Minerva anestesiologica
-
Hypnosis is a physiological mind activity characterized by focused attention, absorption, dissociation and plastic imagination. In the early 19th century, several hundred surgical interventions were described with hypnosis as the sole anesthetic, in an epoch when no anesthetic drugs were available; then hypnosis was prejudicially abandoned and forgotten after its introduction. In the past two decades, an increasing number of studies on hypnosis has shown its capacity to modify the activity of the prefrontal cortex, default mode network and pain neuromatrix (including the anterior cingulate cortex, amygdala, thalamus, insula and somatosensory cortex) and increase pain threshold up to the level of surgical anesthesia. ⋯ The wealth of data available in the literature provides clear evidence of its meaningful effects on perioperative emotional distress, pain, medication consumption, physiological parameters, duration of surgery and outcome. Hypnosis may be used as follows: 1) as sole anesthetic, in minor surgery and invasive maneuvers and/or selected patients; 2) as adjuvant of pharmacological anesthesia (local anesthesia and/or sedation); 3) as an adjuvant technique in both pre- and postoperative phases in patients submitted to general anesthesia. Hypnosis, unlike any other therapeutic tools, does not call for drugs or equipment and is an attractive technique: it is free of charge, not burdened with proved adverse events and promises to help improving cost/benefits ratio.
-
Minerva anestesiologica · Dec 2016
Randomized Controlled Trial Multicenter Study Comparative StudyBacterial colonization is decreased after tunneling femoral perineural catheters.
Infection of perineural catheter is rare, although bacterial colonization is frequent. An observational study reported that subcutaneous tunneling perineural catheter could decrease its colonization rate. We performed a comparative study to assess the incidence of catheter related bacterial colonization of tunnelized femoral perineural catheters. ⋯ Tunneled subcutaneous perineural catheter decreased the incidence of colonization. Moreover, tunnelization is an effective technique for securing the perineural catheter.
-
Minerva anestesiologica · Dec 2016
Multicenter StudyHospital disaster preparedness in Italy: a preliminary study utilizing the World Health Organization hospital emergency response evaluation toolkit.
Natural and human-initiated disasters are occurring with greater devastating consequences and increased frequency. During these events, hospitals have the burden to care for acutely ill and injured patients. The aim of this study was to evaluate the level of disaster preparedness of Italian hospitals. ⋯ The study revealed that a large majority of Italian hospitals evaluated are not well prepared to manage potential disasters. Also, all important elements of hospital preparedness, such as the command system, surge capacity, and safety, were insufficiently implemented. Nationwide standards, guidelines and procedures are required to improve hospital disaster preparedness in Italy.
-
Minerva anestesiologica · Dec 2016
Randomized Controlled TrialContinuous epidural versus wound infusion plus single morphine bolus as postoperative analgesia in open abdominal aortic aneurysm repair: a randomized non-inferiority trial.
We compared a bundle of interventions including wound infiltration and continuous infusion with local anesthetics plus a single morphine bolus (CWI-M) with continuous epidural infusion (CEI) as postoperative analgesia. ⋯ CWI-M was comparable to CEI in in postoperative pain control, but it was associated with higher need of rescue systemic opiates and with a worse early pain control.