Minerva anestesiologica
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Minerva anestesiologica · Jan 2025
The impact of remimazolam compared to propofol on postoperative delirium: a systematic review and meta-analysis.
The administration of benzodiazepines has been linked to the occurrence of postoperative delirium (POD) among patients undergoing surgery. In this review, we aim to appraise the current controversy regarding the role of remimazolam in POD. ⋯ Based on the available evidence, perioperative remimazolam administration is not associated with a significant rise in the incidence of POD.
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Minerva anestesiologica · Jan 2025
Transesophageal echocardiography monitoring for liver transplantation: where are we now?
Intraoperative hemodynamic monitoring is crucial for managing patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT) due to their complex cardiovascular and pulmonary abnormalities. Traditionally, pulmonary artery catheterization (PAC) has been the standard for hemodynamic monitoring during OLT. However, the use of transesophageal echocardiography (TEE) has increased due to its real-time visualization of cardiac and vascular structures, which aids in managing hemodynamic instability during the three surgical phases of OLT: pre-anhepatic, anhepatic, and neo-hepatic. ⋯ Although TEE in patients with ESLD poses risks, particularly in the presence of esophageal varices, studies show a low incidence of complications when performed by experienced operators. Focused TEE protocols have proven effective in detecting common causes of hemodynamic instability with fewer views. This review summarizes the applications and safety considerations of TEE during OLT.
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Minerva anestesiologica · Dec 2024
New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.
The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants. ⋯ The addition of perineural dexamethasone-dexmedetomidine combination has shown a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anesthesia compared to perineural single adjunct. This is consistent with clinical studies (trials, observational studies and reports) of a marked prolongation of the local anesthetic effect. Nevertheless, further studies are needed to ascertain the full potential of this technique and all possible associated risks.