Minerva anestesiologica
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Minerva anestesiologica · Dec 2017
Randomized Controlled TrialThe impact of Dexmedetomidine or Xylocaine continuous infusion on opioid consumption and quality of recovery following laparoscopic sleeve gastrectomy: a randomized double blinded controlled study.
Postoperative pain control for morbidly obese patients represents a challenge because of their sensitivity towards opioid-induced respiratory depression. We elected both dexmedetomidine and xylocaine (lidocaine) continuous infusions as adjuvants because they lack respiratory depression side effect. ⋯ Continuous infusion of either dexmedetomidine or xylocaine reduces postoperative opioid consumption, pain and improve the quality of recovery following laparoscopic sleeve gastrectomy.
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Minerva anestesiologica · Dec 2017
Meta AnalysisRisk of spontaneous fungal peritonitis (SFP) in hospitalized cirrhotic patients with ascites: a systematic review of observational studies and meta-analysis.
Spontaneous fungal peritonitis (SFP) is an infection of ascitic fluid occurring in cirrhotic patients. SFP prevalence varies from 0% to 41% of patients with spontaneous peritonitis (SP) and a positive ascitic fluid culture. Cirrhotic patients with SFP who fail to show improvement with empirical antibiotic therapy, before the identification of the fungal pathogen, have high mortality (89.5-100%). Although the weight of the disease is so dramatic, more recent guidelines on infections in cirrhosis do not consider SFP management. The aim of this meta-analysis was to investigate the association between hospitalization (at least 48-72 hours after admission) and risk of SFP. ⋯ This meta-analysis suggests that hospitalization is related to a significant increase of SFP risk.
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Minerva anestesiologica · Dec 2017
ReviewThe surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery.
The immediate postoperative course in the post-anesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the difficulties that may delay the postoperative recovery. ⋯ The main finding is that current evidence suggests inflammation to potentially impair on almost all organ dysfunctions observed in the post-anesthesia care unit (PACU), but with a scarcity of intervention studies using glucocorticoids to control inflammation. We, therefore, suggest a future research focus on the role of inflammation and effect of glucocorticoids in the PACU setting to improve patient recovery.