Minerva anestesiologica
-
Minerva anestesiologica · Feb 2017
Prevention of Respiratory Insufficiency after Surgical Management (PRISM) trial: report of the protocol for a pragmatic randomised controlled trial of Continuous Positive Airway Pressure (CPAP) to prevent respiratory complications and improve survival following major abdominal surgery.
Over 300 million patients undergo surgery worldwide each year. Postoperative morbidity - particularly respiratory complications - are most frequent and severe among high-risk patients undergoing major abdominal surgery. However, standard treatments, like physiotherapy or supplemental oxygen, often fail to prevent these. Preliminary research suggests that prophylactic continuous positive airways pressure (CPAP) can reduce the risk of postoperative respiratory complications. However, without evidence from a large clinical effectiveness trial, CPAP has not become routine care. This trial aims to determine whether early postoperative CPAP reduces the incidence of respiratory complications and improves one-year survival following major intra-peritoneal surgery. ⋯ This is the first proposed clinical effectiveness trial of postoperative CPAP to prevent respiratory complications of which we are aware. The large sample size and multicenter international design will make the result generalizable to a variety of healthcare settings.
-
Minerva anestesiologica · Feb 2017
Preoperative functional assessment and optimization in surgical patient. Changing the paradigm.
Functional capacity has been shown to be a major determinant of surgical outcome since it is related to postoperative complications, activity and daily function, level of independence and quality of life. Anesthesiologists as "perioperative physicians", can identify those scoring systems that assess functional capacity, whether from the basic physical history and walk test to the most complex such as cardiopulmonary exercise testing, and formulate intraoperative and postoperative interventions (rehabilitation) to minimize the impact of surgery on the recovery process. Nevertheless, the preoperative period can be used as an opportune time to increase functional reserve in anticipation of surgery, thus enabling the patient to better withstand the metabolic cost of surgical stress (prehabilitation). There is a compelling evidence that prehabilitation programs, including physical exercise, nutritional optimization and relaxation strategies, can enhance preoperative physiological reserve, however further studies are needed to identify the most appropriate protocols for those patients at risk, and assess the impact of such programs on clinically meaningful surgical outcomes.
-
Minerva anestesiologica · Feb 2017
Meta AnalysisAnalgesia-Nociception monitoring for opioid guidance: meta-analysis of randomized clinical trials.
The adequate suppression of nociception is, besides induction of unconsciousness and immobility, the main objective during anesthesia. Analgesics, most commonly opioids, are usually titrated by established clinical surrogates of nociception. Recently, monitoring techniques became available to evaluate analgesia/nociception during anesthesia and provide better measures then clinical evaluation alone. They are primarily derived from autonomic response on physiologic standard measures. ⋯ Monitoring analgesia/nociception is often reliant on regular physiologic conditions, like sinus rhythm. Opioid guidance dependent on analgesia/nociception monitoring during anesthesia may have beneficial and clinically relevant effects, however the number of currently available randomized controlled studies is low and conclusions are hampered by heterogeneity. More studies with focussed clinical endpoints are therefore needed.