Minerva anestesiologica
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The transversalis fascia plane and the quadratus lomborum blocks target the branches of T12-L1 nerves and provide analgesia in patients undergoing surgery involving the corresponding dermatomes. The transversalis fascia is believed to contribute to determine the spread of local anesthetic in such blocks. Nonetheless, the anatomy of this fascia and its possible role in these blocks still have to be precisely defined. ⋯ Considering the thinness of the transversalis fascia and the small size of the triangular space that contains the target nerves, this is most likely a virtual, ideal rather than realistic injection site. Accordingly, it is probable that the local anesthetic is injected in the much wider retroperitoneal space and reaches the nerves by spreading backwards through the thin transversalis fascia.
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Minerva anestesiologica · Jan 2019
Editorial CommentThe search for the holy grail for regional anesthesia continues.
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Minerva anestesiologica · Jan 2019
Comment LetterSingle lung ventilation associated to ECMO: an alternative approach to manage ventilator-induced lung injuries in infants.
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Minerva anestesiologica · Jan 2019
Review Meta AnalysisComparative effectiveness of pharmacologic interventions to prevent shivering after surgery: a network meta-analysis.
Although many drugs have been studied to prevent postoperative shivering, their comparative effectiveness is unknown. We attempted to assess the comparative effectiveness of the pharmacologic strategies to prevent shivering after surgery including intravenous (IV) and intrathecal (IT) meperidine, IV and IT dexmedetomidine, IV and IT clonidine, nefopam, tramadol, ketamine, and serotonin receptor antagonists. ⋯ Nefopam was ranked best regarding both severity and incidence of postoperative shivering. In addition to nefopam, tramadol, meperidine IV and IT, and dexmedetomidine IV were ranked high. However, there was significant heterogeneity regarding the individual drug regimen and surgery type, precluding firm conclusion. Further randomized trials are required to compare the efficacy of the drugs with high rank.
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Xenon is a colorless and odorless noble gas, licensed for human use as an anesthetic gas as well as a radiological marker. The MAC of this gas is about 63% but xenon anesthesia is associated with fast recovery of cognitive function and cardiovascular stability. ⋯ Currently, there are few studies about the effect of xenon on ischemia reperfusion injury of transplantable organs and insufficient clinical data upon its effect on intracranial and cerebral perfusion pressure. We shortly review the pros and cons of xenon as an anesthetic agent.