Articles: operative.
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Minerva anestesiologica · Dec 2022
Randomized Controlled TrialParavertebral block versus erector spinae plane block for analgesia in modified radical mastectomy: a randomized, prospective, double-blind study.
Pain control after breast surgery is crucial and supported with regional techniques. Paravertebral block (TPVB) is shown to be effective in postoperative pain management. Erector spinae plane block (ESPB) is assumed to have a similar analgesic effect as an easier and safer block. Our aim was to compare TPVB and ESPB for modified radical mastectomy (MRM) in terms of analgesic efficiency and dermatomal spread. ⋯ Thoracal paravertebral block reduced morphine consumption compared to ESPB after MRM, albeit a small difference. A through coverage of TPVB may be preferred with experienced operators in MRM due to lower pain scores.
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Randomized Controlled Trial
Advantages of Transmuscular Quadratus Lumborum Block via Subfascial Approach versus Extrafascial Approach for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized Controlled Study.
We aimed to compare the analgesic effect and incidence of lower limb weakness of transmuscular quadratus lumborum (TQL) block via subfascial approach with that via extrafascial after laparoscopic cholecystectomy (LC). ⋯ TQL block via subfascial had the advantages of better analgesic effect and less lower limbs weakness after LC over that via extrafascial.
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Anesthesia and analgesia · Dec 2022
Incidence, Outcomes, and Risk Factors for Preincision Cardiac Arrest in Cardiac Surgery Patients.
We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery. ⋯ Cardiac arrest after anesthetic induction is rare in cardiac surgical patients in our investigation. Though most patients are rescued, morbidity and mortality remain higher. Reduced left ventricular ejection fraction and moderate/severe pulmonary hypertension are associated with greater risk for preincision cardiac arrest.
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Minerva anestesiologica · Dec 2022
Research progress of goal-directed fluid therapy in prone position surgery.
Goal-directed fluid therapy (GDFT) is currently recognized as a scientific and reasonable method of perioperative capacity management. However, most of the studies on GDFT are carried out in the supine position, while there are few studies on applying GDFT in the prone position. ⋯ Although it is controversial whether the GDFT strategy can improve the clinical outcome of patients undergoing prone position surgery, it is still the mainstream choice of fluid therapy. In the future, we need to explore further the method of predicting the fluid responsiveness of patients in the prone position, improve the GDFT strategy, and guide the perioperative fluid therapy of patients in the prone position.
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Long-lasting local anesthetic use for perioperative pain control is limited by possible cardiotoxicity (e.g., arrhythmias and contractile depression), potentially leading to cardiac arrest. Off-target cardiac sodium channel blockade is considered the canonical mechanism behind cardiotoxicity; however, it does not fully explain the observed toxicity variability between anesthetics. The authors hypothesize that more cardiotoxic anesthetics (e.g., bupivacaine) differentially perturb other important cardiomyocyte functions (e.g., calcium dynamics), which may be exploited to mitigate drug toxicity. ⋯ Our data illustrate differences in calcium dynamics between anesthetics and how calcium may mitigate bupivacaine cardiotoxicity. Moreover, our findings suggest that bupivacaine cardiotoxicity risk may be higher than for ropivacaine in a calcium deficiency context.