Minerva anestesiologica
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Minerva anestesiologica · Apr 2018
Randomized Controlled Trial Comparative StudyAirway management with fastrach laryngeal mask versus spritztube: a prospective randomised manikin-based study.
A new promising device, the Spritztube (ST), was developed combining the ability to perform both supraglottic ventilation and orotracheal fibreoptic intubation using the same device, allowing an easy passage from supraglottic ventilation to tracheal ventilation avoiding apnea. The present study aims to compare the speed and the subjective ease of insertion of the novel tracheal tube (Spritztube®) compared to the intubating laryngeal mask airway Fastrach™ (FT-LMA) in a simulation environment. ⋯ In a manikin simulation setting, insertion and intubation with and ST was performed 11 s slower than with use of a FT-LMA.
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Minerva anestesiologica · Apr 2018
Randomized Controlled TrialRepeated alveolar recruitment maneuvers with and without positive end-expiratory pressure during bariatric surgery: a randomized trial.
Positive end-expiratory pressure (PEEP) is considered essential in protective ventilation, while it may lead to hemodynamic impairment. In the present study, we investigated the effect of repeated alveolar recruitment maneuvers (ARMs) with or without additional PEEP on the arterial oxygenation of obese patients who were undergoing bariatric surgery. ⋯ Repeated ARMs, either with or without PEEP, improve early postoperative oxygenation and shorten time to extubation. ARMs without PEEP result in lower airway pressure and less hemodynamic impairment in patients who were undergoing bariatric surgery.
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Minerva anestesiologica · Apr 2018
Assessment of rotational thromboelastometry for the prediction of red blood cell requirements in orthotopic liver transplantation.
In liver transplantation most studies were designed to predict massive transfusion rather than whether or not transfusion is required. We hypothesized that (presurgery) data from thromboelastometry may predict perioperative blood requirements. ⋯ Presurgical EXTEM maximum amplitude at 10 min <35 mm is highly predictive of red blood administration during liver transplantation.
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There is an increased interest in the current literature to evaluate the potential clinical benefit of a sustained deep neuromuscular blockade (i.e. a post-tetanic count ≤3) during various laparoscopic surgical procedures. This deep block concept represents a new area of clinical research, which concerns both, anesthesiologists and surgeons. We reviewed a selection of recent publications about the indications and the potential benefits of a maintained deep neuromuscular blockade during different laparoscopic procedures. ⋯ Moreover, first evidence suggests that deep block may reduce perioperative surgical complications and improve patient's outcome. There are situations during laparoscopic surgery where a better communication between surgeon and anesthesiologist may improve patient's outcome. Moreover, clinical research has now to identify which additional procedures and type of patients may benefit most from this new deep block concept and ultimately, whether the implementation of a routine deep neuromuscular block may affect patient's outcome.