Minerva anestesiologica
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Minerva anestesiologica · Sep 2023
Enhanced extracorporeal carbon dioxide removal by acidification and metabolic control.
Extracorporeal carbon dioxide removal (ECCO
2 R) promotes protective ventilation in patients with acute respiratory failure, but devices with high CO2 extraction capacity are required for clinically relevant impact. This study evaluates three novel low-flow techniques based on dialysate acidification, also combined with renal replacement therapy, and metabolic control. ⋯ The three techniques achieved a significant extracorporeal CO2 removal allowing a relevant reduction in minute ventilation with a sufficient safety profile. -
Minerva anestesiologica · Sep 2023
Effect of expiratory flow limitation on ventilation/perfusion mismatch and perioperative lung function during pneumoperitoneum and Trendelenburg position.
Laparoscopic surgery and Trendelenburg position may affect the respiratory function and alter the gas exchange. Further the reduction of the lung volumes may contribute to the development of expiratory flow limitation (EFL). The latter is associated with an increased risk of postoperative pulmonary complications. Our aim was to investigate the incidence of EFL and to evaluate its effect on pulmonary function and intraoperative V/Q mismatch. ⋯ Expiratory flow limitation is a common phenomenon during gynecological laparoscopic surgery associated with worsen gas exchange, increased V/Q mismatch and altered lung mechanics. Our study showed that patients experiencing EFL during surgery showed a higher risk for PPCs.
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Minerva anestesiologica · Sep 2023
Randomized Controlled TrialEffect of intraoperative low vs. conventional tidal volume on the incidence of postoperative acute kidney injury after noncardiac surgery: a two-center randomized clinical trial.
In adults undergoing noncardiac surgery, the correlation between intraoperative tidal volume and postoperative acute kidney injury (AKI) is unclear. This study aimed to investigate the effects of low tidal volume ventilation on the incidence of postoperative AKI compared with conventional tidal volume in adults undergoing noncardiac surgery. ⋯ Among adults undergoing noncardiac surgery, low tidal volume mechanical ventilation did not significantly reduce the incidence of postoperative AKI compared with conventional tidal volume.
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Minerva anestesiologica · Sep 2023
Randomized Controlled TrialTransversus abdominis plane block versus caudal block with bupivacaine and dexmedetomidine for unilateral inguinal hernia repair in pediatric patients: a randomized clinical trial.
This study compared the transversus abdominis plane (TAP) block with bupivacaine and dexmedetomidine to the same mixture in the caudal block in delivering postoperative analgesia in children after unilateral inguinal hernia surgery. ⋯ The TAP block and caudal block provide good postoperative analgesia in children undergoing unilateral inguinal hernia repair. Adding dexmedetomidine to the TAP block was superior to the caudal block in terms of extending the length of the initial analgesic request, lowering analgesic requirement, and lowering pain scores without causing substantial adverse effects.