Minerva anestesiologica
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As mortality is now low for many cardiac surgical procedures, there has been an increasing focus on patient centered outcomes such as recovery and quality of life. The Enhanced Recovery After Surgery (ERAS) cardiac society recently published the first set of guidelines for cardiac surgery which will be useful as a starting point to help translate this philosophy for the benefit of those undergoing cardiac surgery. At the same time there are many advances in other areas such as mechanical circulation, diagnostics and quality metrics. ⋯ Those specialists who work in cardiac anaesthesia and critical care are well placed to contribute to these changes. Accompanying this work is the development of technologies to improve recognition of and intervention to prevent early organ dysfunction. Measuring, benchmarking and publishing quality outcomes from cardiac surgical centres is likely to improve services and benefit our patients.
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Minerva anestesiologica · May 2021
Serum G protein-coupled estrogen receptor-1 levels and its relation with death in patients with sepsis: a prospective study.
The sex hormone estrogen has an immune-supporting role in both trauma and sepsis-related to its immune-modulator role. The aim of the current study was to examine the prognostic role of (serum G Protein-coupled estrogen receptor-1) GPER-1 in sepsis and sepsis-related mortality. ⋯ Serum GPER-1 can be used as a new prognostic factor for survival in patients diagnosed with sepsis.
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Minerva anestesiologica · May 2021
Direct oral anticoagulants in point-of-care monitoring: an ex-vivo study (NOAPOC).
Anticoagulatory activity of direct oral anticoagulants (DOACs) is not routinely measurable by point-of-care monitoring. Thus, the aim of this study was to evaluate the influence of dabigatran/rivaroxaban on point-of-care testing. ⋯ Prolongation of CT-EXTEM and CT-INTEM indicates delayed initiation of clot formation. The CT-EXTEM seems to facilitate qualitative monitoring of dabigatran. In contrast, qualitative monitoring of rivaroxaban by CT-EXTEM may be limited as rivaroxaban may affect the measurement at therapeutic plasma levels. It seems that clot formation is faster/firmer in the presence of increased dabigatran plasma levels. This can be attributed to a non-dose-dependent effect via increased fibrin polymerization and second to a dose-dependent effect via increased platelet sensitivity to thrombin.