Minerva anestesiologica
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Minerva anestesiologica · Jul 2020
Review Meta AnalysisDrugs for anaesthesia and analgesia in the preterm infant.
There is largely an absence of validated evidence-based therapies in term- and preterm newborn infants, due to a lack of pharmacological clinical trials. As a consequence, the drugs and doses used in clinical practice are extrapolated from dose-ranging trials performed in older patients. Drugs administered to the preterm infant are invariably off-label. The aim of this current review is to identify commonly used anesthetic and analgesic agents in this patient population, assess the existing evidence base, in terms of safety, efficacy, pharmacokinetics and pharmacodynamics, current indications and doses. ⋯ Preterm infants are characterized by remarkable metabolic and developmental differences when compared with adults. It is not possible to derive guidelines or clinical recommendations based on the existing evidence.
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Minerva anestesiologica · Jul 2020
Randomized Controlled TrialComparison of the i-gelTM with the AuraGainTM laryngeal mask airways in patients with a simulated cervical immobilization: a randomized controlled trial.
The use of second generation supraglottic airway devices is recommended for airway rescue in failed tracheal intubation. This study was performed to compare the clinical performance of the i-gel™ with that of the AuraGain™ in patients with simulated cervical immobilization. ⋯ The i-gel™ and the AuraGain™ showed comparable oropharyngeal leak pressures and success rates in the first attempt in patients with simulated cervical immobilization. However, the i-gel™ was easier to insert and required less time for insertion than the AuraGain™.
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Minerva anestesiologica · Jul 2020
Observational StudyNeuromuscular monitoring using TOF-Cuff® versus TOF-Scan®: an observational study under clinical anesthesia conditions.
Anesthesia guidelines advise objective neuromuscular monitoring. Acceleromyography, the standard technique used in clinical practice, is commonly used with the train-of-four (TOF) nerve stimulation pattern. Objective of this study was to compare the performance of two devices, TOF-Scan® and TOF-Cuff®. ⋯ TOF-Cuff® consistently recorded the endpoints earlier than TOF-Scan®. Despite large intra-individual variations found with both devices, these results could be meaningful in a clinical setting.
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Minerva anestesiologica · Jul 2020
A new pressure guided management tool for epidural space detection: feasibility assessment in a clinical scenario.
The detection of epidural space is usually performed by the technique of loss of resistance (LOR) without technological support, although there are few commercial options. In this work, we aimed to assess the feasibility of a new, non-invasive, mechatronic system for LOR detection in clinical settings. The system allows monitoring the pressure exerted on the syringe plunger by the clinician during the puncture. The LOR is related to the mentioned pressure. ⋯ The proposed mechatronic system successfully detected the LOR in the large part of cases using the configurations characterized by the best trade-off between system sensitivity and range of measurements. A non-significant increment of the procedure time is related to the use of the system.
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Presepsin is the soluble fragment of CD14, a multifunctional glycoprotein expressed on the surface of innate immune cells. In healthy individuals, presepsin is present in very low concentrations with reference values ranging from 60 to 382 pg/mL. ⋯ Elevated plasma presepsin concentration has also been reported in patients undergoing cardiac and non-cardiac surgery and it has further been evaluated as a potential independent predictor of perioperative cardiovascular complications and mortality. Combined cardiac and inflammatory biomarker evaluation may offer additive predictive information, but further investigations in large populations are required to determine presepsin diagnostic and prognostic value, in order to personalize therapy and reduce surgical patients' morbidity and mortality.