Minerva anestesiologica
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The growing number of laparoscopic surgical procedures performed in obese patients has increased the need to explore suitable analgesic techniques for a prone population to postoperative complications. The morbidly obese population may particularly benefit from the opioid-sparing or the opioid-free anesthesia/analgesia, which maximize the use of locoregional techniques. ⋯ Inadequate needle positioning, failed regional analgesia, and possible related risks must be counterbalanced by adequate evidence of effectiveness. The present article will discuss the pros and cons of TAP block in the treatment of obese patients.
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Minerva anestesiologica · Sep 2019
Long-term functional and psychological recovery in a population of ARDS patients treated with VV-ECMO and in their caregivers.
Acute respiratory distress syndrome (ARDS) survivors are affected with long-term physical/mental impairments, with improvements limited mostly to the first year after intensive care (ICU) discharge. Furthermore, caregivers of ICU patients exhibit psychological problems after family-member recovery. We evaluated the long-term physical and mental recovery of ARDS survivors treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), and the long-term psychological impact on their caregivers. ⋯ At almost three-year follow-up, ARDS survivors treated with VV-ECMO showed reduced health-related quality-of-life and high risk of psychological impairment, in particular PTSD. Caregivers of this population were at high psychological risk as well.
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Minerva anestesiologica · Sep 2019
ReviewPatient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support.
The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i.e. pendelluft); (D) diaphragm injury. ⋯ For them, current evidence indicates that high-flow nasal cannula alone may be superior to intermittent sessions of low-PEEP NIV delivered through face mask, while continuous high-PEEP helmet NIV likely promotes treatment success and may mitigate lung injury. The optimal initial noninvasive treatment of hypoxemic respiratory failure/ARDS remains however uncertain; high-flow nasal cannula and high-PEEP helmet NIV are promising tools to enhance success of the approach, but the best balance between these techniques has yet to be identified. During noninvasive support, careful clinical monitoring remains mandatory for prompt detection of treatment failure, in order not to delay intubation and protective ventilation.
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Minerva anestesiologica · Sep 2019
ReviewInjection pressures measuring for a safe peripheral nerve block.
The performance of a precise and safe peripheral nerve blockade (PNB) can currently rely on the aid of the ultrasounds and nerve stimulators. The injection pressure monitoring may be beneficial to perform a safer procedure. This review focuses on the pressures measured during PNB among studies conducted on animal, and human models. ⋯ So it is desirable to make further studies in order to assess them. In the future, the monitoring of the pressure could allow the use of a minimal quantity of anesthetic, empowering the safety of the nerve blocks. Moreover, the sensitive system should not be invasive and it should not hinder the job of the anesthetists.
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Minerva anestesiologica · Sep 2019
Observational StudySevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit.
Light sedation is the prerequisite for weaning from mechanical ventilation. Our aim was to evaluate the technical feasibility and efficacy of sevoflurane delivered by anesthetic conserving device (ACD) for sedation of children during weaning from mechanical ventilation. ⋯ Sevoflurane administration by ACD is technically feasible in critically ill children. It provides sedation within the desired sedation interval 89% of time, with short time to extubation after termination of administration. Decrease in mean arterial pressure warrants good hemodynamic monitoring and optimization of preload. Longer sevoflurane sedation and higher ETsevo is associated with development of reversible psychomotor dysfunction.