Minerva anestesiologica
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Minerva anestesiologica · Oct 2020
ReviewAnesthesia for patients with psychiatric illnesses: a narrative review with emphasis on preoperative assessment and postoperative recovery and pain.
The physical and psychological fragility of patients with psychiatric illness poses critical importance in the preoperative assessment, evaluation, and choice of premedication, which includes regular therapy, as well as concerns about polypharmacy with possible interactions of anesthetics, analgesics, and psychiatric medications. A considerable effort is to reduce risks for exacerbations or relapses of imminent illness in the postoperative period. In this narrative review, the goal was also set towards the use of proper tools for the preoperative assessment of anxiety and management of postoperative pain. ⋯ Psychiatrist involvement is necessary throughout the perioperative period, starting preoperatively and continuing after discharge. Clinical pharmacologists should be part of the team during the management of critically ill patients when polypharmacy can cause undesirable effects. Psychosocial wellbeing of surgical patients with psychiatric co-morbidity depends deeply on the collaboration of medical staff, family, and friends and international guidelines aim to establish standards, including but not limited to postoperative management.
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Minerva anestesiologica · Oct 2020
Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives?
Epidural analgesia can no longer be routinely recommended as standard of care as part of abdominal surgery ERAS protocols.
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Minerva anestesiologica · Oct 2020
The assessment of esophageal pressure using different devices: a validation study.
Although esophageal pressure measurement could help clinicians to improve the ventilatory management of acute respiratory distress syndrome (ARDS) patients, it has been mainly used in clinical research. Aim of this study was to compare the measurements of end-expiratory esophageal pressure, end-expiratory transpulmonary pressure and lung stress by three systems: a dedicated manual device, taken as gold standard, a new automatic system (Optivent) and a bedside equipment, consisting of a mechanical ventilator and a hemodynamic monitor. ⋯ Both Optivent and the bedside system showed clinically acceptability if compared to the gold standard device. The possibility to apply one of these systems could allow a wider use of esophageal pressure in clinical practice.