Minerva anestesiologica
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Minerva anestesiologica · Sep 2023
Effect of expiratory flow limitation on ventilation/perfusion mismatch and perioperative lung function during pneumoperitoneum and Trendelenburg position.
Laparoscopic surgery and Trendelenburg position may affect the respiratory function and alter the gas exchange. Further the reduction of the lung volumes may contribute to the development of expiratory flow limitation (EFL). The latter is associated with an increased risk of postoperative pulmonary complications. Our aim was to investigate the incidence of EFL and to evaluate its effect on pulmonary function and intraoperative V/Q mismatch. ⋯ Expiratory flow limitation is a common phenomenon during gynecological laparoscopic surgery associated with worsen gas exchange, increased V/Q mismatch and altered lung mechanics. Our study showed that patients experiencing EFL during surgery showed a higher risk for PPCs.
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Minerva anestesiologica · Sep 2023
Randomized Controlled TrialTransversus abdominis plane block versus caudal block with bupivacaine and dexmedetomidine for unilateral inguinal hernia repair in pediatric patients: a randomized clinical trial.
This study compared the transversus abdominis plane (TAP) block with bupivacaine and dexmedetomidine to the same mixture in the caudal block in delivering postoperative analgesia in children after unilateral inguinal hernia surgery. ⋯ The TAP block and caudal block provide good postoperative analgesia in children undergoing unilateral inguinal hernia repair. Adding dexmedetomidine to the TAP block was superior to the caudal block in terms of extending the length of the initial analgesic request, lowering analgesic requirement, and lowering pain scores without causing substantial adverse effects.
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Minerva anestesiologica · Sep 2023
Observational StudyThe choice of perioperative inotropic support impacts the outcome of small infants undergoing complex cardiac surgery: an observational study.
Vaso-inotropic agents are frequently used to prevent and/or treat low cardiac output syndrome in infants undergoing surgery for congenital heart disease. Due to the lack of comparative studies, their use is largely dependent on physician- and center preferences. The aim was to assess the impact of two different inotropic regimens, milrinone-epinephrine versus dobutamine on postoperative morbi-mortality in young children undergoing complex cardiac surgery. ⋯ In young infants undergoing complex cardiac surgery, milrinone combined with epinephrine is associated with a higher incidence of postoperative morbidity or mortality compared to dobutamine for perioperative inotropic support. Further prospective randomized studies are required to confirm this finding.
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Minerva anestesiologica · Sep 2023
Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy: an update.
The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, ocular, respiratory, and hemodynamic homeostasis. ⋯ Close coordination between the anesthesia and surgical teams is required for a successful surgery. This updated review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP.