Minerva anestesiologica
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Minerva anestesiologica · Sep 2019
ReviewRole of automated pupillometry in critically ill patients.
Pupillary examination has fundamental diagnostic and prognostic values in clinical practice. However, pupillary assessment was relied until present on manual, qualitative, examination, using manual flash penlights or lamps. ⋯ The potential for quantitative pupillometry is multiple in the setting of critical care, for the monitoring and detection of secondary cerebral insults and to assess brainstem dysfunction and early coma outcome prognostication, and in the intra-operative anesthesiology setting, to assess analgesia and opioid requirement. Here, we describe the pupillometry technique and review recent critical care and anesthesiology studies that demonstrate the value and potential clinical utility of quantitative pupillometry as neuromonitoring bedside modality.
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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
Clinical TrialAutomated measurement of neutrophil CD64 expression for diagnosing sepsis in critically ill patients.
Although early identification of sepsis improves outcome, prompt and correct diagnostic remains often challenging. The expression of the high affinity immunoglobulin-Fc fragment receptor I CD64 on neutrophils is upregulated during acute inflammation. We here aimed at determining the usefulness of its rapid measurement in diagnosing sepsis. ⋯ This prospective study demonstrates the moderate performance of the neutrophil CD64 index, assessed through the Accellix-CD64® device, in diagnosing sepsis in the critically ill patient. However, repeat measurements improve its accuracy and may help to predict ICU-acquired infections.
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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.
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Minerva anestesiologica · Sep 2019
Editorial CommentLong-term outcome after VV ECMO: like the iceberg beneath the Titanic.
Abstract