Minerva anestesiologica最新文献

Background: Flow-controlled ventilation (FCV) ensures a constant gas flow whereby precise determination of dynamic compliance is feasible. Accordingly, ventilator pressure settings can be adjusted to achieve the highest compliance. This setting will automatically adapt tidal volume to the functionally available lung volume as a personalized approach. This is in contrast to current ventilation settings, where fixed tidal volumes according to predicted body weight (PBW) are recommended. Aim of this subgroup-analysis was to determine whether applied tidal volume differs in male and female patients after compliance guided individualization of ventilation parameters.

Methods: A sub-group analysis of 24 patients randomized to receive flow-controlled ventilation in cardiac surgery was performed. Linear mixed-effects model was used in order to investigate sex related differences in respiratory parameters.

Results: Compliance guided pressure titration led to comparable pressure settings in male (N.=18) and female (N.=6) patients. In contrast, the applied tidal volume was significantly lower in female patients (8.6 vs. 9.9, 95% CI: -2.3 to -0.2 mL/kg PBW; P=0.029) compared to male individuals, due to a significantly lower compliance (49.3 vs. 70.3, 95% CI: -33.1 to -8.8 mL/cmH2O; P=0.003). Gas exchange parameters were comparable in either sex.

Conclusions: Female patients were found to receive lower tidal volumes after compliance guided individualization compared to men during cardiac surgery. This finding may indicate that the functionally available lung volume in women is lower and thus using PBW may not adequately comply with sex related differences, which supports the use of a personalized ventilation strategy.

Background: The aim of the study is to investigate doctors' and nurses' beliefs and attitudes towards family presence and open visiting policies in Pediatric Intensive Care Units (PICUs) in Italy.

Methods: A multicentric nationwide study was carried out in all 30 Italian PICUs. All doctors and nurses were asked to complete the Italian version of the Beliefs and Attitudes toward Visitation in ICU Questionnaire (BAVIQ). The questionnaire consists of 20 questions on beliefs and 14 on attitudes towards visiting.

Results: The response rate was 89% (925 questionnaires), with 87% of nurses and 94% of doctors responding. Most respondents (85%) believed that visiting has a beneficial effect on the patient and that an open visiting policy can reduce parental anxiety (68%). However, nearly half the respondents believed that an open policy interferes with direct nursing care (45%) and makes them feel checked up on (49%). Multiple logistic regression conducted on the eight most representative items showed that factors associated with beliefs and attitudes opposing open visiting policies were: being a nurse, geographic area (working in PICUs in Central Italy or the South and Islands) and working in a cardiac surgery unit. Age showed a trend of younger professionals being more convinced that an open visiting policy can be beneficial for patients.

Conclusions: Most healthcare professionals in Italian PICUs believe that an open visiting policy for families is beneficial for both the patient and his/her family. However, despite an overall positive attitude among PICU staff members, there is still some resistance in Italy, particularly among nurses and in cardiac surgery units.

Lumbar and sacral tattoos are popular amongst all ages. Some physicians are concerned that passing a needle through a pigmented area during lumbar puncture may deposit toxic material into the central nervous system, resulting in late complications. In this review, we highlight the tattooing process with an emphasis on anatomy and physiology of the skin, and the pathophysiology and toxicology of tattoos. We conclude that there is perhaps no evidence yet to suggest that pigment can be transported into the central nervous system from a well healed tattoo. There is insufficient evidence to endorse placement of a needle through a tattoo into the neuraxis before it is completely healed. The Fermi paradox 'absence of evidence is not evidence of absence of effect' still holds in light of emerging evidence that tattoos may be linked to lymphoma.

Background: The objective of this study was to assess the impact of preoperative sphenopalatine ganglion block (SPGB) on postoperative pain and assess intraoperative and postoperative analgesic consumption in patients undergoing septorhinoplasty.

Methods: In this prospective, randomized controlled study, 72 patients were included and divided into two groups: group 1 (36 patients) received the sphenopalatine ganglion block (SPGB), while group 2 (36 patients) served as the control group. Patient assessments, using the numerical rating scale (NRS), were conducted at the postoperative first hour, fourth hour, and 24^th hour. Additionally, intraoperative hemodynamics, analgesic requirements, and postoperative analgesic requirements were documented.

Results: The patients in group 1 exhibited significantly lower NRS scores at postoperative first, fourth, and 24^th hour than those in group 2 (P<0.001 for all three time points). Additionally, the mean Riker Sedation-Agitation Scale (RSAS) scores were significantly lower in group 1 than in group 2 (P=0.006). Both intraoperative remifentanil use and postoperative analgesic consumption were significantly higher in patients in group 2 (P<0.001 and 0.004, respectively) than those in group 1. Analysis of intraoperative heart rate and mean arterial pressure (MAP) revealed that patients in group 1 had lower postoperative heart rates (P=0.040) than those in group 2, and MAP values after intraoperative block, at 30 min, and postoperatively were significantly lower (P=0.005, P=0.001, and P=0.034, respectively) than those in group 2.

Conclusions: We advocate for the adoption of the noninvasive SPGB method in patients undergoing septorhinoplasty surgery. This approach significantly reduces the need for intraoperative analgesics, alleviates postoperative pain, and reduces the demand for postoperative analgesics. Moreover, it improves the overall surgical experience because of its ease of application, contributing to a more comfortable surgical process.

Introduction: Enhanced recovery after cardiac surgery in selected low-risk patients, has the potential to improve outcomes and reduce the burden of healthcare costs. Anesthesia-related challenges play a major role in the successful implementation of Enhanced Recovery After Surgery (ERAS) protocols, with particular emphasis placed on fast-track extubation. Acknowledging the importance of this practice, the Italian Association of Cardiac Anesthesiologists and Intensive Care (ITACTAIC) has advocated for an initiative to establish a consensus offering practical recommendations for fast-track extubation after adult cardiac surgery.

Evidence acquisition: After conducting a systematic review, all randomised control trials (RCTs) published between 2013 and 2023 were meticulously selected and analysed during a consensus meeting that involved statement voting.

Evidence synthesis: Out of the 2268 publications identified using the search string, 60 RCTs were selected and classified into six groups, each evaluating specific interventions associated with extubation within 6 hours post-surgery. The authors examined 20 RCTs pertaining to loco-regional anesthesia, 19 analysing elements of general anesthesia, 12 focused on surgery-related aspects and techniques, three examining ventilation, two exploring anesthesia depth monitoring, and four addressing miscellaneous aspects. The expert panel approved 16 statements with 15 achieving high agreement and one obtaining moderate agreement. Finally a total of eight interventions were considered associated with fast-track extubation: parasternal block, erector spinae plane block, alpha agonist in the operating room (OR), opioids in the OR, dexmedetomidine in the intensive care unit (ICU), minimal invasive surgical access, anesthesia depth monitoring, adaptative support ventilation.

Conclusions: In the first consensus document ever published by a scientific society addressing practical recommendations for fast-track extubation post-cardiac surgery, the authors identified sixteen interventions commonly associated with fast-track extubation in selected adult cardiac surgery patients.

In recent years, the resuscitation of trauma patients has improved; however, pain related to trauma remains associated with systemic complications. In trauma patients, pain should be considered a vital sign, and its control is crucial for reducing complications, improving patient satisfaction, and enhancing the quality of life. The multimodal analgesia approach is the mainstay in pain control, and growing evidence in the literature supports a greater role of regional anesthesia in the management of trauma casualties. In this review, we offer the reader an updated general framework of the various approaches available for pain treatment in polytraumatized patients, with a focus on the opportunities presented by regional anesthesia. We will examine different types of locoregional anesthesia blocks and describe ultrasonographic execution techniques.

Background: Several studies demonstrate that both external oblique ıntercostal block (EOIB) and modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) contribute to analgesia in the anterior abdomen by targeting the thoracoabdominal nerves through distinct pathways. However, the sensory assessment and dermatomal analysis remain poorly understood.

Methods: This prospective observational study aimed to determine the sensory assessment and dermatomal regression rate of EOIB and M-TAPA in patients undergoing laparoscopic cholecystectomy. The study included a total of 24 patients, with 12 patients in each group. Blocks were performed bilaterally, administering 25 mL of bupivacaine 0.25% for each side, resulting in a total volume of 50 mL. The anterior abdominal wall was vertically partitioned into the midabdomen, left-lateral abdomen, and right-lateral abdomen, and horizontally divided into the epigastric, umbilical, and hypogastric regions. Sensory block was assessed at the 45^th minute with cold stimulus and pinprick. Subsequent evaluations were at intervals of 6, 10, 14, 18, 22, and 24 hours.

Results: The blocked area percentile with cold sensation in the anterior abdomen was 43.07% (36.67-55.74) with EOIB, 40.49% (34.05-43.67) with M-TAPA (P=0.3219). When the region above the intertubercular plane was examined with cold sensation, EOIB covered 55.92% (46.75-62.07), and M-TAPA covered 49.60% (40.39-54.03) of the epigastric and umbilical areas. Assessment of the midabdominal portion of the anterior abdomen revealed that the blocked area percentile was statistically significantly higher in the M-TAPA group with both cold sensation and pinprick. At 45 minutes, the percentage of blocked dermatomes was 100% between T7-T8 in the EOIB group and between T7-T10 in the M-TAPA group. Both groups exhibited lower success rates in dermatomes T5 and T12, with no sensory block within the L1 dermatome, and cutaneous dermatomal block status either absent or negligible after 24 hours. All trocar entries were located within the cutaneous sensory block for both blocks, except for trocar C, which was located most laterally.

Conclusions: Bilateral EOIB and M-TAPA produce a comparable sensory cutaneous block in the anterior abdomen, particularly in the umbilical and epigastric regions. Additionally, the midabdominal cutaneous blocked area was greater in patients undergoing M-TAPA, suggesting a more consistent distribution along the anterior cutaneous branches of the thoracoabdominal nerves.