Minerva anestesiologica
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Minerva anestesiologica · May 2023
Observational StudyMortality and incidence of cardiovascular events in patients treated with aspirin and statins at one year after myocardial injury in noncardiac surgery: a prospective observational study.
Recommendations on the diagnosis and management of myocardial injury in noncardiac surgery (MINS) show remarkable variability. Mortality reports also vary. We aimed to describe mortality and major adverse cardiovascular and cerebrovascular event (MACCE) rates in patients with silent MINS treated with postoperative aspirin-statin therapy and with cardiology follow-up. ⋯ Rates of mortality and MACCE in patients with silent MINS were high despite aspirin-statin therapy and cardiology follow-up. Further prospective research is needed to assess new postoperative care protocols that might effectively improve outcomes.
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Minerva anestesiologica · May 2023
Meta AnalysisEarly versus late tracheostomy for traumatic brain injury: a systematic review and meta-analysis.
Tracheostomy is the most frequent bedside surgical procedure performed on patients with traumatic brain injury who require mechanical ventilation. To compare the effects of early tracheostomy vs. late tracheostomy on the duration of mechanical ventilation in patients with traumatic brain injury, we carried out a systematic review and meta-analysis. ⋯ The findings from this meta-analysis suggest that early tracheostomy in severe TBI patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient's early rehabilitation and discharge.
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Minerva anestesiologica · May 2023
Observational StudyPerformance of the Hypotension Prediction Index in living donor liver transplant recipients.
The Hypotension Prediction Index (HPI) was recently introduced and clinically validated in different surgical conditions. This prospective observational study evaluated HPI's performance in living donor liver transplant recipients under the hypothesis that HPI would be inferior to the previously reported predictability in major surgery due to the surgical characteristics of liver transplantation. ⋯ HPI in this observational study in living donor liver transplantation predicted hypotension with moderate-to-low accuracy, its predictive value being highest in the neohepatic phase and lowest in the anhepatic phase.
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Minerva anestesiologica · May 2023
Acute and chronic pain management in sport medicine: an expert opinion looking at an alternative mechanism-based approach to the pharmacological treatment.
In the last decades there has been a huge increase in people who practice sports requesting an increase of the performance. Consequently, also incidence of acute and chronic pain is highly increased in this population of "healthy" people. Pain represents not only a signal of a lesion occurred during the sportive activity, but also (and almost) an unbalance of posture or an overuse of specific articulations or muscles, that has to be resolved not only with a correct physiotherapeutic approach, but also with a careful diagnosis of the complex mechanisms that sustain the pain. ⋯ Hence, the pain therapist assumes a pivotal role in the management of pain in people who practice sports, for his skills in pain diagnosis, and for the possibility to introduce new mechanism-based therapies. In the last decade, these new therapies, such as regenerative medicine and peripheral neuromodulation, have demonstrated their effectiveness not only to reduce pain, but also to facilitate the healing process and the faster return to the sportive activity. In this expert opinion we summarize the most recent data to support this approach, focalizing not only on how to treat specific pain syndromes but also on how pain therapist could drive, through a careful diagnosis of the pain mechanism, to a new simultaneous mechanism-based disease modifying approach in people with pain practicing sport.