Minerva anestesiologica最新文献

{"title":"When less is more: rethinking neuromuscular blockade in suspension laryngoscopy.","authors":"Manuel Á Gómez-Ríos, Alfredo Abad-Gurumeta","doi":"10.23736/S0375-9393.26.20072-X","DOIUrl":"10.23736/S0375-9393.26.20072-X","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"656-658"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593189","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":"Hemodynamic monitoring during ECMO.","authors":"Martin Mirus, Paul Klinitzke, Peter M Spieth","doi":"10.23736/S0375-9393.26.19888-5","DOIUrl":"10.23736/S0375-9393.26.19888-5","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is an established life-saving therapy for severe acute respiratory distress syndrome and cardiogenic shock, yet it profoundly alters cardiopulmonary physiology and challenges conventional hemodynamic monitoring. Both venovenous (VV) and venoarterial (VA) ECMO modify venous return, ventricular loading conditions, pulmonary vascular resistance, and ventriculo-arterial coupling, leading to complex interactions between native and extracorporeal circulation. As a result, many standard monitoring techniques, particularly indicator-based and pressure-derived methods, lose validity or require careful reinterpretation under ECMO conditions. This review summarizes current evidence on hemodynamic monitoring during VV- and VA-ECMO and critically evaluates commonly used modalities, including echocardiography, invasive arterial pressure monitoring and pulse wave analysis, transpulmonary thermodilution, pulmonary artery catheterization, and microcirculatory monitoring. We highlight configuration-specific pathophysiology, key methodological limitations, and typical sources of misinterpretation for each technique. Particular emphasis is placed on the dissociation between macrocirculatory variables and tissue perfusion, the impact of parallel circulation and flow mixing in VA-ECMO, and the persistence of occult shock despite apparently adequate systemic targets. We propose a physiology-guided, multimodal monitoring framework that integrates pressure, flow, volumetric, and microcirculatory information with serial echocardiography. No single monitoring modality adequately captures the hemodynamic complexity of ECMO patients; instead, informed interpretation of complementary parameters and longitudinal trends is essential to guide individualized clinical decision-making and avoid delayed recognition of ventricular failure or regional hypoperfusion.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":"92 7-8","pages":"750-761"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562526","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":"Combination of rectointercostal and external oblique intercostal blocks for pediatric liver transplantation.","authors":"Selcuk Alver, Mehmet I Büget, Ertan Emek, Halil Erbis, Bahadir Ciftci","doi":"10.23736/S0375-9393.26.19948-9","DOIUrl":"10.23736/S0375-9393.26.19948-9","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"785-786"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284474","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":"Medicine regenerative versus steroids: time to reconsider treatment of chronic inflammatory pain.","authors":"Maurizio Marchesini, Wassim Raffoul, Massimo Allegri","doi":"10.23736/S0375-9393.26.19712-0","DOIUrl":"10.23736/S0375-9393.26.19712-0","url":null,"abstract":"<p><strong>Background: </strong>Chronic musculoskeletal and spinal pain is a major clinical challenge. Corticosteroid (CS) injections provide rapid analgesia, but it is typically short-lived and may have adverse tissue-related effects. The most commonly used regenerative treatment is platelet-rich plasma (PRP), which modulates inflammation and extracellular matrix turnover and partly affects nociceptive signalling. PRP also has potential for longer-term disease-modifying benefits. This review compares PRP with CS in key musculoskeletal joints and spinal pain indications with focus on effectiveness, durability, and safety.</p><p><strong>Methods: </strong>We conducted a review with a systematic search of PubMed/MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar (January 2000 - March 2025). English-language randomized controlled trials (RCTs) and prospective studies evaluating PRP versus CS (± local anesthetic) in osteoarthritis, tendinopathies, and spinal pain (discogenic, facet/zygapophyseal, sacroiliac joint, radicular) were included. The primary outcomes were pain intensity, function, and durability. Safety information was extracted when reported. Given the heterogeneity in the PRP formulations (leukocyte-poor/leukocyte-rich, platelet dose, activation), target tissues, and follow-up, the findings were synthesized qualitatively according to anatomical region and integrated with mechanistic evidence.</p><p><strong>Results: </strong>Across indications, CS showed an early advantage at 2-8 weeks, whereas PRP demonstrated superior pain and functional outcomes at ≥3-6 months. In plantar fasciitis and osteoarthritis of the knee, PRP outperformed CS at 3-12 months. In gluteal tendinopathy, benefits of PRP emerged by 12 weeks. For cervical/lumbar facet and sacroiliac joint pain, PRP yielded more durable relief up to six months. In epidural approaches, PRP was non-inferior in the short term and in some studies superior by 24 weeks, and intradiscal PRP showed encouraging longer-term signals. Both strategies were generally safe, although local/systemic adverse events were more frequent with CS. Outcome variability was partly attributable to heterogeneity of PRP products.</p><p><strong>Conclusions: </strong>For inflammatory-degenerative musculoskeletal and spinal conditions, PRP seems to offer more persistent benefits than CS, while CS is valuable for rapid short-term analgesia. Treatment selection should be guided by phenotype. Standardization of PRP protocols (composition, dose, activation) and high-quality multicentre RCTs are still needed. Conceptualizing PRP as primarily an immuno-inflammatory modulator drug in pain therapy rather than strictly \"regenerative\" may better explain its longer-term effects.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"726-738"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840112","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 ultrasound-guided serratus posterior superior intercostal plane block on analgesia and respiratory parameters in multiple rib fractures.","authors":"Elif Sarikaya Özel, Mehmet G Taflan","doi":"10.23736/S0375-9393.26.19946-5","DOIUrl":"10.23736/S0375-9393.26.19946-5","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"782-785"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486570","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":"Novel deep iliacus plane block for postoperative analgesia after proximal femur fracture surgery: a single-case experience.","authors":"Mehmet G Taflan, Elif Sarikaya Özel, Bahadır Ciftci","doi":"10.23736/S0375-9393.26.19935-0","DOIUrl":"10.23736/S0375-9393.26.19935-0","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"776-778"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378123","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":"Beyond analgesia: successful anesthetic management of total implantable venous access port implantation with serratus posterior superior intercostal plane block in a high-risk cardiac patient.","authors":"Çağdaş Baytar, Özcan Pişkin","doi":"10.23736/S0375-9393.26.19865-4","DOIUrl":"10.23736/S0375-9393.26.19865-4","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"766-767"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106043","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":"Lumbosacral erector spinae plane block vs. fascia iliaca block in elderly patients with hip fracture.","authors":"Lorenza Sbucafratta, Francesco Marrone","doi":"10.23736/S0375-9393.26.19938-6","DOIUrl":"10.23736/S0375-9393.26.19938-6","url":null,"abstract":"","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"780-782"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504165","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":"Efficacy of intranasal insulin in preventing postoperative delirium and its impact on insulin resistance in elderly non-cardiac surgical patients: a systematic review and meta-analysis.","authors":"Junjun Qin, Weili Zhou, Sengen Chen, Mingyue Cheng, Xiong Shen, Jiasen Ma","doi":"10.23736/S0375-9393.26.19719-3","DOIUrl":"10.23736/S0375-9393.26.19719-3","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common and serious complication in elderly patients and has been established to be associated with insulin resistance (IR), a key marker of dysregulated glucose metabolism. Therefore, this study aims to systematically evaluate the efficacy of intranasal insulin in preventing POD in elderly non-cardiac surgery patients and to further investigate whether its mechanism of action is related to the improvement of IR.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journals Database and Chinese Biomedical Literature Database from inception to October 19, 2025, to identify randomized controlled trials that compared elderly patients who were administered intranasal insulin during the perioperative period with those who were not. The primary outcomes of this study were the incidence of POD and the efficacy of different insulin dosing regimens. The secondary outcome was the change in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values before and after surgery. Data from eligible trials were pooled to calculate the combined risk ratio (RR) or standardized mean difference (SMD).</p><p><strong>Results: </strong>Analysis of seven trials involving 778 elderly patients showed that, compared to placebo, intranasal insulin significantly reduced POD incidence on day one (RR: 0.33; 95%CI: 0.22 to 0.47; P<0.001) and its cumulative incidence over three days (RR: 0.31; 95%CI: 0.22 to 0.44; P<0.001) and five days (RR: 0.32; 95%CI 0.18 to 0.56; P<0.001). In contrast, the change in HOMA-IR across the surgery period did not differ significantly between the two groups (SMD: -0.27; 95%CI: -0.77 to 0.23; P=0.290).</p><p><strong>Conclusions: </strong>Intranasal insulin is effective in reducing the incidence of POD. This benefit is likely mediated through central nervous system glucose metabolism, rather than by reversing peripheral IR, a premise that requires validation in future trials.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"739-749"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147776146","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":"Role of dexmedetomidine as an adjuvant to bupivacaine in external oblique intercostal plane block for post thoracotomy pain: a randomized controlled trial.","authors":"Fatma E Aboharga, Saad A Moharam, Mohammed S Elsharkawy, Mohamed E Mahmoud, Ahmed S Elsaily, Khaled Hamama, Shaimaa W Zahra, Mohamed A Ahmed, Shady A Ismaeil","doi":"10.23736/S0375-9393.26.19565-0","DOIUrl":"10.23736/S0375-9393.26.19565-0","url":null,"abstract":"<p><strong>Background: </strong>The duration of peripheral nerve blocks is extended with dexmedetomidine, which has a beneficial impact in reducing the amount of opioid consumption and pain score during and after surgery. The external oblique intercostal plane block (EOIPB) is a new method that specifically targets the sensory nerves responsible for supplying the chest wall, providing pain relief for surgical techniques. This trial's goal was to evaluate the effectiveness of dexmedetomidine as an adjuvant in EOIPB for the management of post-thoracotomy pain (PTP).</p><p><strong>Methods: </strong>In this controlled, randomized, double-blind trial, 40 adult patients of both sexes had open thoracotomies. The patients were divided into two groups: Group D was given 29 mL of 0.25% bupivacaine and 0.5 μg/kg of dexmedetomidine diluted in one mL of saline 0.9%, and Group C (Control Group) received 29 mL of bupivacaine 0.25% plus one mL of saline 0.9%. Total morphine usage over the first 48 hours after surgery was the primary outcome. The secondary outcomes were intraoperative hemodynamics, intraoperative fentanyl consumption, total morphine intake in the first 24 hours, time to the first rescue analgesia, pain score, and the level of patient satisfaction and side effects.</p><p><strong>Results: </strong>Total amount of morphine taken in the first 24 and 48 hours postoperative was markedly reduced in Group D, in contrast to Group C (P<0.05). The first request for rescue analgesia was considerably delayed in Group D, in contrast to Group C (P<0.001). Numerical Rating Scale measurements were notably reduced at 4h, 8h, 12h, and 18h in Group D in contrast to Group C (P<0.05). Patient satisfaction was substantially greater in Group D than in Group C (P=0.041).</p><p><strong>Conclusions: </strong>The addition of dexmedetomidine to bupivacaine as an adjuvant in the EOIPB resulted in effective postoperative analgesia by lowering pain scores and the need for postoperative opioids and delaying the time of the first rescue analgesia.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":" ","pages":"683-691"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593179","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}