Minerva anestesiologica
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Minerva anestesiologica · Aug 2015
ReviewOPRM1 receptor as new biomarker to help the prediction of post mastectomy pain and recurrence in breast cance.
Breast cancer is the most common type of cancer among women worldwide. Short-term postsurgical recovery is complicated by many factors, including imbalanced inflammatory and immune response, acute pain associated with functional impairment, and chronic postmastectomy pain (CPMP), developed by about 25-60% of patients. Opioids, most common drugs used for treatment of cancer pain, are immunosuppressive, and therefore, they might directly and/or indirectly influence long-term cancer recurrence. ⋯ Hence OPRM1 might be used in near future to customize the opioid therapy, avoiding not only opioid side effects but also the disease progression. In this review we evaluate the literature state of the art on this topic and possible steps towards obtaining the safest individualized postmastectomy analgesic therapy. Therefore, a personalized pain treatment strategy might be useful to both manage pain and control cancer disease progression.
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Because intubation can potentially become a lengthy procedure, the risk of arterial oxygen (O2) desaturation during intubation must be considered. Preoxygenation should be routine, as oxygen reserves are not always sufficient to cover the duration of intubation. Three minutes of spontaneous breathing at FiO2=1 allows denitrogenation with FAO2 close to 95% in patients with normal lung function. ⋯ O2 can also be administered during the intubation procedure; techniques include pharyngeal O2, special oxygen mask, or even pressure support ventilation for patients with spontaneous ventilation or positive pressure ventilation to the facial mask for apneic patients. Clinicians (especially anesthesiologists trained in ENT and traumatology) must be prepared to handle life-threatening emergency situations by alternate methods including trans-tracheal ventilation. The availability of equipment and training are two essential components of adequate preparation.
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Minerva anestesiologica · Aug 2015
Observational StudyAssessment of cerebral oxygenation in neurocritical care patients: comparison of a new four wavelengths forehead regional saturation in oxygen sensor (EQUANOX™) with brain tissue oxygenation. A prospective observational study.
Because of restricted information given by monitoring solely intracranial pressure and cerebral perfusion pressure, assessment of the cerebral oxygenation in neurocritical care patients would be of interest. The aim of this study was to determinate the correlation between the non-invasive measure regional saturation in oxygen (rSO2) with a third generation NIRS monitor and an invasive measure of brain tissue oxygenation tension (PbtO2). ⋯ rSO2 cannot be used as a substitute for PbtO2 to monitor cerebral oxygenation in neurocritical care patients.