Minerva anestesiologica
-
Minerva anestesiologica · Feb 2020
ReviewUncontrolled donation after circulatory death and liver transplantation: evidence and unresolved issues.
This review aimed at summarizing the available evidence on liver transplantation from uncontrolled donation after circulatory death (uDCD) on differences in protocols, donor management, in and ex vivo perfusion techniques from center to center. Uncontrolled DCDs represent a unique, complex model of ischemia-reperfusion injury, so far not completely understood. Nevertheless, results on liver transplantation from uDCDs are promising in terms of long-term graft survival. ⋯ Values and kinetics of transaminanes during normothermic regional perfusion (nRP) should not considered absolute contraindication at least for ex vivo perfusion. Intraoperative evaluation at organ recovery remains pivotal since macroscopic alterations (i.e. hepatic rupture, an abnormal appearance of gall bladder and choledocus) still represent contraindications for organ retrieval. Concerning ex vivo perfusion, the debate is still open, since the choice of type of machine perfusion (mainly hypothermic vs. normothermic) varies from center to center, mainly relying to the single center experience (especially in controlled DCD), surgeons' believes and/or criteria translated from animal models.
-
Minerva anestesiologica · Feb 2020
Randomized Controlled TrialEffect of quadratus lumborum block on postoperative analgesic requirements in pediatric patients: a randomized controlled double blinded study.
Quadratus lumborum block (QLB) is a newly-defined trunk block performed with local anesthetic injection by imaging the abdominal muscles with ultrasonography (US) guidance; thus, analgesia is expected to be ensured from the T7-L1 dermatomal segment level. In the study, the aim was making the comparison between the quadratus lumborum block and the intravenous analgesia with tramadol on postoperative analgesic effect in pediatric patients undergoing lower abdominal surgery. ⋯ In conclusion, we believe QLB1 provides effective analgesia in the postoperative period for lower abdominal surgery in pediatric patients.
-
Minerva anestesiologica · Feb 2020
Randomized Controlled TrialGastric emptying of "clear liquid drinks" assessed with gastric ultrasonography: a blinded, randomized pilot study.
Protein-containing liquids may delay gastric emptying and increase risk of aspiration. Commercial whey protein nutritional drinks (WPNDs) are advertised as "clear liquid nutritional drinks" and can be mistaken for protein-free, carbohydrate-based clear liquids. We used gastric ultrasonography to compare gastric emptying of a protein-free, carbohydrate-based clear liquid with that of a WPND in healthy volunteers. ⋯ Although consumption of a WPND was associated with a larger estimated GV in this pilot study, a larger study is necessary to conclude whether patients must fast longer than two hours after consumption of a WPND.
-
Minerva anestesiologica · Feb 2020
Randomized Controlled TrialRespiratory and hemodynamic effects of three different sedative regimens for drug induced sleep endoscopy in sleep apnea patients. A prospective randomized study.
Drug induced sleep endoscopy (DISE) has emerged as a promising tool for customizing the adequate surgical approach to relieve airway obstruction in sleep apnea patients. We aimed to compare propofol, dexmedetomidine or ketofol with regards their efficacy and safety for sedation in patients with obstructive sleep apnea (OSA) undergoing DISE procedure. ⋯ Dexmedetomidine and ketofol provided a safe respiratory profile compared to propofol during DISE without significant hemodynamic adverse events.