Minerva anestesiologica
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Minerva anestesiologica · Jul 2015
Time course of cytokines, hemodynamic and metabolic parameters during hyperthermic intraperitoneal chemotherapy.
Systemic response to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) causes the activation of endocrine, metabolic, hemodynamic and inflammatory processes. The aim of this work is to describe and analyze the time course of the inflammatory markers concentration during CRS+HIPEC in plasma and peritoneal fluids and the association with hemodynamic and metabolic parameters. ⋯ The most significant variations are those of IL-6 and PCT. The cytokines level parallel the hemodynamic derangements. Treatment during HIPEC should mimic the established treatment during sepsis and septic shock.
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Minerva anestesiologica · Jul 2015
Editorial CommentAbout the benefits and limitations of pilot studies.
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Minerva anestesiologica · Jul 2015
ReviewSurveillance samples and selective digestive decontamination in the intensive care unit.
Surveillance cultures are essential in the management of infection in the intensive care unit. They are crucial in the assessment of the efficacy of selective digestive decontamination.
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Minerva anestesiologica · Jul 2015
Targets of perioperative fluid therapy and their effects on postoperative outcome: A systematic review and meta-analysis.
Perioperative fluid management plays a fundamental role in maintaining organ perfusion, and is considered to affect morbidity and mortality. Targets according to which fluid therapy should be administered are poorly defined. This systematic review aimed to identify specific targets for perioperative fluid therapy. ⋯ Targeting any one of these goals resulted in less postoperative complications (pooled data analysis: OR 0.53; CI95, 0.34-0.83; P=0.005) and a shorter length of intensive care unit/hospital stay, but no difference in postoperative mortality (pooled data analysis: OR 0.61; CI95, 0.33-1.11; P=0.12). This systematic review identified three goals for perioperative fluid administration, targeting of which appeared to be associated with less postoperative complications and shorter intensive care unit/hospital lengths of stay. Perioperative mortality remained unaffected.
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Minerva anestesiologica · Jul 2015
Observational StudyPreoperative autonomic nervous system analysis may stratify the risk of hypotension after spinal anaesthesia.
Studies on pregnant women undergoing cesarean delivery or elderly men scheduled for prostate brachytherapy have demonstrated the predictive value of heart rate variability (HRV) analysis for hypotension during spinal anesthesia. We conducted a prospective observational study to investigate if preoperative HRV analysis may have a role in identifying the risk of hypotension following spinal anesthesia in otherwise healthy patients. ⋯ Preoperative analysis of autonomic nervous system modulation might be useful to stratify the risk of post-spinal hypotension and it might indicate the need for careful monitoring or prophylactic fluids.