Minerva anestesiologica最新文献

{"title":"Tailoring postoperative physiologic monitoring: lessons learned from hypoxaemia monitoring after bariatric surgery in patients with obstructive sleep apnoea.","authors":"Andrea DE Gasperi","doi":"10.23736/S0375-9393.25.18928-1","DOIUrl":"10.23736/S0375-9393.25.18928-1","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"367-369"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of tension capnothorax on respiratory mechanics and individualized PEEP during robotic-assisted thoracic surgery: a prospective pilot observational study.","authors":"Álvaro Buñuel, Ricard Navarro-Ripoll, Stefano Italiano, Manuel López-Baamonde, Enric Barbeta, Robert Gatherer, Carlos Ferrando","doi":"10.23736/S0375-9393.24.18632-4","DOIUrl":"10.23736/S0375-9393.24.18632-4","url":null,"abstract":"<p><strong>Background: </strong>Tension capnothorax during robotic-assisted thoracic surgery (RATS) might promote intraoperative atelectasis, which predisposes to ventilation-induced lung injury (VILI). Lung-protective mechanical ventilation including recruitment maneuver (RM) and individualized positive-end expiratory pressure (iPEEP) minimizes VILI. This study examines the effects of capnothorax on respiratory mechanics (respiratory system compliance, Crs), and the potential differences in the iPEEP before-and-after capnothorax.</p><p><strong>Methods: </strong>This is a prospective, observational pilot study enrolling patients scheduled for RATS using continuous tension capnothorax. The effects of capnothorax were analyzed with respiratory mechanics and volumetric capnography at different time points. The primary outcome were differences in Crs just before-and-after capnothorax. We also tested the iPEEP before-and-after capnothorax. After a RM, a PEEP titration trial was used to indentify the iPEEP.</p><p><strong>Results: </strong>A total of 30 patients were included in the analysis. The application of capnothorax significantly impaired respiratory system mechanics, as shown by a decreased in Crs from 40 (7) to 21 (8) mL/cmH<inf>2</inf>O, P<0.001) and an increase in driving pressure (DP) from 8 (3) to 16 (5) cmH<inf>2</inf>O, P<0.001. A non-significantly increase was shown for dead spaces. RM + iPEEP significantly improved Crs from 21 (8) to 43 (8) mL/cmH<inf>2</inf>O and DP from 16 (5) to 8 (2) cmH<inf>2</inf>O (P<0.001). iPEEP before capnothorax was 6 (2) cmH<inf>2</inf>O, which increased to 12 (4) cmH<inf>2</inf>O, P<0.001 after it.</p><p><strong>Conclusions: </strong>Tension capnothorax during RATS impairs respiratory system mechanics and increases iPEEP requirements to maintain an open-lung condition. Individualized PEEP after CO<inf>2</inf> insufflation restores respiratory system mechanics and alveolar dead space.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"404-412"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of safety and efficacy of commonly used sedatives in bronchoscopy examination: a Bayesian network meta-analysis of randomized controlled trials.","authors":"Weiying Chen, Feng Chen, Xiaodan Luo, Dongmei Li, Hong Li, Fuhai Bai","doi":"10.23736/S0375-9393.24.18426-X","DOIUrl":"10.23736/S0375-9393.24.18426-X","url":null,"abstract":"<p><strong>Introduction: </strong>Propofol, dexmedetomidine, midazolam, and remimazolam are widely used for sedation during bronchoscopy. The purpose of this network meta-analysis was to compare the safety and efficacy of these four sedative drugs for bronchoscopy.</p><p><strong>Evidence acquisition: </strong>PubMed, Embase, Cochrane Libary, and Wed of Science databases were systematically searched to collect randomized controlled trials (RCTs) of propofol, dexmedetomidine, midazolam, and remimazolam for bronchoscopy from the inception of the database to December 25, 2023. The search strategy we used was (sedative subject terms or sedative free terms) AND (bronchoscopy subject terms or bronchoscopy free terms), without language restrictions. The included studies were randomized controlled trials. Two authors independently searched the databases, selected studies, and extracted data.</p><p><strong>Evidence synthesis: </strong>Eleven RCTs and 1,076 patients were finally included. The results showed that in terms of hypoxemia, compared to midazolam (RR=0.156, 95% CI [0.031, 0.677]), placebo (RR=1.109, 95% Cl [0.014, 0.977]), propofol (RR=0.112, 95% Cl [0.021, 0.553]), and remimazolam (RR=0.104, 95% Cl [0.012, 0.991]), dexmedetomidine significantly reduced the occurrence of hypoxemia (P<0.05). A surface under the cumulative ranking curve (SUCRA) value indicated a higher ranking of a treatment plan, suggesting that the treatment plan is more advantageous. In terms of hypoxemia, the SUCRA ranking was as follows: dexmedetomidine (98%) > midazolam (57%) > placebo (33%) > remimazolam (32%) > propofol (30%). In terms of arrhythmia, the SUCRA ranking was as follows: dexmedetomidine (89%) > placebo (44%) > remimazolam (42%) > midazolam (40%) > propofol (35%). In terms of bronchoscopy time, the SUCRA ranking was as follows: propofol (68%) > remimazolam (67%) > midazolam (66%) > dexmedetomidine (37%) > placebo (12%).</p><p><strong>Conclusions: </strong>Compared to midazolam, remimazolam, and propofol, dexmedetomidine significantly reduced the occurrence of hypoxemia and arrhythmia during bronchoscopy. Additionally, bronchoscopy procedures performed under propofol sedation exhibited the shortest operating time.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"430-439"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why do ERAS?","authors":"Olle Ljungqvist, Luca Gianotti","doi":"10.23736/S0375-9393.25.18840-8","DOIUrl":"10.23736/S0375-9393.25.18840-8","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"365-366"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERAS and the challenge of the new technologies.","authors":"Elena Bignami, Brigida Leoni, Tania Domenichetti, Matteo Panizzi, Luis A Diego, Valentina Bellini","doi":"10.23736/S0375-9393.25.18746-4","DOIUrl":"10.23736/S0375-9393.25.18746-4","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) and all new technologies (NTs) into enhanced recovery after surgery (ERAS) protocols offers significant opportunities to address implementation challenges and improve patient care. Despite the proven benefits of ERAS, limitations such as resistance to change, resource constraints, and poor interdepartmental communication persist. AI can play a crucial role in overcoming ERAS implementation barriers by simplifying clinical plans, ensuring high compliance, and creating patient-centered approaches. Advanced techniques like machine learning and deep learning can optimize preoperative management, intraoperative phases, and postoperative recovery pathways. AI integration in ERAS protocols has the potential to revolutionize perioperative medicine by enabling personalized patient care, enhancing monitoring strategies, and improving clinical decision-making. The technology can address common postoperative challenges by developing individualized ERAS plans based on patient risk factors and optimizing perioperative processes. While challenges remain, including the need for external validation and data security, the authors suggest that the combination of AI, NTs, and ERAS protocols should become an integral part of routine clinical practice. This integration ultimately leads to improved patient outcomes and satisfaction in surgical care, transforming the perioperative medicine landscape by tailoring pathways to patients' needs.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"462-471"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification for postoperative hypoxemia among bariatric surgery patients.","authors":"Naveen Perisetla, Jose Malavet, Christopher Popiolek, Giorgio Melloni, Ashley Mooney, Maha Balouch, Peter Wu, Jeffrey Weiss, John Hodgson, Enrico Camporesi","doi":"10.23736/S0375-9393.24.18595-1","DOIUrl":"10.23736/S0375-9393.24.18595-1","url":null,"abstract":"<p><strong>Background: </strong>Patients with obesity, especially those suffering from obstructive sleep apnea (OSA), are prone to postoperative respiratory hypoxemia. The PRODIGY (prediction of opioid-induced respiratory depression in patients monitored by capnography) Score is used to predict respiratory complications that factor in sleep-disordered breathing. Data on the impact of OSA on the frequency and timing of postoperative desaturation trends after bariatric surgery are lacking.</p><p><strong>Methods: </strong>This cohort study included 195 patients who underwent robotic-assisted bariatric surgery between June 2022 and December 2023. Patients underwent were classified by OSA status (yes/no) and PRODIGY Risk Score (high/intermediate/low). All patients received low or opioid sparing anesthesia and were continuously monitored postoperatively using the Masimo Rad-97 device (Masimo, Irvine, CA, USA). Postoperative monitoring averaged 14.5 hours, including tracking several variables and SpO<inf>2</inf> values. We documented desaturations and opioid usage in 2-hour intervals. Patients also underwent 30-day postoperative follow-up. Descriptive statistics were analyzed based on OSA status and PRODIGY scores using Student's t-test, ANOVA, and Fisher's Exact Test.</p><p><strong>Results: </strong>Most study patients (57.4%) had OSA, were significantly older, and were predominantly female. Patients with OSA had substantially more prolonged exposure to SpO<inf>2</inf> ranges between 80-95% and experienced more frequent desaturation events between 10 and 14 hours after Post-Anesthesia Care Unit (PACU) discharge. Patients with high PRODIGY scores (>15) had significantly more desaturation events compared to intermediate and low-score groups.</p><p><strong>Conclusions: </strong>Postoperative desaturation rates are significantly higher among patients with OSA with high PRODIGY scores, especially in the delayed postoperative period. Continuous extended postoperative monitoring is warranted for these high-risk patients after bariatric surgery.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"376-384"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of pulsed radiofrequency versus pulse dose mode radiofrequency targeting the pudendal nerve in patients with pudendal neuralgia: a prospective randomized controlled clinical trial.","authors":"Saeid Elsawy, Ahmed Fergani, Ragaa Herdan, Rasha Hamed, Yara H Abbas, Hamdi Abbas, Ahmed F Abdelatif","doi":"10.23736/S0375-9393.25.18678-1","DOIUrl":"10.23736/S0375-9393.25.18678-1","url":null,"abstract":"<p><strong>Background: </strong>Pudendal neuralgia is a painful, neuropathic condition involving the pudendal nerve dermatome. It is a difficult-to-treat chronic pain disorder that affects both men and women equally. The aim of this study was to detect the efficacy and safety of two distinctive therapeutic types of radiofrequency: pulsed radiofrequency and pulse dose radiofrequency, as treatment modalities for cases of pudendal neuralgia, assessed by changes in the Visual Analogue Scale between the two groups.</p><p><strong>Methods: </strong>Of the one hundred patients enrolled for this study, 80 cases with pudendal neuralgia fulfilled the inclusion/exclusion criteria. They were randomly assigned into two groups: PRF Group, including 38 patients who underwent Pulsed radiofrequency, and PDRF Group, including 39 patients who underwent Pulse dose radiofrequency. The primary outcome was pain assessment using the visual analogue score, while the secondary outcome included the patient health questionnaire-9, the amount of postintervention drug utilization, and treatment adverse events.</p><p><strong>Results: </strong>The two studied groups were matched for the basic demographic data. However, the difference in the mean VAS score was present over time within each group (P<0.05) but it was insignificant between the two groups at one hour, 48 hours, two weeks, one, three, and six months (P>0.05), PDRF Group showed a non-significant reduction in visual analogue score, compared to PRF Group. Additionally, there was a statistically significant reduction in patient health questionnaire-9 within each group over time, P<0.05. while between both groups at one, three, and six months, there was insignificant reduction among both groups (P>0.05) and more reduction in the PDRF group.</p><p><strong>Conclusions: </strong>Both pulsed radiofrequency and pulse dose radiofrequency were equally effective and safe as a treatment method for managing pudendal neuralgia cases. Considering both modalities in cases with proven pudendal neuralgia is valuable.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":"91 5","pages":"413-421"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified thoracoabdominal nerves block through perichondrial approach is effective in reducing postoperative opioids requirements in patients undergoing laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis.","authors":"Alessandro DE Cassai, Burhan Dost, Dario Bugada, Yunus E Karapinar, Müzeyyen Beldagli, Mirac S Ozkal Yalin, Ali Ahiskalioglu, Serkan Tulgar","doi":"10.23736/S0375-9393.24.18490-8","DOIUrl":"10.23736/S0375-9393.24.18490-8","url":null,"abstract":"<p><strong>Introduction: </strong>The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC.</p><p><strong>Evidence acquisition: </strong>We searched Pubmed Central, Scopus and Cochrane Central Register of Controlled Trials (from inception to until 1 July 2024). The effects of the M-TAPA were compared with those of sham block, placebo and no intervention. Randomized controlled trials, observational and retrospective studies were included. The primary outcome was postoperative opioid consumption at 24 hours, while secondary outcomes included pain scores at 12 and 24 hours, postoperative nausea and vomiting (PONV), and rescue analgesic requirements.</p><p><strong>Evidence synthesis: </strong>This meta-analysis included six studies encompassing four randomized controlled trials, one retrospective study, and one prospective observational study, with a total of 350 patients. The analysis demonstrated a significant reduction in postoperative opioid consumption (MD -9.06; 95% CI -11.6 to -6.48, P=0.001) in the M-TAPA group. Additionally, patients receiving M-TAPA reported lower pain scores at 12 and 24 hours postoperatively. The risk of PONV was significantly reduced (OR 0.19; 95% CI 0.10 to 0.39, P=0.001), and fewer patients required rescue analgesics (OR 0.24; 95% CI 0.09 to 0.65, P=0.05).</p><p><strong>Conclusions: </strong>M-TAPA block provides superior analgesia when compared with control group in LC.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"440-449"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serratus posterior superior intercostal plane block + quadroiliac plane block for scoliosis surgery: two novel blocks away from the surgical field.","authors":"Bora Bilal, Bahadır Çiftçi, Ali Ahiskalioğlu, Mustafa Özdemir, Feyza Çalişir, Serkan Tulgar","doi":"10.23736/S0375-9393.24.18759-7","DOIUrl":"10.23736/S0375-9393.24.18759-7","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"478-480"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The deep rectus sheath block plus rectus sheath block in awake laparotomy surgery in the elderly patient.","authors":"Gian M Petroni, Andrea Sanapo, Francesca DE Sanctis, Emanuele Nazzarro, Walter Ciaschi, Chiara Maggiani, Stefano Meloncelli, Carla Stecco, Roberto Cirocchi, Pierfrancesco Fusco","doi":"10.23736/S0375-9393.24.18731-7","DOIUrl":"10.23736/S0375-9393.24.18731-7","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"473-474"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}