Minerva anestesiologica
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Minerva anestesiologica · Oct 2012
Comparative StudyThe sensibility and specificity of cerebral oximetry, measured by INVOS - 4100, in patients undergoing carotid endarterectomy compared with awake testing.
Selective shunting during carotid endarterectomy (CEA) is advocated to reduce shunt-related stroke. Cerebral monitoring is essential for temporary carotid shunting. Many techniques are available for cerebral monitoring; however, none is superior to monitoring the patient's neurological status (awake testing) while performing the procedure under local anesthesia (LA). Cerebral oximetry (CO) has previously been used to show the adequacy of cerebral circulation in patients undergoing CEA. This investigation was designed to compare the performance of the INVOS-4100 cerebral oximeter and the neurologic functions, by means of detecting cerebral ischemia induced by carotid cross-clamping, in patients undergoing CEA under LA, namely cervical plexus block. ⋯ The results of this study suggest that the usefulness of CO in predicting cerebral ischemia is modest. Cerebral monitoring with INVOS-4100 has a high negative predictive value, but the positive predictive value is low.
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Minerva anestesiologica · Oct 2012
The use of social networking to explore knowledge and attitudes toward organ donation in Italy.
Currently, online social media have become increasingly popular and can provide the opportunity to provide and acquire information regarding knowledge and attitudes toward organ donation and transplantation. To evaluate participants' knowledge about organ donation, information sources and donation principles, an on-line survey was distributed through social network in Italy. ⋯ Efforts must be aimed at involving schools and family doctors in education about donation; the use of social networks can represent a way of improving such knowledge.
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Minerva anestesiologica · Oct 2012
Editorial CommentAirway management: have we really planned it all?
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Recent data show an alarming increasing trend in obesity around the world. Mechanical ventilation in this population requires specific ventilatory settings due to the mechanical and inflammatory alterations observed in obesity. ⋯ In order to reduce lung stress and strain, as well as minimize the risk of ventilator associated lung injury, mechanical ventilation management should be conducted with the following strategies: 1) stepwise recruitment maneuver before positive end-expiratory pressure application, which requires titration according to respiratory system dynamic compliance; and 2) tidal volume (VT) titration according to inspiratory capacity. In summary, the overall objective is to ensure an adequate setting of ventilator parameters in order to minimize the inflammatory impact already present in obese patients as well as prevent further lung damage.
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Minerva anestesiologica · Oct 2012
ReviewInterfaces for noninvasive mechanical ventilation: technical aspects and efficiency.
Noninvasive mechanical ventilation (NIV) has become a standard of care in select patients with both hypercapnic and non-hypercapnic acute respiratory failure (ARF). Consequent to the increasing use of NIV, new interfaces of different designs, shapes, sizes, and materials have been proposed for clinical use in recent years. The aim of this report is to examine the most relevant physiological aspects related to the choice of interface with particular emphasis on the problems related to dead space and air leaks that may affect the synchrony between the patient and the machine, ultimately determining the patient's compliance and therefore NIV success.