Minerva anestesiologica
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Minerva anestesiologica · Nov 2024
Assessment of the organ function as the primary intention of clinical reasoning applied to the critically ill patient.
This article examines how clinical reasoning about the critical patient is currently treated and draws attention to some critical issues already often highlighted in the literature. Traditional approaches to clinical reasoning, even when applied to critical patients, prioritize identifying structured diseases. In contrast, the critical care setting demands an alternative approach that aligns with the intensivist's goal of supporting or substituting vital organ functions. ⋯ This discourse emphasizes a deep understanding of physiology and pathophysiology as foundational for practical clinical reasoning in critical care. Finally, we propose a structured assessment method that prioritizes pinpointing the compromised organ function, elucidating the pathophysiological mechanism responsible, hypothesizing potential causes, and testing these hypotheses to guide therapeutic interventions. This approach aligns clinical reasoning with the intensivist's goal: supporting and restoring vital functions in the critically ill patient.
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Minerva anestesiologica · Nov 2024
Ultrasonography versus conventional palpation for epidural analgesia in pediatrics undergoing midabdominal urological operations: a randomized clinical trial.
Epidural block may be facilitated by ultrasound (US), particularly in pediatrics. Our goal was to compare pre-procedural US with traditional palpation for epidural block in pediatrics undergoing midabdominal urological procedures. ⋯ Preprocedural US facilitated epidural block in pediatrics undergoing mid-abdominal urological operations compared with conventional techniques.
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Minerva anestesiologica · Nov 2024
Analgesic efficacy of ultrasound-guided rhomboid intercostal block versus serratus plane block in modified radical mastectomy: a prospective randomized controlled study.
This research aimed to assess the analgesic efficacy of ultrasound-guided rhomboid intercostal block (RIB) or serratus plane block (SPB) versus IV opioid among modified radical mastectomy (MRM) patients. ⋯ Both rhomboid intercostal and serratus anterior plane blocks were efficient for analgesia after modified radical mastectomy. However, RIB had better analgesic efficacy compared to SPB.
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Minerva anestesiologica · Nov 2024
Renal resistive index assessment by intraoperative transesophageal echocardiography is associated with acute kidney injury after cardiac surgery: a prospective observational study.
Acute kidney injury (AKI) is a major health burden after cardiac surgery. Renal vasoconstriction and venous congestion can be assessed via transesophageal echocardiography (TEE). The primary objective is to determine feasibility of measuring intraoperative Renal resistive index (RRI) and portal vein pulsatility fraction (PF) by TEE. The secondary objectives are to determine the association between RRI and/or PF and postoperative AKI, Intensive Care Unit (ICU) length of stay, hospital length of stay, and 30-day mortality. ⋯ This study demonstrates high feasibility for obtaining intraoperative TEE measurement of RRI and PF and significant correlation between postoperative AKI with pre CPB RRI, post chest closure RRI, and the combination of RRI at the three timepoints.
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Minerva anestesiologica · Nov 2024
Comparison of remimazolam and propofol on postoperative subjective quality of recovery in patients undergoing general anesthesia: a meta-analysis of randomized controlled trials.
Remimazolam, a recently approved drug for surgical sedation and general anesthesia, has been compared with propofol in previous studies regarding its efficacy as a general anesthetic. However, the question of whether remimazolam demonstrates non-inferiority to propofol in postoperative subjective quality of recovery (QoR) among patients under general anesthesia has not been definitively answered. ⋯ Remimazolam is similar to propofol in terms of postoperative subjective QoR for patients receiving general anesthesia.