Minerva anestesiologica
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Minerva anestesiologica · Aug 2011
Interventional lung assist enables lung protective mechanical ventilation in acute respiratory distress syndrome.
The feasibility and safety of a pumpless arteriovenous extracorporeal lung assist system (pECLA) has been demonstrated in previous studies of patients with severe respiratory insufficiency. The aim of this report was to examine whether pECLA is feasible in a center that is new to the technology and to determine the positive and adverse effects associated with its use. ⋯ pECLA is an effective and manageable technique to support gas exchange in ARDS patients. This retrospective case series demonstrates the feasibility of pECLA in a center that did not have prior experience with this technique. pECLA may decrease further lung injury by minimizing the amount of time for which the lung is exposed to high stress and/or strain.
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Minerva anestesiologica · Jul 2011
ReviewPostoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?
Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. ⋯ Both have multifactorial pathogenesis but differ in numerous other ways, with delirium being well-defined and acute in onset and postoperative cognitive dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological problems that can be encountered when evaluating cognitive deficits postoperatively.
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Minerva anestesiologica · Jul 2011
ReviewPerioperative management of proximal hip fractures in the elderly: the surgeon and the anesthesiologist.
The comprehensive management of proximal hip fractures in elderly patients requires dedicated and responsive teamwork. Elderly patients often present with several comorbidities and the immediate treatment of a fracture has to optimize both medical therapy and analgesic control in order to reduce surgical and anesthetic complications and to preserve as much cognitive functioning as possible. The elderly are uniquely exposed to complications related to bed rest, delirium and postoperative cognitive dysfunction (POCD), which appear to be independent factors of morbidity. ⋯ The best choice of surgical treatment depends on the type of fracture as well as the patient's age and medical condition. However, the type of anesthesia management, which includes neuraxial blocks, peripheral nerve blocks and/or general anesthesia, has to be tailored towards generated the best outcome. We present a review from a surgical and anesthetic perspective on the most common perioperative issues in proximal fracture repair.