Minerva anestesiologica
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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
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 TrialIs breakthrough pain better managed by adding programmed intermittent epidural bolus to a background infusion during labor epidural analgesia? A randomized controlled trial.
Breakthrough pain (BTP) is a common problem during labor analgesia. Programmed intermittent epidural bolus (PIEB) has demonstrated superior to background epidural infusion (BEI) concerning BTP, but the effect of combining both modes remains unknown. We hypothesized that this combination could reduce BTP incidence. ⋯ Adding PIEB to BEI+PCEA improved labor analgesia by significantly reducing the needs of rescue analgesia and prolonging the duration of effective analgesia. This combination provoked a higher consumption of local anesthetic with no detected clinical consequences.
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Minerva anestesiologica · Oct 2019
Randomized Controlled TrialUtility of ultrasonography in identification of midline and epidural placement in severely obese parturients.
Due to body habitus, lumbar epidural placement can be challenging in severely obese parturients. Several studies have been published assessing the usefulness of ultrasonography in the placement of neuraxial blocks. One patient population that is under-represented in these studies is the severely obese parturient. We sought to determine if performing an abbreviated ultrasound exam of the lumbar spine to determine midline by locating spinous process could facilitate lumbar epidural placement in severely obese parturients. ⋯ The use of an abbreviated ultrasound exam to identify midline in severely obese parturients can reduce the time required for lumbar epidural placement.