Minerva anestesiologica
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Minerva anestesiologica · Nov 2022
Meta AnalysisRemimazolam versus traditional sedatives for procedural sedation: a systematic review and meta-analysis of efficacy and safety outcomes.
Remimazolam is a novel and ultra-short-acting benzodiazepine currently approved for procedural sedation and induction of general anaesthesia, with a possible indication for ICU sedation. This study aimed to evaluate the efficacy and safety of remimazolam and traditional sedatives for patients undergoing procedural sedation. ⋯ Remimazolam is a safe and effective sedative for procedural sedation on account of a higher success procedure rate, a faster recovery, a shorter discharge time, and a superior safety profile in comparison with traditional sedatives. Larger sample-sized and well-designed clinical trials are needed to verify our finding.
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Minerva anestesiologica · Nov 2022
Randomized Controlled TrialEfficacy of intravenous versus intraperitoneal lidocaine for postoperative analgesia in laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled trial.
Laparoscopic cholecystectomy (LC) has become the gold standard for gallbladder removal due to the low degree of invasiveness. However, postoperative pain still persists. Local anesthetics provide analgesia, reduce opioid consumption, and accelerate the return of bowel activity with a rare incidence of toxicity. However, it is still inconclusive to verify the more superior route of administration. This study aimed to compare the efficacy of intravenous lidocaine infusion, intraperitoneal lidocaine instillation, and placebo in reducing postoperative analgesia. ⋯ Intravenous lidocaine is superior to intraperitoneal lidocaine instillation and placebo in reducing postoperative analgesic requirement and visceral pain within the first six hours. Intravenous infusion is a simple and reliable method for reducing abdominal pain following laparoscopic cholecystectomy.
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Minerva anestesiologica · Nov 2022
Dynamic assessment of Surge Capacity in a large hospital network during Covid-19 pandemic.
The COVID-19 pandemic has provided an unprecedented scenario to deepen knowledge of surge capacity (SC), assessment of which remains a challenge. This study reports a large-scale experience of a multi-hospital network, with the aim of evaluating the characteristics of different hospitals involved in the response and of measuring a real-time SC based on two complementary modalities (actual, base) referring to the intensive care units (ICU). ⋯ The results provide benchmarks to better understand ICU hospital response capacity, highlighting the need for a more flexible approach to SC definition.
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Minerva anestesiologica · Nov 2022
The past, the present and the future of machine learning and artificial intelligence in anesthesia and Post Anesthesia Care Units (PACU).
Over the past decade, artificial intelligence (AI) has largely penetrated our daily life. Hence, our expectations regarding clinical AI are very high. However, in healthcare and especially in perioperative medicine, the impact of AI is still relatively limited. ⋯ If successfully implemented and integrated into the clinical workflow, AI-assisted perioperative medicine could become more preventative and personalized. However, AI implementation is not the final step. New challenges will follow implementation including algorithm maintenance, continuous monitoring, and improvement.
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Minerva anestesiologica · Nov 2022
Understanding left ventricular diastolic dysfunction in anesthesia and intensive care patients: "a glass with progressive shape change".
Left ventricular (LV) diastolic dysfunction is a commonly encountered condition and its impact on the anesthesia and the intensive care population is often underestimated. The study of the diastole is known as "diastology" and comprises four phases: isovolumetric relaxation, early filling phase, diastasis, and late filling phase. Diastolic function needs at least the same attention as systolic function, since its alteration has been associated with worse prognosis. ⋯ First, we use a metaphor to consider the LV as a glass that progressively changes its shape and height along the disease course, resembling variable end-diastolic pressures and volumes at different stages while progressing with diastolic dysfunction. We guide readers in the process of diagnosis and grading of LV diastolic dysfunction, with description of pathophysiological changes in LV relaxation and consequently in the pressure gradient between the left-sided heart chambers. In the second part, starting from physiology we move towards suggestions for the clinical management of anesthesia and intensive care patients with diastolic dysfunction under different scenarios (hypo- and hypervolemia, weaning, sepsis, tachycardia and arrhythmias, right ventricular dysfunction).