Minerva anestesiologica
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Minerva anestesiologica · Oct 2017
Randomized Controlled Trial Comparative StudyComparison of absolute fluid restriction versus relative volume redistribution strategy in low central venous pressure anesthesia in liver resection surgery: a randomized controlled trial.
BACKGROUNDː Lowering central venous pressure (CVP) can decrease blood loss during liver resection and it is associated with improved outcomes. Multiple CVP reducing maneuvers have been described, but direct comparison of their effectiveness and safety has never been performed. METHODSː Patients undergoing resections of two or more liver segments were equally randomized to absolute fluid restriction (AR, N.=17) or relative volume redistribution group (RR, N.=17). ⋯ CONCLUSIONSː In our study, absolute fluid restriction and relative volume redistribution seemed to be equally effective and safe methods of lowering CVP in patients undergoing liver resection. According to our data high SVV might be considered as a low CVP replacement. Pringle maneuver reduced blood loss and transfusion requirement.
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Minerva anestesiologica · Oct 2017
Observational StudyThoracic trauma and acute respiratory distress syndrome in polytraumatized patients admitted to a level I trauma center: a retrospective analysis.
Although thoracic trauma has often been associated with the development of acute respiratory distress syndrome (ARDS) in general, its impact on ARDS in combination with severe concomitant injuries has still to be elucidated. Therefore, the objective of this study was to determine the frequency of thoracic trauma and ARDS in polytraumatized patients, and to evaluate the impact of thoracic trauma on the occurrence and the onset of ARDS. ⋯ Thoracic trauma was identified as major risk factor for ARDS occurrence and earlier onset in polytrauma victims.
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Transportation of a patient between medical facilities without interruption of the medical treatment can be a challenging task. This review aims to define the term "interhospital transport" and give a general overview of the steps for organizing a transfer. Furthermore we discuss the team qualification, equipment standards and how to manage adverse events before and during transport by means of patient triage. ⋯ Relocation team members need a specific training that focus on typical critical events that happen during transport. Technical equipment (ventilator, stretcher, monitor, defibrillator, external pacemaker, blood-gas analyzer) facilitates smooth patient transition from one facility to a distant one. The use of checklists is associated with a reduction of incidents during the transport.
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Minerva anestesiologica · Oct 2017
Comparative StudyIntraoperative dexmedetomidine sedation reduces the postoperative agitated behaviour in elderly patients undergoing orthopaedic surgery compared to the propofol sedation: a retrospective analysis of 855 patients.
Postoperative agitation or confusion is one of the symptoms of hyperactive delirium in elderly patients. We retrospectively evaluated the incidence of postoperative abnormal psychomotor behavior in elderly surgical patients according to the use of different intraoperative sedative agents: dexmedetomidine vs. propofol. ⋯ This study suggests that intraoperative dexmedetomidine sedation, as compared with propofol sedation, may have a greater beneficial effect in reducing agitated behavior in elderly patients undergoing orthopedic surgery with regional anesthesia.