Minerva anestesiologica
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Minerva anestesiologica · Jan 2018
Randomized Controlled TrialEfficacy of ultrasound-guided transversus abdominis plane block and rectus sheath block with ropivacaine and dexmedetomidine in elderly high-risk patients undergoing emergency abdominal surgery.
This study was designed to evaluate the effectiveness and safety of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks with ropivacaine and dexmedetomidine in elderly, high-risk patients undergoing emergency abdominal surgery. ⋯ Ultrasound-guided TAP and RS blocks with ropivacaine and dexmedetomidine are more effective in promoting block effect, prolonging the duration of analgesia, reducing postoperative pain in elderly high-risk patients undergoing emergency abdominal surgery.
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Minerva anestesiologica · Jan 2018
Review Comparative StudySuperiority of ultrasound guided Shamrock lumbar plexus block.
Ultrasound-guided lumbar plexus block (LPB) performed with the Shamrock approach has received much interest since the technique was first described in 2013. The technique is believed to be faster and easier to perform and possibly safer in regards to potential complications compared with other LPBs. In order to outline some favorable characteristics of the Shamrock LPB, we performed an exhaustive search of the current literature; even though it is rather limited. ⋯ The needle trajectory and needle tip location just lateral to the lumbar plexus probably reduces the risk of adverse effects and complications. Ultrasound guided lumbar plexus blockade is an expert technique. The Shamrock technique improves but does not eliminate all the challenges of ultrasound-guided LPB technique.
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Minerva anestesiologica · Jan 2018
ReviewMucosal and cutaneous capnometry for the assessment of tissue hypoperfusion.
In critically ill patients, tissue hypoperfusion is an important cause leading to multi-organ dysfunction and death, and it cannot always be detected by measuring standard global hemodynamic and oxygen-derived parameters. Gastric intramucosal partial pressure of carbon dioxide (PCO2) as measured by gastric tonometry has been recognized to be of clinical value as a prognostic factor, in assessing the effects of particular therapeutic interventions, and as an end-point of resuscitation. However, this technique has several limitations that have hampered its implementation in clinical practice. ⋯ Clinical studies have established that high PslCO2 values and, more especially, high PslCO2 gap (PslCO2 - arterial PCO2) values are correlated with impaired microcirculatory blood flow and a poor outcome in critically ill patients. Sublingual capnography seems to be the ideal noninvasive monitoring tool to evaluate the severity of shock states and the adequacy of tissue perfusion. However, clinical studies are needed to determine the clinical utility of PslCO2 gap monitoring as end-point target to guide resuscitation in critically ill patients.
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Minerva anestesiologica · Jan 2018
Randomized Controlled Trial Comparative StudyClosed loop ventilation mode in intensive care unit: a randomized controlled clinical trial comparing the numbers of manual ventilator setting changes.
There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. ⋯ For mechanically ventilated ICU patients, INTELLiVENT-ASV® significantly reduces the number of manual ventilator setting changes with the same number of arterial blood gas analysis and sedation dose, and is easier to use for the caregivers as compared to conventional ventilation modes.