Minerva anestesiologica
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Minerva anestesiologica · Mar 2023
What's new on septic encephalopathy? Ten things you need to know.
Sepsis associated encephalopathy (SAE) is a frequent complication of sepsis and is associated with a higher risk of short-term mortality and long-term cognitive impairment. The EEG is a sensitive complement of the clinical examination that can also detect and quantify encephalopathy and identify features with prognostic value, such as lack of reactivity. Moreover, despite their effect on outcome is still debated, the EEG is the only tool to detect non-convulsive seizures which can occur in a septic setting. ⋯ Alteration in regulatory systems of cerebral blood flow, namely cerebral autoregulation (CA) and neurovascular coupling, contribute to SAE development. Nowadays, clinicians have access to different tools to assess them at the bedside and CA-based blood pressure protocols should be implemented to optimize cerebral perfusion. Its inauspicious consequences, its complex physiopathology and the lack of efficacious treatment make of SAE a highly active research subject.
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Minerva anestesiologica · Mar 2023
ReviewNoninvasive intracranial pressure monitoring in central nervous system infections.
Intracranial pressure (ICP) monitoring constitutes an important part of the management of traumatic brain injury. However, its application in other brain pathologies such as neuroinfections like acute bacterial meningitis is unclear. Despite focus on aggressive, prompt treatment, morbidity and mortality from acute bacterial meningitis remain high. ⋯ Non-invasive screening using ultrasound of the optical nerve sheath, transcranial doppler, magnetic resonance imaging or preferably a combination of these modalities, provides measurements that can be used as a decision guidance for invasive ICP measurement. The available data do not support the replacement of invasive techniques for continuous ICP measurement in patients with increased ICP. Non-invasive modalities should be taken into consideration in patients with neuroinfections at low risk of increased ICP.
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Minerva anestesiologica · Mar 2023
Randomized Controlled TrialLow-intensity transcutaneous auricular vagus nerve stimulation reduces postoperative ileus after laparoscopic radical resection of colorectal cancer: a randomized controlled trial.
Postoperative ileus (POI) is thought to result from a disrupted sympathetic/parasympathetic balance caused by trauma or surgery. Transcutaneous auricular vagus nerve stimulation (tVNS) is a non-invasive technique involving stimulation of the vagal auricular branch, leading to autonomic regulation and reduced inflammation. Here, the effects of low-intensity transcutaneous auricular vagal stimulation on POI after laparoscopic radical resection of colorectal cancer were investigated. ⋯ Low-intensity transcutaneous auricular vagal stimulation reduced POI after laparoscopic radical resection of colorectal cancer.