Minerva anestesiologica
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Minerva anestesiologica · Mar 2014
ReviewThe "Normobaric Oxygen Paradox": a new tool for the anaesthetist?
Hypoxia is the natural trigger for endogenous EPO production but recently the use of intermittent hyperoxia to stimulate EPO has been postulated and this phenomenon has been called the "normobaric oxygen paradox" (NOP). The "NOP" is a mechanism by which oxygen regulates the expression of the Hypoxia Inducible Factor 1 alpha (HIF-1α). The HIF-1α-depending gene regulation is responsible for many different genetic expressions including EPO and VEGF. ⋯ The precise level of inspired oxygen and the exact timeframe for its iterative administration are not totally known. N-Acetyl-L-Cysteine (NAC) supplementation has been shown to help. All the reported data demonstrate how hyperoxic and hypoxic states can potentially be manipulated if oxygen is been considered as a multifaceted molecule more than just a gas.
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Minerva anestesiologica · Mar 2014
Current practice in obstetric anaesthesia: a 2012 European survey.
New scientific findings are gradually implemented into daily clinical routine. The present questionnaire survey investigated the current practice in obstetric anesthesia in Europe. ⋯ Subarachnoid anesthesia is mostly favored among European anesthesiologists, while general anesthesia is reserved only for cases with anticipated hemorrhage. Fluid coloading and phenylephrine have gained popularity, in line with current knowledge. Conversely, cricoid pressure, standard supplemental oxygen and high oxytocin doses ‑ though strongly questioned ‑ are still advocated by most anaesthesiologists.
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Minerva anestesiologica · Mar 2014
Management program decreases postoperative nausea and vomiting in high-risk and in general surgical patients: a quality improvement cycle.
Preventing postoperative nausea and vomiting (PONV) is a major priority for postsurgical patient care. Our objective was to assess the efficacy of a multimodal postoperative nausea and vomiting (PONV) approach, which was associated with a continuous quality improvement program, in maintaining a low PONV incidence in the PACU. ⋯ We highlight the association with a sharp decrease in PONV incidence over a one-year period and a multimodal PONV approach using feedback to clinicians associated with continuous quality improvement program.
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Minerva anestesiologica · Mar 2014
Review Meta AnalysisA review of the hemodynamic effects of external leg and lower body compression.
External leg and lower body compression (ELC) has been used for decades in the prevention of deep vein thrombosis and the treatment of leg ischemia. Because of systemic effects, the methods have regained interest in anesthesia, surgery and critical care. This review intends to summarize hemodynamic effects and their mechanisms. ⋯ ELC may help future research and optimizing treatment of hemodynamically unstable, surgical or critically ill patients, independent of plasma volume expansion.