Minerva anestesiologica
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Minerva anestesiologica · May 2022
Measuring the impact of anaesthetist-administered medications volumes on intraoperative fluid balance during prolonged abdominal surgery (MEASURE study).
The contribution of intraoperative anesthetist-administered medications (IAAMs) to the total volume of intraoperative intravenous (IV) fluid therapy and their association with postoperative outcomes has never been formally investigated. ⋯ IAAMs significantly increased the total administered fluid volume during pancreaticoduodenectomy. Their inclusion increases the accuracy of postoperative complications predictions. These findings support their inclusion in fluid volumes and balances in future interventional studies.
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Minerva anestesiologica · May 2022
Severe secondary peritonitis: impact of inappropriate initial antimicrobial therapy on prognosis and potential carbapenem-sparing.
Initiation of antimicrobial therapy (IAT) with broad-spectrum antibiotics is usual in Intensive Care Unit (ICU) patients with secondary peritonitis. Carbapenems are widely proposed by recent guidelines contrasting with current antibiotic stewardship policies of carbapenem-sparing. However, prognosis of inappropriate IAT remains unclear in these patients and broad-spectrum antibiotics are probably overused. We aimed to assess the role of inappropriate IAT in ICU patients with secondary peritonitis and the use of carbapenems in our IAT regimens. ⋯ In our study, inappropriate IAT was not associated with a worse prognosis and carbapenems were overused. Extensive delivery of carbapenems proposed by recent guidelines could be reconsidered in the management of these patients.
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Minerva anestesiologica · May 2022
Prognostic role of automatic pupillometry in sepsis: a retrospective study.
Sepsis-associated brain dysfunction is a frequent disorder in septic patients and has a multifactorial pathophysiology. Cholinergic pathways and brainstem dysfunction may result in pupillary alterations. The aim of this study was to evaluate whether early assessment of the Neurological Pupil Index (NPiTM) derived from an automated pupillometry could predict mortality in critically ill septic patients. ⋯ In this study, no independent prognostic role of NPi was observed in septic patients. Further larger prospective studies are needed to better evaluate the role of automated pupillometry in this setting.
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Minerva anestesiologica · May 2022
High flow nasal oxygen, procedural sedation, and clinical governance.
Procedural sedation for therapeutic and diagnostic procedures can now be achieved through deep sedation techniques that guarantee procedural success. Deep sedation techniques are delivered in a variety of non-theatre environments where the usual levels of anesthetic equipment are not practical or economical. Hypoxic events are particularly frequent, and challenge sedation providers. ⋯ Deep sedation services are increasingly applied to subjects with complex co-morbidities, sometimes excluded for safety reasons from surgery under general anesthesia. The development of deep sedation services, delivered by non-anesthesia personnel, to patients with complex co-morbidities requires that services implement appropriate clinical governance tools to prevent deep sedation being the wild west of anesthesia services. Therefore, whilst high flow nasal oxygen may reduce the incidence of peri-procedural hypoxia, the introduction of clinical governance tools and the systematic introduction of initiatives to improve quality, will maintain the safety of deep sedation services.