuropathy presenting for peripheral regional anaesthesia: a European survey and Review of literature.
Diabetic peripheral neuropathy (DPN) is a frequent complication of longstanding diabetes mellitus. There is no evidence-based consensus whether neuropathic patients undergoing peripheral regional anesthesia are at increased risk of neurologic damage. It is unknown whether these controversial results have been incorporated into clinical practice. We conducted a survey to test the hypothesis that the majority of respondents would consider DPN a potential risk factor for nerve damage in regional anesthesia, and would adapt their technique when performing regional anesthesia. In parallel, we sought to summarize the current knowledge-base regarding regional anesthesia and DPN. ⋯ In conclusion, we report the results of the first survey analyzing attitudes and standards of care among European anesthesiologists with regards to regional anesthesia in DPN. While literature is divided on the question whether pre-existing diabetic neuropathy is a risk factor for new neurological deficit after regional anesthesia, most of the responders of this survey take measures to reduce risks, counsel patients on a possible greater risk of neurologic complications, but only a minority of responders would avoid peripheral regional anesthesia altogether.
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The infusion of hydroxyethylstarch (HES) containing fluids has been extremely common worldwide over the last decade. Until recently, HES was probably the most commonly prescribed colloidal preparation in the world. Such prescription continued despite concerns that starch molecules might accumulate in vital organs and that starch preparations might decrease the coagulability of blood. ⋯ Subsequent meta-analyses have confirmed these findings. In response to such strong evidence, over the last few weeks, the Food and Drug Administration has issued a major warning and, in Europe, the EMA suspended the marketing authorization for HES. At least in Europe, the clinical story of HES seems to have come to an end.