Minerva anestesiologica (Minerva Anestesiol )

Description

The journal Minerva Anestesiologica publishes scientific papers on anesthesiology, resuscitation, analgesia and intensive care. Frequency: Monthly. Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation, and Intensive Care.

  • Impact factor
    2.82
  • 5-year impact
    2.12
  • Cited half-life
    3.00
  • Immediacy index
    0.61
  • Eigenfactor
    0.00
  • Article influence
    0.41
  • Website
    Minerva Anestesiologica website
  • ISSN
    1827-1596

Publications in this journal

  • Minerva anestesiologica 07/2015;
  • S Jarosch, C Lehmann
    Minerva anestesiologica 12/2014;
  • J Ripollés Melchor, A Espinosa, E Martínez Hurtado, R Casans Francés, R Navarro Pérez, A Abad Gurumeta, J Calvo Vecino
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    ABSTRACT: The incidence of hypotension associated to spinal anesthesia in elective cesarean section is high. To determine the effects of colloids and crystalloids in the incidence of hypotension induced by spinal anesthesia in elective cesarean section, in an attempt to define which type of fluid and what total volume should be administered. Following the PRISMA methodology a systematic review and meta-analysis were carried out. A systematic Medline/PubMed, EMBASE and Cochrane Library search was made to identify trials were women scheduled for elective cesarean section with spinal anesthesia and volume loading (preload or co--load). The primary outcome was the incidence of hypotension. Stratification into subgroups was made for the primary outcome according to the type of colloid administered, differentiating those studies employing new generation colloids (HES 6% 130/0.4) from those not using such colloids, based on the volume of colloid administered and the combination of a vasopressor. The secondary outcome was the incidence of IONV. 227 controlled clinical trials were analyzed; eleven randomized clinical trials including 990patients were included. A significative decrease of incidence of hypotension associated to spinal anesthesia was observed with the use of colloids compared to crystalloids [RR (95%CI) 0.70 (0.53--0.92), p=0.01]. However, there was no difference between crystalloid and colloid in the risk of intraoperative nausea and vomiting [RR (95%CI) 0.75 (0.41--1.38); p=0.33]. This meta-analysis shows colloid administration to significantly reduce the incidence of hypotension associated to spinal anesthesia in elective cesarean section compared with of crystalloid use.
    Minerva anestesiologica 12/2014;
  • Minerva anestesiologica 12/2014;
  • Minerva anestesiologica 12/2014;
  • Minerva anestesiologica 12/2014;
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    ABSTRACT: Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multi drug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care (ERIC), in order to investigate the number of ICUs using SDD and the factors that prevented the use of SDD. One invitation to the electronic survey was sent to each ERIC unit. The survey focused on department characteristics (intensive care type, local resistance levels), local treatment modalities (antibiotic stewardship) and doctors' opinions (collaborative issues concerning SDD). All ICU's in countries participating in the European Centre for Disease Prevention and Control resistance surveillance program were analyzed. 17% of the ICUs registered in the ERIC database used SDD prophylaxis. Most of these ICUs were located in the Netherlands or Germany. ICUs using SDD were four times more likely to use antibiotic stewardship. Also larger ICUs were more likely to use SDD. On the contrary, resistance to antibiotics was not related to the use of SDD. Also the doctor's opinion that SDD is proven in cluster-randomized trials was not a determinant for not using SDD. SDD is used in a minority of the European ICUs registered in the ERIC database. Larger ICUs and ICUs with a prudent antibiotic policy were more likely to use SDD. Neither antibiotic resistance nor the cluster randomized study design were determinants of the non-use of SDD.
    Minerva anestesiologica 12/2014;
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    ABSTRACT: Sedative drugs are often used at the end of life for different clinical indications, and sometimes sedation is not interrupted until the patient dies. The aim of this study was to estimate the prevalence of patients who died while deeply sedated in Italy in 2007. Cross--sectional survey which asked physicians about the last death that occurred among their assisted patients during the last year, and about their attitudes towards end--of-life decisions. All general practitioners (N=5,710) and a random sample of hospital physicians (N=8,950) from 14 Italian provinces were invited to participate. The response rate was 20%. Among 1,855 reported deaths, 1,466 (79.2%) were classified by physicians as expected or non--sudden. 18.2% of these expected or non--sudden deaths occurred while the patient was deeply sedated. GPs were the least likely to report deep sedation, whereas anesthetists were the most likely. In 8% of cases, sedation occurred along with an abrupt increase in the dosage of opioids during the last day of life, reaching a dosage considered higher than necessary by the doctor. No association with positive attitudes of the physician towards physician assisted death was found, whereas reporting sedation was associated with a positive attitude towards respecting the choice of relatives to forgo life--sustaining treatment in the case of an incompetent patient. Our study confirms the high prevalence of patients in Italy who die while being deeply sedated and shows that different practices may converge under the same label. Careful descriptive language is needed.
    Minerva anestesiologica 12/2014;
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    ABSTRACT: Labile iron appears to play a role in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase--associated lipocalin (NGAL) and hepcidin are involved in iron metabolism and are both upregulated during renal stress. However, in patients at risk, the highest levels of urinary NGAL are associated with AKI severity but the highest urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in ICU patients. Urinary NGAL and hepcidin were quantified within 48 hours of ICU admission in critically ill patients with the systemic inflammatory response syndrome and early signs of kidney dysfunction (oliguria for ≥2 hours and/or a 25 μmol/L creatinine rise from baseline). Diagnostic and prognostic characteristics were assessed by logistic regression and receiver operating characteristics (ROC) analysis. Of 102 patients, 26 had mild AKI and 28 patients had severe AKI on admission. Sepsis (21%), cardiac surgery (17%) and liver failure (9%) were the primary reasons for ICU admission. NGAL increased (P=0.03) whereas hepcidin decreased (P=0.01) with increasing AKI severity. The value of NGAL/hepcidin ratio to detect severe AKI was higher than when NGAL and hepcidin were used individually and persisted after adjusting for potential confounders (adjusted OR 2.40, 95% CI 1.20--4.78). The ROC areas for predicting worsening AKI were 0.50, 0.52 and 0.48 for NGAL, 1/hepcidin and the NGAL/hepcidin ratio, respectively. The NGAL to hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.
    Minerva anestesiologica 12/2014;
  • Minerva anestesiologica 12/2014;
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    ABSTRACT: Restrictions on visiting hours in the ICU are usually adopted worldwide. Current knowledge shows that these limitations are not necessary. In order to identify potential variables that are associated with restricted visiting times we carried out an observational study on visiting policy. We conducted a questionnaire--based nationwide survey among all certified adult Swiss ICUs. An electronic questionnaire was sent by e--mail between May and June 2012 to all chief nurses. Length of permitted visiting time was taken as main endpoint to assess the association with different potential predictor variables using simple and multiple linear regression analysis. Response rate was 73 of 75 ICUs (97%). Only two ICUs (3%) have an unrestricted visiting policy. Median daily visiting time was 8 hours (range: 1.5 to 24 h; interquartile range: 6--10 h). Simple and multiple linear regression analysis demonstrated a significant effect in visiting hours between Italian-- and French--speaking parts of Switzerland with 4.0 hours longer visiting hours in the former (p=0.039) without identifying other predictors. Swiss ICUs have less restrictive visiting policies compared to other Western countries; nevertheless very few Swiss ICUs have unrestricted visitations. Neither medical type of ICU, nor ICU infrastructure was determining the visiting policy in Swiss intensive care setting. Cultural factors, as captured by the linguistic areas are the only identified predictors of visiting hours. Since the current policy is not justified by clinical outcomes but based only on cultural settings, it needs to be definitively reconsidered and unrestricted visiting policies must become the rule rather than the exception.
    Minerva anestesiologica 12/2014;
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    ABSTRACT: Obstructive Sleep Apnea (OSA) increases the perioperative risk of complications. Chronic use of Continuous Positive Airway Pressure (CPAP) by patients decreases the importance of comorbidities caused by the OSA. However, many patients do not adhere to the treatment. Given the postoperative complications, it is important for the anesthesiologist to identify non--adherent patients. This prospective study was designed to identify factors that would predict patient adherence. Ninety patients who were treated by CPAP for more than one year were recruited. Among them, and based on objective criteria such as length of use of CPAP during the night, 75 were considered as being adherent to CPAP, while the other 15 were not. Sixty--two potential causes of non--adherence were investigated (some have not been tested before), and further divided into five categories. Those categories included cultural, intellectual, or economic factors, OSA comorbidities, patient belief about health, ENT--related problems, and pathophysiological features estimating the degree of improvement afforded by CPAP introduction. Multivariate binary logistic regression analysis identified one criterion of non--adherence to treatment, namely the feeling of breathlessness, and three criteria of adherence, namely awareness of the risk of complications, awareness of treatment efficacy, and feeling of being less tired with CPAP therapy. These four new criteria should preoperatively be sought, in order to detect non--adherent patients more efficiently.
    Minerva anestesiologica 12/2014;
  • Minerva anestesiologica 12/2014;
  • Minerva anestesiologica 12/2014; 80(12):1357-1358.
  • Minerva anestesiologica 11/2014;
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    ABSTRACT: Chest wall mechanics can be abnormal in patients with Acute Respiratory Disease Syndrome (ARDS). Therefore, partitioning respiratory system between lungs and chest wall at the bedside is useful to optimize ventilator settings. A non--invasive method for assessing lung elastance (EL), called lung barometry, was previously described on an animal model. This prospective study was designed to compare EL assessed by lung barometry (ELLB) versus esophageal pressure (ELPeso). In sedated, paralyzed patients, PEEP was progressively increased from 5 to 40cmH2O then decreased from 40 to 5cmH2O by step of 5cmH2O every two minutes. ELLB was assessed for each step as the ratio between the change in PEEP and the induced end--expiratory lung volume change measured by direct spirometry. ELPeso was calculated from esophageal pressure measurement at each PEEP. EL and the ratio between EL and respiratory system elastance (ERS) calculated with the two methods were compared. Twenty six adult patients with early onset moderate or severe ARDS were included. There was a linear correlation between ELLB and ELPeso during the increase and decrease of PEEP (R²=0.26 and 0.42, respectively). Concordance using Bland and Altman method demonstrated bias and large limits of agreement during the increase (--0.5cmH2O/L; --25 to 24cmH2O/L) and during the decrease in PEEP (--0.3cmH2O/L; --21 to 20cmH2O/L). There were no linear correlation between ELLB/ERS and ELPeso/ERS during the increase and the decrease of PEEP (R²=0.00; R²=0.00, respectively). In ARDS patients, lung barometry method cannot be used instead of the esophageal pressure measurement to assess EL.
    Minerva anestesiologica 11/2014;
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    ABSTRACT: Because of restricted information given by monitoring solely intracranial pressure and cerebral perfusion pressure, assessment of the cerebral oxygenation in neurocritical care patients would be of interest. The aim of this study was to determinate the correlation between the non--invasive measure regional saturation in oxygen (rSO2) with a third generation NIRS monitor and an invasive measure of brain tissue oxygenation tension (PbtO2). We conducted a prospective, observational, unblinded study including neurocritical care patients requiring a PbtO2 monitoring. Concomitant measurements of rSO2 were performed with a four wavelengths forehead sensor (EQUANOX Advance™) of the EQUANOX™ 7600 System. We determined the correlation between rSO2 and PbtO2 and the ability of the rSO2 to detect ischemic episodes defined by a PbtO2 less than 15 mmHg. The rSO2 ischemic threshold was 60%. During 2 months, 8 consecutives patients, including 275 measurements, were studied. There was no correlation between rSO2 and PbtO2 (r = 0.016 [--0.103 - 0,134], r2 = 0.0003, p = 0.8). On the 86 ischemic episodes detected by PbtO2, only 13 were also detected by rSO2. ROC curve showed the inability for rSO2 to detect cerebral hypoxia episodes (AUC = 0.54). rSO2 cannot be used as a substitute for PbtO2 to monitor cerebral oxygenation in neurocritical care patients.
    Minerva anestesiologica 11/2014;
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    ABSTRACT: The acid--base, biochemical and hematological effects of crystalloid solutions have not been comprehensively evaluated in patients with liver resection. Design: Multicenter, prospective, double--blind randomized controlled trial investigating the biochemical effects of Hartmann's solution (HS) or Plasmalyte--148 (PL) in 60 patients undergoing major liver resection. Primary outcome: Base Excess immediately after surgery. Secondary outcomes: changes in blood biochemistry and hematology. At completion of surgery, patients receiving HS had equivalent mean standard Base Excess (--1.7 ± 2.2 vs. --0.9 ± 2.3 meq/L; p=0.17) to those treated with PL. However, patients treated with HS were more hyperchloremic (difference 1.7 mmol/L, 95% CI: 0.2 to 3.2, p=0.03) and hyperlactatemic (difference 0.8 mmol/L, 95% CI: 0.2 to 1.3; p=0.01). In contrast, patients receiving PL had higher mean plasma magnesium levels and lower ionized calcium levels. There were no significant differences in pH, bicarbonate, albumin and phosphate levels. Immediately after surgery, mean PT and aPTT were significantly lower in the PL group. Intraoperatively, the median (IQR) blood loss in the PL group was 300 ml (200:413) vs. 500 ml (300:638) in the HS group (p=0.03). Correspondingly, the postoperative hemoglobin was higher in the PL group. Total complications were more frequent in the HS Group (56% vs. 20%, relative risk 2.8; 95% CI: 1.3 to 6.1; p=0.007). In liver resection patients, HS and PL led to similar Base Excess values but different post operative plasma biochemistry and hematology values. Understanding of these effects may help clinicians individualize fluid therapy in these patients.
    Minerva anestesiologica 11/2014;
  • Minerva anestesiologica 11/2014;