Minerva anestesiologica
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Minerva anestesiologica · Jun 2014
Assessment of Perioperative Transfusion Requirement for Cirrhotic Patients Undergoing Elective Hepatectomy.
The possibility of outlining a risk profile for perioperative blood transfusion of cirrhotic patients submitted to hepatic resection can help to rationalize transfusion policy. ⋯ The risk profile for transfusion of cirrhotic patients undergoing hepatectomy can be better assessed with a model that combines already known clinical factors and hepatic function indexes.
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Minerva anestesiologica · Jun 2014
ReviewInconsistent Size Nomenclature in Extraglottic Airway Devices.
Extraglottic airway devices (EADs) are frequently used airway devices, yet often they seal poorly, resulting in a functionally unacceptable leak. Optimal size selection of the EAD is therefore critical to the safe and effective use of an EAD. This review is designed to delineate the sizing recommendations of EADs and indicate the differences in order to make the optimal choice for device effectiveness and patient safety. ⋯ Selecting the appropriate size of an EAD is critical to optimal use, although applying the correct size of an EAD has been subject of controversy, as recommendations on sizing differ substantially and are far from a coherent and universal sizing system. Successful use of an EAD depends in part on appropriate size selection, in addition to clinical judgment, as well as patient anatomy and physiology. Standardization in the use of EAD sizes and a consensus about a consistent size systematic of EADs would benefit to promote a safer clinical practice in airway management.
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Minerva anestesiologica · Jun 2014
ReviewProtective lung ventilation in operating room: Systematic Review.
Postoperative pulmonary and extrapulmonary complications adversely affect clinical outcomes and healthcare utilization, so that prevention has become a measure of the quality of perioperative care. Mechanical ventilation is an essential support therapy to maintain adequate gas exchange during general anesthesia for surgery. Mechanical ventilation using high tidal volume (VT) (between 10 and 15 mL/kg) has been historically encouraged to prevent hypoxemia and atelectasis formation in anesthetized patients undergoing abdominal and thoracic surgery. ⋯ There is, however, little evidence regarding a potential beneficial effect of lung protective ventilation during surgery, especially in patients with healthy lungs. Although surgical patients are frequently exposed to much shorter periods of mechanical ventilation, this is an important gap in knowledge given the number of patients receiving mechanical ventilation in the operating room. This review developed the benefits of lung protective ventilation during surgery and general anesthesia and offers some recommendations for mechanical ventilation in the surgical context.
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Minerva anestesiologica · Jun 2014
A pharmacokinetic study of 48-hour sevoflurane inhalation using a disposable delivery system (AnaConDa©) in ICU patients.
Little is known regarding sevoflurane kinetics and toxicity during long-term sedation of intensive care unit (ICU) patients using the AnaConDa® system. The objective of the present study was to establish a pharmacokinetic description of 48-h sevoflurane administration, and to estimate plasma concentrations of metabolites. ⋯ Following 48 hours of sedation using sevoflurane inhalation administered using an AnaConDa® delivery device, sevoflurane washout was rapid. Plasma fluoride levels accumulated over the study period without apparent nephrotoxicity.