Minerva anestesiologica
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Minerva anestesiologica · Jan 2018
ReviewRobotic-assisted thoracoscopic lung surgery: anesthetic impact and perioperative experience.
Anesthesiologists and the perioperative team have a tremendous impact upon clinical outcomes in robotic-assisted thoracoscopic surgery. As anesthesiology is developing its role outside the operating room, the patient population benefits from an expanded focus on perioperative critical care and pain management. This article focuses upon the preoperative optimization, unique intraoperative considerations for surgeons and anesthesiologists, and postoperative management of patients undergoing robotic-assisted thoracoscopic surgery.
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Minerva anestesiologica · Jan 2018
Survey in expert clinicians on validity of automated calculation of optimal cerebral perfusion pressure.
Optimal cerebral perfusion pressure (CPPopt) targeting in traumatic brain injury (TBI) patients constitutes an active and controversial area of research. It has been suggested that an autoregulation guided CPP therapy may improve TBI outcome. Prerequisites of a CPPopt intervention study would be objective criteria for the CPPopt detection. This study compared the agreement between automated and visual CPPopt detection. ⋯ The overall agreement between automated CPPopt and visual CPPopt identified by autoregulation experts was high, except for those cases when the curve was deemed by the clinicians not reliable enough to yield a trustworthy CPPopt.
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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
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.