Minerva anestesiologica
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Minerva anestesiologica · Jul 2021
Meta AnalysisNon-specialist therapeutic strategies in acute respiratory distress syndrome: a meta-analysis.
Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. We undertook a meta-analysis of randomized controlled trials (RCTs) to determine the mortality benefit of non-specialist therapeutic interventions for ARDS available to general critical care units. ⋯ Among non-specialist therapeutic strategies available to general critical care units, low tidal volumes and prone position ventilation for greater than 12 hours improve mortality in ARDS.
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Minerva anestesiologica · Jul 2021
Randomized Controlled TrialComparison of arterial blood pressure and cardiac index-based hemodynamic management on cognitive function in elderly patients undergoing spinal surgery: a randomized clinical trial.
Postoperative delayed neurocognitive recovery (DNR) is frequent in elderly patients. Prevention of DNR is essential to achieve a better postoperative outcome. ⋯ CI-based hemodynamic management provided better postoperative cognitive function and higher intraoperative rScO2 when compared with MAP-based hemodynamic management.
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Minerva anestesiologica · Jul 2021
Chronic Pain and COVID-19: pathophysiological, clinical and organizational issues.
During the lockdown phase of the COVID-19 pandemic, a call not to neglect the continuum of care of patients who present with chronic diseases, including pain, was made. In the field of pain, COVID-19 had an impact both from a clinical (i.e., the influence of SARS-CoV-2 infection on pain) and organizational (i.e., how patients with chronic pain should be managed in the post-COVID-19 era) perspective. Furthermore, patients with chronic pain are also frequently frail subjects, affected from multiple comorbidities and hence are at increased risk of infection. On these bases, how the necessity to continue pain therapy will be pursued in the post-COVID-19 era? In this paper, we comment on the above-mentioned topics, on the basis of available data and our experience as pain therapists.
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Minerva anestesiologica · Jul 2021
Observational StudyDetermination of the initial minimum effective dose of 0.5% bupivacaine with 20mcg of fentanyl for an operative fixation of fractured neck of femur. A prospective, observational trial.
Fractured neck of femur (FNF) is a common cause of morbidity and mortality in elderly. Spinal catheter allows fractionation of local anesthetic dose which combined with intrathecal opioid leads to a dose reduction and better hemodynamic stability. The primary objective of this paper was to investigate the initial minimum local anesthetic dose (iMLAD) of 0.5% isobaric bupivacaine with 20 μg of fentanyl administered via spinal catheter in order to commence the operative fixation of FNF. ⋯ This study demonstrates that the placement of a spinal catheter allows for careful titration of local anesthetic, enabling a reduction of the initial intrathecal dose of 0.5% isobaric bupivacaine below 0.4 mL (2 mg) and leading to a significant reduction of a dose required for the whole surgery when combined with an intrathecal opioid.