Minerva anestesiologica
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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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Core body temperature (CBT) patterns associated with sleep have not been described in the critically ill. This study aimed to characterize night-time sleep and its relationship to CBT in ICU patients. ⋯ Patients recovering in ICU commonly have CBT loss of rhythmicity or a significant phase shift with loss of normal night-time patterns of sleep architecture. Appropriate care plans to promote sleep and circadian rhythm require further investigation of contributing factors such as environment, clinical care routines, illness type and severity.
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Perioperative medicine is a patient-centered, multidisciplinary and integrated clinical practice that starts from the moment of contemplation of surgery until full recovery. Every perioperative phase (preoperative, intraoperative and postoperative) must be studied and planned in order to optimize the entire patient management. Perioperative optimization does not only concern a short-term outcome improvement, but it has also a strong impact on long term survival. ⋯ Perioperative medicine is the cornerstone of surgical patient management and the tools deriving from the application of AI seem very promising as a support in optimizing the management of each individual patient. Despite the increasing help that will derive from the use of AI tools, the uniqueness of the patient and the particularity of each individual clinical case will always keep the role of the human mind central in clinical and perioperative management. The role of the physician, who must analyze the outputs provided by AI by following his own experience and knowledge, remains and will always be essential.
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Acute kidney injury (AKI) is frequent after cerebral insults, with an incidence close to 10% in both traumatic brain injury (TBI) and cerebrovascular disease. AKI in this context has substantial impact on mortality and neurological outcome. Numerous factors may play a role in the development of AKI after brain injury: intravascular volume depletion, raised-intra-abdominal pressure, rhabdomyolysis or sepsis in TBI; age, ischemic heart disease or arteriosclerotic disease in stroke. ⋯ Indeed, inflammation and immune system activation are core mechanisms for the development of AKI. Last, direct lesions of specific area of the brain might lead to vasomotor changes and AKI. In this work, we reviewed the epidemiology of AKI after brain injury and examine potential mechanisms suggesting a causal relationship between these two entities.