Minerva anestesiologica
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Minerva anestesiologica · Apr 2021
Randomized Controlled TrialEffect of dexmedetomidine on CD4+ T cells and programmed cell death protein-1 in postoperative analgesia: a prospective, randomized, controlled study.
Surgical trauma inhibits cellular immunity. Dexmedetomidine produces opioid-sparing effect and an impact on immune response. ⋯ Dexmedetomidine increases the differentiation of Th1 and Treg cells and reduces the expression of PD-1 on CD4+ T cells. Dexmedetomidine may assist to ameliorate postoperative pain and attenuate proinflammatory response. There might be a negative correlation between pain and Th1 cells.
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Minerva anestesiologica · Apr 2021
Future in regional anesthesia and pain medicine: neuropathic pain and robotic limbs.
Phantom Limb Pain (PLP) is a dysesthesic painful sensations perceived in the lost limb, resulting from complex interactions between structural and functional nervous systems changes. We analyze its main pathogenetic models and speculate on candidate therapeutic targets. The neuroma model considers PLP to arise from spontaneous activity of residual limb injured axons. ⋯ Relief of PLP depends solely on motor and somatosensory circuitry engagement, making anthropomorphic visual feedback dispensable. Existing and apparently contradicting theories might not be mutually exclusive. All of them involve several intertwined potential mechanisms by which replacing the amputated limb by an artificial one could counteract PLP.
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Minerva anestesiologica · Apr 2021
Randomized Controlled TrialThe Oxygen Reserve Index as a determinant of the necessary amount of postoperative supplemental oxygen.
Although blood gas analysis (BGA) is important for supplemental oxygen titration, it is invasive, intermittent, costly, and burdensome for staff. We assessed whether the Oxygen Reserve Index (ORi™), a novel pulse oximeter-based index that reflects the partial pressure of oxygen (PaO
2 ), could determine the amount of postoperative supplemental oxygen. We also evaluated the extent of hyperoxia and hypoxia. ⋯ Based on our results, ORi might be useful to titrate postoperative oxygen supplementation. -
Minerva anestesiologica · Apr 2021
Low diaphragm muscle mass predicts adverse outcome in patients hospitalized for Covid-19 pneumonia: an exploratory pilot study.
The aim of this study was to evaluate whether measurement of diaphragm thickness (DT) by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. ⋯ Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO
2 /FiO2 , but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.