Minerva anestesiologica
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Minerva anestesiologica · Mar 2016
Point-of-care coagulation management algorithms during ECMO support: are we there yet?
Haemorrhagic and thromboembolic events are common and the main cause for morbidity and mortality in patients treated with extracorporeal membrane oxygenation (ECMO). Monitoring of an adequate anticoagulation is, therefore, essential in patients during ECMO therapy. This review aims to describe the current evidence and emerging data relating to anticoagulation therapy and point-of-care (POC) coagulation monitoring in ECMO patients. ⋯ However, no single laboratory-based or POC coagulation test can reliably predict the emergence of haemorrhagic or thrombotic events. Further, treatment algorithms based on POC testing are scarce for ECMO patients. Larger prospective studies are necessary to evaluate the usefulness of POC coagulation monitors or a combination of them in potentially improving anticoagulation and decreasing haemorrhagic and thromboembolic complications.
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Minerva anestesiologica · Mar 2016
Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study.
Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. ⋯ The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due to pre-existing kidney disease and postoperative hypotension, calling for increased focus on perioperative fluid management and optimisation of the perioperative care of patients with pre-existing kidney disease.
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Minerva anestesiologica · Mar 2016
Near-zero difficult tracheal intubation and tracheal intubation failure rate with the "Besta Airway Algorithm" and "Glidescope® in morbidly obese" (GLOBE).
Unpredicted Difficult Tracheal Intubation (DTI) with Macintosh occurs frequently in obese patients. We investigated the incidence of DTI using an algorithm based on pre-operative assessment with the El-Ganzouri Risk Index (EGRI) and Glidescope® routine use. ⋯ The incidence of Difficult Tracheal Intubation and Intubation Failure was reduced to near-zero using Glidescope® and the Besta Airway Algorithm in this sample of morbidly obese patients.
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Minerva anestesiologica · Mar 2016
Observational StudyDynamic view of postoperative pain evolution after total knee arthroplasty: a prospective observational study.
Having a dynamic view of postoperative pain resolution allows a better understanding of the transition towards chronic pain. Sleep and quality of life are important determinants of satisfaction after total knee arthroplasty (TKA), besides functional recovery and pain. ⋯ The trajectories of the different types of pain after TKA show their non-linear evolution, highlighting the need of a better pain control at precise moments. Sleep disturbances and alterations of quality of life are still present one year after the surgery.