Minerva anestesiologica (Minerva Anestesiol)

Publications in this journal

• Article: Evaluation of continuous monitoring of stroke volume and cardiac output in patients supported by an intra-aortic balloon pump.

  M Podbregar, M Košir, D Stajer, J Zdovc, S Plaskan
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  ABSTRACT: Background: Currently available minimally invasive devices cannot provide continuous determination of stroke volume (SV) or cardiac output (CO) in patients supported with an intra-aortic balloon pump (IABP). Our aim was to evaluate the accuracy of Dat-con™ monitor for continuous SV and CO determination in such patients. Methods: SV (SVdat-con) and CO (COdat-con) were determined by Dat-con™ monitor in 35 patients supported by IABP, at baseline and after 103 therapeutic interventions. Echocardiography was used to measure SV (SVecho) and CO (COecho) from velocity time integral and cross-sectional area of left ventricular outflow tract. Monitored and echocardiographic values were compared using Bland-Altman's statistics. Results: Bias in baseline SVdat-con compared to SVecho was 0.2ml, with 1.96 limits of agreement (SD) of ±4.8ml and with percentage error of 11%. Bias of baseline COdat-con compared to COecho was 0.03 l/min, with 1.96 SD of ±0.435 l/min with percentage error of 10.9%. After therapeutic interventions, bias of SVdat-con compared to SVecho was -0.3 ml, with 1.96 SD of ±4.8 ml and with percentage error of 10.5%. Agreement for SV changes was >95% (exclusion zone: changes <10%). Bias of COdat-con compared to COecho after therapeutic interventions was -0.03 l/min, with 1.96 SD of ±0.45 l/min. Conclusions: The accuracy and trending of continuous determination of SV and CO with Dat-con™ monitor in patients supported by IABP is equivalent to echocardiography.
  Minerva anestesiologica 05/2013;
• Article: Tracheal amylase dosage as a marker for microaspiration: a pilot study.

  B Filloux, A Bedel, S Nseir, J Mathiaux, B Amadéo, B Clouzeau, J Pillot, T Saghi, F Vargas, G Hilbert, D Gruson, A Boyer
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  ABSTRACT: Background: Devices that limit microaspiration through the cuffs of endotracheal tubes could help prevent ventilator-associated pneumonia (VAP). The amount of tracheal microaspirations could be a relevant study endpoint. The aim of our study was to assess whether amylase measured in tracheal secretions constituted a relevant marker for microaspiration. Methods: Twenty-six patients, intubated for at least 48 h and supplied with a subglottic secretion-suctioning device, constituted a group with a high risk of microaspiration. Twelve non-ventilated patients that required a bronchoscopy procedure constituted a group with a low risk of microaspiration (the control group). Tracheal (T) amylase was compared between the groups. In the intubated group, a series of oral (O), subglottic (Sg) and tracheal (T) suction samples were collected and T/O, T/Sg, Sg/O amylase ratios were determined. Results: Amylase was measured in 277 (89 Sg, 96 B, 92 T) samples from the intubated group and in 12 T samples from the control group. Tracheal amylase was lower in the control group than the intubated group (191 [10-917] vs. 6661 [2774-19,358] IU/L, p<0.001). Amylase gradually increased from tracheal (6661 [2774- 19,358] IU/L), to subglottic (130,750 [55,257-157,717] IU/L), to oral samples (307,606 [200,725-461,300] IU/L), resulting in a median 5.5% T/O ratio. In a subset of intubated patients, T amylase samples were assessed in two different laboratories, and gave reproducible results. Conclusions: Tracheal amylase was easy to collect, transport, and measure. The T/O amylase ratio is a first step towards quantifying oropharyngeal to tracheal microaspiration in mechanically-ventilated patients.
  Minerva anestesiologica 05/2013;
• Article: Informed Consent For Tracheostomy Procedures In Intensive Care Unit: An Italian National Survey.

  M Vargas, G Servillo, M Antonelli, I Brunetti, F De Stefano, C Putensen, P Pelosi
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  ABSTRACT: Introduction: Critically ill patients in Intensive Care Unit (ICU), due to their temporary or permanent incompetence, are often not capable to provide informed consent (IC), although required, for not emergency invasive procedures, like elective tracheostomy. By Italian law, a person with partially/temporarily physical/mental impairment needs a legal tutorship appointed by the court (Support Administrator, SA). We performed a national survey in Italy to investigate IC practice for elective tracheostomy procedure in critically ill conscious and unconscious patients in ICU. Methods: Questions about IC were included in a survey concerning the clinical practice of tracheostomy in ICU. The survey was approved by the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI, n° 434 - 28 March 2012) and sent by e-mail to all members included in its mailing list. The duration of the survey was three months from April to June 2012. All required information was referred to the year 2011. Results: The mailed questionnaire correctly fulfilled was sent back by 131/427 (30%) national ICUs. Our data showed 1) in conscious patients, IC was obtained by 82,4% of ICUs; 2) in unconscious patients, IC was obtained in only 61,8% with different procedures not following the current Italian law, 3) for surgical tracheostomy performed in operating room, IC was obtained in conscious and unconscious patients in only 69,8% and 47,2% of ICUs, respectively, 4) risk/benefit informative document was provided in 61,1% ICUs, but available only in 47,2% of ICUs performing tracheostomy in operating room. Conclusions: In Italian ICUs, participating to this study, the procedures related to IC for conscious and unconscious critically ill patients requiring surgical or percutaneous tracheostomy are not in line with current legal rules and procedures.
  Minerva anestesiologica 05/2013;
• Article: Absent right superior vena cava.

  A Banzato, A Bianchi
  Minerva anestesiologica 05/2013;
• Article: Fusarium spp: an evolving challenges to critically ill patients.

  E Mannu, R Foddanu, S Sanna, P Ena, L Brazzi
  Minerva anestesiologica 05/2013;
• Article: Management of the patient with diabetic peripheral neuropathy presenting for peripheral regional anaesthesia: a European survey and Review of literature.

  P Lirk, M V H Rutten, I Haller, M F Stevens, J Laudolff-Birmingham, M Hollmann, B Birmingham
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  ABSTRACT: Background: Diabetic peripheral neuropathy (DPN) is a frequent complication of longstanding diabetes mellitus. There is no evidence-based consensus whether neuropathic patients undergoing peripheral regional anaesthesia are at increased risk of neurologic damage. It is unknown whether these controversial results have been incorporated into clinical practice. Objective: We conducted a survey to test the hypothesis that the majority of respondents would consider DPN a potential risk factor for nerve damage in regional anaesthesia, and would adapt their technique when performing regional anaesthesia. In parallel, we sought to summarize the current knowledge-base regarding regional anaesthesia and DPN. Methods: We therefore performed (1) a literature search to review current literature and (2) an online computerbased survey among members of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). Results: The overall response rate was 19 % (584 responders / 3,107 invitations). We received. About a quarter of participants would avoid regional anaesthesia in patients with diabetic neuropathy, and 59 % of respondents would counsel patients with diabetic neuropathy about increased risk of regional anaesthesia. When techniques were modified, most participants would decrease or omit epinephrine, while fewer respondents would decrease dose of local anaesthetic or perform other adjustments. More than eighty percent agreed with the statement that nerve blocks could be performed safely in diabetic neuropathic patients. Conclusions: In conclusion, we report the results of the first survey analyzing attitudes and standards of care among European anaesthesiologists with regards to Regional Anaesthesia in DPN. While literature is divided on the question whether pre-existing diabetic neuropathy is a risk factor for new neurological deficit after regional anaesthesia, most of the responders of this survey take measures to reduce risks, counsel patients on a possible greater risk of neurologic complications, but only a minority of responders would avoid peripheral regional anaesthesia altogether.
  Minerva anestesiologica 05/2013;
• Article: Current developments in the treatment of neuropathic pain in AIDS patients.

  A Eroglu
  Minerva anestesiologica 05/2013;
• Article: Key points for intraoperative management of percutaneous endoscopic lumbar discectomy (PELD) for anesthesiologists.

  M Tsuchiya, Y Kyoh
  Minerva anestesiologica 05/2013;
• Article: Evaluation of acid-base status in brain dead donors and the impact of metabolic acidosis on organ retrieval.

  J H Lee, M S Kim, S Na, S O Koh, J Sim, Y S Choi
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  ABSTRACT: Background: Pathophysiologic changes after brain death can lead to acid-base disturbances. The primary aim of this study was to clarify the acid-base state and its source in brain dead donors using Stewart's approach. Additionally, we investigated whether the presence of metabolic acidosis affected the number of organs retrieved from donors. Methods: A retrospective review of electronic medical records was performed for brain dead donors who had undergone organ harvesting during the past 5 years in a tertiary medical center. The parameters related to acidbase disturbance and the number of organs retrieved from the donors was assessed. Results: Sixty one brain dead donors were evaluated in this study. Twenty three (37.7%) of these patients had metabolic acidosis at the initial diagnosis of brain death. Metabolic acidosis resulted from hyperchloremia and a large strong ion gap. The severity of metabolic acidosis was masked by hypernatremia and hypoalbuminemia. In addition, donors without metabolic acidosis also showed mixed acid-base disturbances in which metabolic acidosis induced by significant hyperchloremia was combined with metabolic alkalosis caused by hypoalbuminemia and hypernatremia. Although more organs were retrieved from the donors without metabolic acidosis than those with metabolic acidosis (P=0.012), serum albumin level (P=0.010) and donor age (P<0.001), rather than metabolic acid-base disturbances, significantly correlated with the number of organs retrieved in multivariate regression analysis. Conclusion: Most brain dead donors exhibited metabolic acid-base disturbances. However, rather than metabolic acidosis, serum albumin level and donor age were well correlated with the number of organs retrieved.
  Minerva anestesiologica 05/2013;
• Article: Effects of Intraoperative Colloid Administration on Outcome in a Population- Based General Surgical Cohort: A Propensity Score Analysis.

  J Canet, S Sabaté, V Mazo
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  ABSTRACT: Background: Many studies on colloids have recently been retracted, leaving us with uncertain evidence of their safety. We aimed to analyze whether intraoperative colloid administration is associated with postoperative complications. Methods: The prospectively compiled database of the ARISCAT study of a large, representative cohort of general surgical patients was reanalyzed to compare outcomes according to whether intraoperative colloids were administered or not; a propensity score was used to adjust for potential confounders. The primary outcomes were major postoperative complications. Secondary outcomes were postoperative hospital-free days within 90 days and mortality at 30 and 90 days. In a retrospective survey we asked each center's data collectors to estimate the proportions of the different colloids administered during the study period. Results: Of 2462 patients analyzed, 556 (22.6%) received some type of colloid intraoperatively. The median (25th-75th percentile) of total fluids administered was significantly higher in patients receiving colloids (10.0 [6.9-14.1] mL·kg-1·h-1 vs 8.8 [6.0-12.8] mL·kg-1·h-1 for patients not receiving colloids; P<0.01]). The median volume of colloids administered was 7.5 (6.3-10.4) mL·kg-1. An estimated 75.7% of the patients received thirdgeneration hydroxyethyl starches (130/0.4). Significantly associated complications, after propensity score adjustment, were atelectasis, respiratory infection, bronchospasm, arrhythmia, sepsis, paralytic ileum, and hyperglycemia. Patients receiving colloids had 1.9 fewer postoperative hospital-free days (P<0.006). There were no significant differences in 30- and 90-day mortality. Conclusions: Our study suggests an association of intraoperative colloid administration, mainly of 130/0.4 hydroxyethyl starches, with diverse major postoperative complications and longer hospital stay. Controlled studies are urgently needed to assess the safety profile of colloid use in surgical patients.
  Minerva anestesiologica 05/2013;
• Article: Perioperative management of Wilson disease for therapeutic abortion: A report.

  P B Rao, N Singh, S K George
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  ABSTRACT: Wilson disease (WD) or hepatolenticular degeneration is an autosomal recessive disorder with reduction in the synthesis of the copper transporter protein ceruloplasmin. It is characterized by cirrhosis, extrapyramidal symptoms and Kayser-Fleischer (KF) corneal rings. The outcome of this genetic defect is the accumulation of copper in body tissues and consequent hepatic and neurological impairment in addition to involvement of all other organs demanding great concern to the anaesthesiologist in the peri-operative period. Here we discuss the perioperative issues in the management of a case of WD with pregnancy scheduled for termination under anesthesia.
  Minerva anestesiologica 05/2013;
• Article: Efficacy of endotoxin adsorption therapy (polymyxin B hemoperfusion) for methicillin-resistant Staphylococcus aureus toxic shock syndrome. A case report about five patients.

  T Taniguchi, K Sato, A Kurita, T Noda, M Okajima
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  ABSTRACT: Background: Toxic shock syndrome (TSS), which can be life-threatening, is clinically and pathologically characterized by the presence of high fever, skin rash, desquamation, hypotension, and multiple organ failure caused by an enterotoxin produced by Staphylococcus aureus. In this study, we evaluated the effects of endotoxin adsorption therapy (polymyxin B [PMX] hemoperfusion) in critical patients with methicillinresistant Staphylococcus aureus TSS (MRSA-TSS) who showed no improvement with the conventional therapy. Methods: Five MRSA-TSS patients (men/women: 3/2; median age: 39 years) who showed no improvement with the conventional therapy underwent PMX hemoperfusion in addition to the conventional therapy. The primary outcomes were change in the systolic arterial pressure (SAP) and requirement of a vasopressor after PMX hemoperfusion, and the secondary outcomes were change in laboratory data and sequential organ failure assessment (SOFA) scores 24 h after the therapy. Results: The median duration of PMX hemoperfusion was 9 h (range, 4-20 h). SAP significantly increased (from 89 to 125 mmHg, p<0.05) and the requirement of a vasopressor significantly decreased (from 10 to 2, p<0.05) after PMX hemoperfusion. Furthermore, the patients' white blood cell count decreased (from 17640 to 10090 /uL, p<0.05), and SOFA scores decreased (from 13 to 9, p<0.05) after PMX hemoperfusion. All patients recovered and were discharged from the ICU. Conclusion: Our results showed that PMX hemoperfusion significantly improved the hemodynamics and severity in patients with life-threatening MRSA-TSS.
  Minerva anestesiologica 05/2013;
• Article: The Effect Of Angiotensin Converting Enzyme Gene I/D Polymorphism And Its Expression On Clinical Outcome In Acute Respiratory Distress Syndrome.

  A E Tsantes, P Kopterides, S Bonovas, P Bagos, G Antonakos, G K Nikolopoulos, A Gialeraki, V Kapsimali, E Kyriakou, S Kokori, K Dima, A Armaganidis, I Tsangaris
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  ABSTRACT: Background: The role of the D allele of the angiotensin-converting enzyme (ACE) gene I/D polymorphism in the clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) remains controversial. Our aim was to assess simultaneously the effect of the ACE I/D polymorphisms as well as the serum and BALF ACE levels on prognosis of patients with ARDS. Methods: 69 mechanically ventilated patients with ALI/ARDS were recruited. ACE activity levels both in serum and BALF were assessed by chemical methods. Patients were genotyped for ACE I/D polymorphisms. Time-to-event analysis evaluated the variables associated with the 28-day and 90-day mortality. Finally, we performed a meta-analysis of studies examining the association between ACE I/D polymorphisms and mortality of ALI/ARDS patients. Results: In the multivariable model, age, lung compliance, serum lactate and serum ACE levels were significantly associated with both 28- and 90-day mortality. No significant correlation was found between serum and BALF ACE levels (Spearman's rho=0.054; p=0.66). Serum ACE concentrations were significantly higher (p=0.046) in patients with D/D genotype versus the two other groups combined (I/D and I/I genotypes). The meta-analysis of 6 studies (including ours) provided evidence that D allele is significantly associated with increased mortality in ALI/ARDS patients, yielding a per-allele odds ratio of 1.76 (95% CI: 1.19, 2.59). Conclusions: Serum ACE levels appear to be affected by the I/D polymorphism and are correlated with prognosis in patients with ALI/ARDS indicating that further investigation of the clinical significance of the ACE in ARDS might be of value.
  Minerva anestesiologica 05/2013;
• Article: Hemodynamic changes associated with spinal and general anesthesia for hip fracture surgery in severe ASA III elderly population: a pilot trial.

  A Messina, L Frassanito, D Colombo, A Vergari, G Draisci, F Della Corte, M Antonelli
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  ABSTRACT: Background: Patients affected by hip fracture (HF) have high risk of perioperative complications. Despite regional anesthesia is widely used, hypotension is common and increases the risk of myocardial ischemia. The aim of this work was to study hemodynamic changes following spinal (SA) and general (GA) anesthesia in this selected population of patients. Methods: Twenty patients over 70 years old, ASA III, scheduled for HF repair were randomized to receive SA or general anesthesia GA. Hemodynamic responses to SA and GA were analyzed trough LiDCO™plus monitor (LiDCO Ltd., Cambridge, UK). Results: SA provided a more stable hemodynamic profile. SA group received less interventions to keep mean arterial pressure (MAP) within limits. GA group had intraoperative cardiac index (CI), stroke volume index (SVI) and MAP significantly lower than baseline. Despite both groups experienced hypotension after the induction, MAP reduction in SA group was primarily due to systemic vascular resistance index (SVRI) decline, whereas hypotension in GA group was primarily due to a reduction in SVI and CI. The coefficient of variation (CV) was significantly higher in GA group for CI, SVI, MAP and heart rate (HR) within one hour analysis comparing to SA group. SA group had an higher CV for SVRI. Conclusions: SA in the elderly population with hip fracture provides a more stable hemodynamic profile requiring less intervention to keep MAP close to baseline value. Hypotension was common in SA and GA after induction and within intraoperative period. A larger randomized clinical study should be performed to confirm these preliminary data.
  Minerva anestesiologica 05/2013;
• Article: Effect of volatile anesthetics on the ischemia-reperfusion injury.

  A M De Wolf, J F A Hendrickx
  Minerva anestesiologica 05/2013; 79(5):480-1.
• Article: Weaning of the patient with tracheostomy. Role of continuous positive airway pressure.

  R Kopp, J Bickenbach
  Minerva anestesiologica 05/2013; 79(5):474-6.
• Article: Can renin predict the mortality of patients in Intensive Care Unit?

  O Kurt, M Cakar, S Balta, M Akhan, E Arslan, S Demirkol
  Minerva anestesiologica 05/2013; 79(5):574.
• Article: Comparison of oxidative stress in ASA physical status I patients scheduled for minimally invasive surgery under balanced or intravenous anesthesia.

  M G Braz, L G Braz, J R Braz, D T Pierine, C R Correa, A L Ferreira, L R Carvalho, K J Yeum, D M Salvadori
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  ABSTRACT: Background: The effects of anesthetics on inflammation and oxidative parameters, evaluated in patients without comorbidities undergoing minor surgery, remain unknown. The present study aimed to investigate the inflammatory and oxidative stress status in adult patients undergoing elective minimally invasive surgery, using different anesthetic techniques. Methods: Thirty patients classified as ASA physical status I, who were scheduled for minor surgeries (tympanoplasty or septoplasty), were randomly allocated into two groups: balanced (BAL) anesthesia maintained with isoflurane or total intravenous anesthesia (TIVA) with propofol. Blood samples were drawn prior to the induction of anesthesia (baseline), 120 min after the beginning of anesthesia and one day after surgery. The pro-inflammatory cytokine IL-6 was determined by flow cytometry; DNA oxidation was evaluated by the single cell gel electrophoresis assay, and plasma malondialdehyde (lipid peroxidation biomarker) and antioxidant status were determined through fluorometry. Results: Increased IL-6 was observed one day after surgery in both groups (P<0.0001). Malondialdehyde levels did not change among the time points assessed or between the groups (P>0.05).Whereas BAL anesthesia had no effect on acid nucleic and antioxidant status, TIVA decreased oxidized/alkylated purines (P=0.03) and increased antioxidant status (P=0.002) during anesthesia. The two groups did not differ show significantly in DNA oxidation or antioxidant status (P>0.05). Conclusion: BAL anesthesia maintained with isoflurane and TIVA maintained with propofol are safe by virtue of not causing oxidative stress status in ASA physical status I patients undergoing minimally invasive surgeries. Moreover, even in minor surgeries, TIVA with propofol produces an antioxidant effect in patients.
  Minerva anestesiologica 04/2013;
• Article: A biomarker panel: an additional resource in acute stroke evaluation?

  T Kimura, T Nishikawa
  Minerva anestesiologica 04/2013;
• Article: Pediatric Enoxaparin overdose: more attention to Thromboelastography monitoring.

  A Pittalis, M L Tuccillo, F Savron, C Schember, D Morri, C Dell'oste
  Minerva anestesiologica 04/2013;