Minerva anestesiologica
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Minerva anestesiologica · Mar 2021
Meta AnalysisThe effect of neuromuscular blocking agents use in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials.
With the latest addition from Re-evaluation of Systemic Early Neuromuscular Blockade (ROSE) Trial result, the question of mortality benefit from neuromuscular blocking agents (NMBAs) in different studies, remained unanswered. We hypothesize that NMBAs use in moderate to severe acute respiratory distress syndrome (ARDS) does not influence intensive care unit (ICU) mortality. ⋯ Early 48-hour NMBAs infusion in patients with moderate to severe ARDS was associated with reduced ICU mortality without improvement in oxygenation, VFDs, 28-day and 90-day mortality. It did not contribute significantly to ICU-AW. Based on these results, NMBAs infusion is recommended for moderate to severe ARDS for its short-term benefit in early phase of disease. Prolonged use of NMBAs beyond 48 hours requires further study.
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Minerva anestesiologica · Mar 2021
Can visual inspection of the electrical activity of the diaphragm improve the detection of patient-ventilator asynchronies by pediatric critical care physicians?
Patient-ventilator asynchronies are challenging during pediatric mechanical ventilation. We hypothesized that monitoring the electrical activity of the diaphragm (EAdi) together with the "standard" airway opening pressure (Pao) and flow-time waveforms during pressure support ventilation would improve the ability of a cohort of critical care physicians to detect asynchronies in ventilated children. ⋯ This single center study suggests that the EAdi waveform may improve the ability of pediatric intensivists to detect missed efforts and auto-triggering asynchronies. Further studies are required to determine the clinical implications of these findings.
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Minerva anestesiologica · Mar 2021
Randomized Controlled TrialComparison of Remifentanil consumption in pupillometry-guided versus conventional administration in children: a randomised controlled trial.
Remifentanil is a commonly used opioid analgesic during anesthesia in children. Objective measurement of pain is required for adequate dosing of remifentanil. We investigated whether pupillometry-guided remifentanil administration can reduce intraoperative consumption of remifentanil in children. ⋯ Pupillometry-guided remifentanil administration in children undergoing general anesthesia can reduce the intraoperative remifentanil consumption.
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Minerva anestesiologica · Mar 2021
Observational StudyECG changes after non-cardiac surgery: a prospective observational study in intermediate-high risk patients.
Efforts to mitigate the risk for perioperative cardiac events focus on both patient's and operation's risk and often include a preprocedural electrocardiogram (ECG). The merits of postprocedural ECG for detection of occult cardiac events occurring during surgery are unknown. We aim to explore the incidence of pre, and new postprocedural ECG pathologies in an intermediate-high risk population undergoing non-cardiac surgery. ⋯ Pre-, but most importantly, postoperative ECG changes are common in intermediate-high risk surgical patients. Postoperative ECG may be valuable to disclose silent cardiovascular events that occurred during surgery.
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Minerva anestesiologica · Mar 2021
Audit of international intraoperative haemotherapy and blood loss documentation on anaesthetic records.
Anesthetic records facilitate information transmission to the next healthcare professional and should contain all relevant information of perioperative care. While most anesthesia societies provide guidelines for record content, important topics like hemotherapy and hemostatic therapy are not well represented. We considered the quality of anesthetic records with regard to the documentation options for hemotherapy and hemostatic therapy. A secondary objective was to examine guidelines for appropriate recommendations. ⋯ Most of the evaluated anesthetic records did not contain fields for relevant aspects of perioperative hemotherapy, hemostatic therapy and diagnostics. Guidelines and protocols for anesthetic documentation should include these topics to ensure information transfer and patient safety.