Minerva anestesiologica
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Neuraxial analgesia and anesthesia are widely used in obstetric anesthesia. The most frequent complication after neuraxial blocks is post-dural puncture headache. It can occur after unintentional dural puncture during epidural procedures or after spinal anesthesia. ⋯ A wide variety of prophylactic and therapeutic measures have been tried. So far, the therapeutic epidural blood patch is the only treatment for which there is enough evidence to recommend its routine use for severe cases of post-dural puncture headache. Larger multicenter trials are needed to back up alternative treatment strategies.
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Minerva anestesiologica · May 2019
ReviewCoronary angiogram after cardiac arrest? Reasonably and sensibly.
The role of emergency coronary angiography after cardiac arrest and return of spontaneous circulation is not yet completely clear. While patients with a high risk of acute coronary lesion and with a presumed favorable neurological outcome should undergo a coronary angiography as soon as possible, the decision to perform it is questionable in patients who are less likely to have a coronary cause of arrest, and when clinical characteristics raise serious concerns regarding neurological outcome. In this paper, we analyze the main advantages and drawbacks of a coronary angiogram after a successfully resuscitated cardiac arrest.
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Minerva anestesiologica · May 2019
Observational StudySize and shape of the inferior vena cava before and after a fluid challenge: a pilot study.
Recent meta-analyses failed to support the reliability of ultrasound assessment of the inferior vena cava (IVC) to predict fluid responsiveness. However, the techniques utilized were heterogeneous. We hypothesized that the variability of the elliptic section and caliber of the IVC along its course may influence ultrasound evaluation. Therefore, we investigated IVC size and shape at four levels, before and after a fluid challenge. ⋯ The elliptic section should be considered when assessing IVC size. AP diameters are shorter and more affected by the respiratory cycle. After a fluid challenge, an increase of blood velocity associated with unchanged AP diameters may suggest fluid responsiveness.
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Minerva anestesiologica · May 2019
ReviewExtracorporeal blood purification techniques in children with hyper-inflammatory syndromes: a clinical overview.
Data on clinical applications of blood purification techniques in children are scarce. The aim of this review is to offer a clinical overview, as complete as possible, on blood purification in children with hyper-inflammatory syndromes (HS). A review of the literature using the PubMed, EMBASE, Web of Science, and Scopus databases, on the most recent data about blood purification in children was conducted until June 2018. ⋯ The use of polymixin B and other adsorbing columns in children with septic shock and HS is increasing, but results are still limited by the observational nature of the studies. Based on the low-level of available evidence, no conclusions can be drawn regarding the efficacy and safety of blood purification in children. Further research with more clinically robust data is needed to determine the impact of different extracorporeal blood purification techniques in this pediatric population.