Minerva anestesiologica
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Minerva anestesiologica · Oct 2019
Editorial CommentDo we need a strategy to reduce postoperative hypoxemia in morbidity obese patients?
Abstract
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Minerva anestesiologica · Oct 2019
Randomized Controlled TrialHigh-flow nasal cannula oxygenation reduces postoperative hypoxemia in morbidly obese patients: a randomized controlled trial.
Postoperative pulmonary complications (PPCs) are common in high-risk surgical patients. Postoperative ventilatory management may improve their outcome. Supplemental oxygen through a high-flow nasal cannula (HFNC) has become an alternative to classical oxygenation techniques, although the results published for postoperative patients are contradictory. We examined the efficacy of HFNC in postoperative morbidly obese patients who were ventilated intraoperatively with an open-lung approach (OLA). ⋯ Early application of HFNC in the operating room before extubation and during the immediate postoperative period decreases postoperative hypoxemia in obese patients after bariatric surgery who were intraoperatively ventilated using an OLA approach.
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Minerva anestesiologica · Oct 2019
Randomized Controlled TrialA preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption.
Data from patient questionnaires reveal that the intensity of postoperative pain is widely underestimated. Insufficient pain control may contribute to impaired short- and long-term outcome. Preoperative administration of methadone might potentially improve postoperative pain control due to its long pharmacological half-life. ⋯ A single dose of methadone administered at anesthesia induction prior to moderate-to-severely painful surgery is a possible strategy to reduce postoperative morphine consumption.
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Minerva anestesiologica · Oct 2019
Clinical TrialBody Mass Index does not affect intraoperative goal-directed fluid requirements.
Perioperative normovolemia is a major determinant of tissue oxygen availability and postoperative outcome. Thus, adequate volume replacement therapy remains an essential part of perioperative management. Nevertheless, volume optimization in overweight and obese surgical patients with alterations in cardiovascular function, peripheral perfusion, and body composition remains challenging. We, therefore, tested the hypothesis that Body Mass Index (BMI) correlates with fluid requirements during goal-directed management. Furthermore, we evaluated subcutaneous tissue oxygen tension (PsqO2) as an indicator of intravascular volume status and peripheral perfusion. ⋯ BMI did not affect intraoperative fluid requirements. Doppler-guided intravascular volume optimization was associated with well-maintained subcutaneous tissue oxygen availability in all BMI groups.