Minerva anestesiologica
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Minerva anestesiologica · Jul 2011
Effects on cardiac function of a novel low viscosity plasma expander based on polyethylene glycol conjugated albumin.
Plasma expanders have become increasingly advantageous when compared to blood transfusion, due to their long shelf-life and cost-effectiveness. A new generation of plasma expander based on polyethylene glycol (PEG) conjugated to human serum albumin (PEG-HSA) has shown positive microvascular effects during extreme hemodilution and fluid resuscitation from severe hemorrhagic shock. PEG conjugation increases uniformly albumin molecular weight (MW) and colloidal osmotic pressure, with minor effects on viscosity. ⋯ PEG-HSA, a low viscosity plasma expander, had beneficial effects on cardiac function when compared to conventional colloidal plasma expanders with higher viscosities. Maintenance of homeostasis during hemodilution and resuscitation from hemorrhagic shock using PEG-HSA will lead to a significant decrease of the use of blood, thus alleviating in part, forecasted blood shortages, and significantly reducing morbidity and mortality associated with the use of blood in transfusion medicine.
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Minerva anestesiologica · Jun 2011
ReviewPreoperative evaluation in geriatric surgery: comorbidity, functional status and pharmacological history.
The demand for elective and emergency surgery by older patients is increasing. This review examines the current practice of preoperative evaluation in geriatric anesthesia and provides an overview of new insights in this field. Preoperative anesthesia consultation is essential to examine the patient, evaluate the operative risk and plan preventive perioperative actions. ⋯ A strong joint action with the surgical team is essential. Currently, while many resources are employed to assess preoperative cardiac risk and despite the dramatic increase in the number of elderly surgical patients, the association between older age itself and surgical complications has not been fully investigated, and preoperative evaluation of functional status is not yet a part of routine preoperative practice. Creating a new culture and developing appropriate clinical, scientific and relational approaches to these patients represent the core of the challenge.
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In 2007 the non-heart-beating organ donation (NHBD) "Programma Alba" (Sunrise Programme) started in Pavia, Italy. The initial plan was to cut down waiting list for kidney transplantation, while its final aim is to shorten organ transplantation waiting lists. When compared to European countries and the USA, the Italian NHBD program has taken longer to get established. ⋯ Of these, six NHBD kidneys have been transplanted. Currently, four patients are out of dialysis. This report is a detailed description of NHBD "Programma Alba" and its preliminary results.