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Gupta DK, Mazzeo AT. Cross-Cultural Teachings from Cremation Practices: Atmaram for the Departed, Shiva Linga for the Living, and Odontoid Fracture for the Neurosurgeons! Neurol India 2023; 71:536-538. [PMID: 37322753 DOI: 10.4103/0028-3886.378664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Atmaram bone (C2 axis vertebra) is usually handed over to the family of the deceased on the next day after cremation during the ''Asthi sanchaya '' commemoration. ''Asthi visarajan'' involves the practice of immersing the bones and ashes of the deceased in the Holy Ganges river as per Hindu beliefs. Atmaram bone, which usually does not burn during cremation, is handed over to the family of the departed (asthi sanchaya) after cremation which is then immersed in the holy Ganges river ( asthi visarajan). Atma means soul, Ram means Lord and Atmaram combined means the one who is Lord of his own soul." Worshiping of Lord Shiva (while living) and Asthi sanchaya-Asthi visarajan (of the departed) are two religious venerations in Hinduism. Atmaram bone was handed over to me for immersion in the holy Ganges on November 6, 2020, after conducting the asthi sanchaya of my mother during the coronavirus disease 2019 (COVID-19) pandemic. Atmaram bone looked like a Shivalinga statue to most who looked at it, whereas it resembled the image of the axis vertebrae (C2 vertebra) to me when I saw it that sacred day. Atmaram bone, the Shivalinga, and the C2 axis vertebra are among the most precious and sacred objects that humans can handle as relatives, as devotees, and as neurosurgeons, respectively. Asclepius, possibly a skilled war surgeon/neurosurgeon, was worshipped at Asclepieia. Trephination surgery in neurosurgery and religion are intertwined historically. Though there is no published literature, neurosurgeons in various parts of the world do offer religious prayers prior to major neurosurgical operations. In line with the religious veneration of worshipping Shiva Ling or immersion of bones of the departed soul in the Holy Ganges river, we believe it is the sacred responsibility of the operating neurosurgeon to perform surgery in complex craniovertebral junction. As neurosurgeons, we cannot ignore the axis in the living, the odontoid fracture in the injured, and the Atmaram in the deceased.
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Affiliation(s)
- Deepak K Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India
| | - Anna T Mazzeo
- Department of Anesthesia and Intensive Care, University of Messina, Messina ME, Italy
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Maimone S, Mazzeo AT, Squadrito G, Raimondo G. Sodium load and intravenous antimicrobials in patients with cirrhosis. Dig Liver Dis 2019; 51:1490-1492. [PMID: 31439451 DOI: 10.1016/j.dld.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022]
Affiliation(s)
- S Maimone
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy.
| | - A T Mazzeo
- Department of Surgical Sciences, Anesthesia and Intensive Care, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Molinette, Turin, Italy
| | - G Squadrito
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Raimondo
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Hutchinson PJ, Kolias AG, Tajsic T, Adeleye A, Aklilu AT, Apriawan T, Bajamal AH, Barthélemy EJ, Devi BI, Bhat D, Bulters D, Chesnut R, Citerio G, Cooper DJ, Czosnyka M, Edem I, El-Ghandour NMF, Figaji A, Fountas KN, Gallagher C, Hawryluk GWJ, Iaccarino C, Joseph M, Khan T, Laeke T, Levchenko O, Liu B, Liu W, Maas A, Manley GT, Manson P, Mazzeo AT, Menon DK, Michael DB, Muehlschlegel S, Okonkwo DO, Park KB, Rosenfeld JV, Rosseau G, Rubiano AM, Shabani HK, Stocchetti N, Timmons SD, Timofeev I, Uff C, Ullman JS, Valadka A, Waran V, Wells A, Wilson MH, Servadei F. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement. Acta Neurochir (Wien) 2019; 161:1261-1274. [PMID: 31134383 PMCID: PMC6581926 DOI: 10.1007/s00701-019-03936-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. METHODS The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. RESULTS The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. CONCLUSIONS In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.
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Affiliation(s)
- Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Tamara Tajsic
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Abenezer Tirsit Aklilu
- Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
| | - Ernest J Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - B Indira Devi
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Dhananjaya Bhat
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - Randall Chesnut
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Idara Edem
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece
| | - Clare Gallagher
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Corrado Iaccarino
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Mathew Joseph
- Department of Neurosurgery, Christian Medical College, Vellore, India
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Tsegazeab Laeke
- Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oleg Levchenko
- Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Paul Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anna T Mazzeo
- Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Daniel B Michael
- Oakland University William Beaumont School of Medicine and Michigan Head & Spine Institute, Auburn Hills, MI, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Gail Rosseau
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andres M Rubiano
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
- MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Nino Stocchetti
- Department of Physiopathology and Transplantation, Milan University, Milan, Italy
- Neuroscience Intensive Care Unit, Department of Anaesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shelly D Timmons
- Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Chris Uff
- Department of Neurosurgery, The Royal London Hospital, London, UK
- Queen Mary University of London, London, UK
| | - Jamie S Ullman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
| | - Alex Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Vicknes Waran
- Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam Wells
- Department of Neurosurgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark H Wilson
- Imperial Neurotrauma Centre, Department of Surgery and Cancer, Imperial College, London, UK
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
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Fanelli V, Costamagna A, Carosso F, Rotondo G, Pivetta EE, Panio A, Cappello P, Mazzeo AT, Del Sorbo L, Grasso S, Mascia L, Brazzi L, Romagnoli R, Salizzoni M, Ranieri MV. Effects of liver ischemia-reperfusion injury on respiratory mechanics and driving pressure during orthotopic liver transplantation. Minerva Anestesiol 2018; 85:494-504. [PMID: 30394062 DOI: 10.23736/s0375-9393.18.12890-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND During orthotopic liver transplantation (OLT), liver graft ischemia-reperfusion injury (IRI) triggers a cytokine-mediated systemic inflammatory response, which impairs graft function and disrupts distal organ homeostasis. The objective of this prospective, observational trial was to assess the effects of IRI on lung and chest wall mechanics in the intraoperative period of patients undergoing OLT. METHODS In 26 patients undergoing OLT, we measured elastance of the respiratory system (ERS), partitioned into lung (EL) and chest wall (ECW), hemodynamics, and fluid and blood product intake before laparotomy (T1), after portal/caval surgical clamp (T2), and immediately (T3) and, at 90 and 180 minutes post-reperfusion (T4 and T5, respectively). Interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), IL-1β and tumor necrosis factor-α plasma concentrations were assessed at T1, T4 and T5. RESULTS EL significantly decreased from T1 to T2 (13.5±4.4 vs 9.7±4.8 cmH2O/L, P<0.05), remained stable at T3, while at T4 (12.3±4.4 cmH2O/L, P<0.05) was well above levels recorded at T2, reaching its highest value at T5 (15±3.9 cmH2O/L, P<0.05). Variations in ERS, EL, driving pressure (∆P) and trans-pulmonary pressure (∆PL) significantly correlated with changes in IL-6 and MCP-1 plasma concentrations, but not with changes in wedge pressure, fluid amounts, and red blood cells and platelets administered. No correlation was found between changes in cytokine concentrations and ECW. CONCLUSIONS We found that EL, ECW, ∆P and ∆PL underwent significant variations during the OLT procedure. Further, we documented a significant association between the respiratory mechanics changes and the inflammatory response following liver graft reperfusion.
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Affiliation(s)
- Vito Fanelli
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy - .,Department of Surgical Science, University of Turin, Turin, Italy -
| | - Andrea Costamagna
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Fabio Carosso
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Giuseppe Rotondo
- Department of Surgical Science, University of Turin, Turin, Italy
| | | | - Angelo Panio
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Cappello
- Laboratory of Tumor Immunology, Experimental Medicine Research Center (CeRMS), University of Turin, Turin, Italy
| | - Anna T Mazzeo
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.,Department of Surgical Science, University of Turin, Turin, Italy
| | - Lorenzo Del Sorbo
- Division of Respirology and Critical Care Medicine, Department of Medicine, Toronto General Hospital, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Salvatore Grasso
- Unit of Anesthesia and Intensive Care, Department of Emergency Medicine and Organ Transplant (DETO), University of Bari, Bari, Italy
| | - Luciana Mascia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Luca Brazzi
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.,Department of Surgical Science, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Marco V Ranieri
- Department of Anesthesia and Intensive Care Medicine, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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Abstract
Traumatic brain injury can be defined as the most complex disease in the most complex organ. When an acute brain injury occurs, several pathophysiological cascades are triggered, leading to further exacerbation of the primary damage. A number of events potentially occurring after TBI can compromise the availability or utilization of energy substrates in the brain, ultimately leading to brain energy crisis. The frequent occurrence of secondary insults in the acute phase after TBI, such as intracranial hypertension, hypotension, hypoxia, hypercapnia, hyperthermia, seizures, can then increase cerebral damage, and adversely affect outcome. Neuromonitoring techniques provide clinicians and researchers with a mean to detect and reverse those processes that lead to this energy crisis, especially ischemic processes, and have become a critical component of modern neurocritical care. Which is the best way to monitoring the brain after an acute injury has been a matter of debate for decades. This review will discuss how monitoring the injured brain can reduce secondary brain damage and ameliorate outcome after acute brain injury.
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Affiliation(s)
- Anna T Mazzeo
- Unit of Anesthesia and Intensive Care, Department of Surgical Sciences, University of Turin, Turin, Italy -
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences and Associated JPN Apex Trauma Centre, New Delhi, India
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Gupta D, Singla R, Mazzeo AT, Schnieder EB, Tandon V, Kale SS, Mahapatra AK. Detection of metabolic pattern following decompressive craniectomy in severe traumatic brain injury: A microdialysis study. Brain Inj 2017; 31:1660-1666. [DOI: 10.1080/02699052.2017.1370553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Singla
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anna T Mazzeo
- Department of surgical sciences, Anesthesia and intensive care section, University of Torino, Italy
| | - Eric B. Schnieder
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston Department of Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - S. S. Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - A. K. Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Castioni CA, Amadori A, Bilotta F, Bolzon M, Barboni E, Caricato A, Dall'acqua G, DI Paola F, Forastieri Molinari A, Gritti P, LA Rosa I, Longo M, Maglione C, Martorano P, Munari M, Perotti V, Rasulo F, Ruggiero M, Santoro A, Scudeller L, Tumolo M, Mazzeo AT. Italian COnsensus in Neuroradiological Anesthesia (ICONA). Minerva Anestesiol 2017; 83:956-971. [PMID: 28492296 DOI: 10.23736/s0375-9393.17.11753-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anesthetic management of patients undergoing endovascular procedures for treating intracranial aneurysms or cerebrovascular malformations must consider a number of specific challenges, in addition to those associated with anesthesia for other specialties. In addition to maintenance of physiological stability, manipulation of systemic and cerebral hemodynamic parameters may be required to treat any sudden unexpected catastrophic neurological events. A multidisciplinary group including neuro- and pediatric anesthesiologists, interventional neuroradiologists, neurosurgeons, and a clinical methodologist contributed to this document. This consensus working group from 21 Italian institutions identified open questions regarding the best practices for management of anesthesia during endovascular neuroradiological procedures for intracranial aneurysms and cerebrovascular malformations, and addressed these by formulating practical consensus statements. At the first meeting in November 2015, nine key areas were identified regarding choice of anesthetic, patient monitoring, hemodynamic targets, postoperative care, and the management of neuromuscular blockade, anticoagulant and/or antiplatelet therapy, and special considerations for pediatric patients. Nine subgroups were established and a medical librarian performed literature searches in the Cochrane and MEDLINE/PubMed databases for each group. Groups drafted literature summaries and provisional responses in the form of candidate consensus statements based on evidence, when possible, and clinical experience, when this was lacking. Final wording was agreed at a meeting in April 2016 and where possible evidence was graded using United States Preventive Services Task Force criteria. Consensus (defined as >90% agreement) was based on evidence, clinical experience, clinician preference, feasibility in the Italian healthcare system, and cost/benefit considerations.
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Affiliation(s)
- Carlo A Castioni
- Anesthesia and Critical Care Medicine 2, San Giovanni Bosco Hospital, Turin, Italy -
| | - Andrea Amadori
- Neuro-Anesthesiology and Intensive Care Unit, CTO Careggi University Hospital, Florence, Italy
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Moreno Bolzon
- Neuro-Intensive and Neuro-Anesthesiology Care Unit, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - Edoardo Barboni
- Department of Neuroscience, Anesthesia and Intensive Care Unit, University of Marche, Ancona, Italy
| | - Anselmo Caricato
- Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, "A. Gemelli" Teaching Hospital, Sacro Cuore Catholic University, Rome, Italy
| | - Guido Dall'acqua
- Unit of Neuroradiology, Department of Clinical Radiology, Azienda ULSS 9 Treviso, Treviso, Italy
| | - Francesco DI Paola
- Unit of Neuroradiology, Department of Clinical Radiology, Azienda ULSS 9 Treviso, Treviso, Italy
| | - Andrea Forastieri Molinari
- Emergency Department, Anesthesiology and Intensive Care Medicine, Intensive Care Unit, A. Manzoni Hospital, Lecco, Italy
| | - Paolo Gritti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Italia LA Rosa
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marcello Longo
- Unit of Neuroradiology, "G. Martino" University Hospital, Messina, Italy
| | - Carla Maglione
- Postoperative Intensive Care Unit, Department of Anesthesia, Burn Center and Hyperbaric Center, Antonio Cardarelli Hospital, Naples, Italy
| | - Pietro Martorano
- Unit of Neuro-Anesthesia, Emergency Department, "Ospedali Riuniti" Marche University Hospital, Ancona, Italy
| | - Marina Munari
- Unit of Neuro-Intensive and Neuro-Anesthesiology Care, Department of Anesthesia and Intensive Care Medicine, Padua University Hospital, University of Padua, Padua, Italy
| | - Valerio Perotti
- Section of Anesthesia in Speciality Surgeries, Department of Emergency and Internal Medicine, Policlinico Universitario Agostino Gemelli, Sacro Cuore Catholic University, Rome, Italy
| | - Frank Rasulo
- Department of Anesthesia, Critical Care and Emergency Medicine, Spedali Civili University Hospital, Brescia, Italy
| | - Maria Ruggiero
- Department of Neuroradiology, AUSL Romagna, Cesena, Italy
| | - Antonio Santoro
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miriam Tumolo
- Department of Anaesthesia and Intensive Care, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Anna T Mazzeo
- Unit of Anesthesia and Intensive Care, Department of Surgical Sciences, University of Turin, Turin, Italy
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Mazzeo AT, Battaglini I, Brazzi L, Mascia L. The link between anesthesiology and neurology: a mindful cooperation to improve brain protection. Minerva Anestesiol 2016; 83:69-78. [PMID: 27314597 DOI: 10.23736/s0375-9393.16.11212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preventing neurological injury is mandatory during the perioperative period of any kind of surgery and in the care of critically ill patients in the intensive care unit. During daily practice, both anesthesiologists and neurologists focus on brain protection as an integral part of systemic homeostasis maintenance. This article highlights the intriguing overlap between anesthesiology and neurology in clinical practice along with its potential implications for outcome. Moreover, it focuses on the importance of the complementary expertise of both specialists in maintaining cerebral homeostasis, with the aim of improving outcome. A review of available evidence on anesthesiology and neurology interplay in clinical practice along with its potential implications for outcome has been conducted. Clinical vigilance and the use of shared monitoring and diagnostic technology could allow early recognition and treatment of cerebral dysfunction occurring in the perioperative period or in the critical care setting, thus reducing morbidity and mortality. In order to improve patient safety and outcome, neurologists and anesthesiologists should more closely and successfully collaborate, using shared monitoring tools and integrating traditional areas of expertise. Daily activity, education, research and training programs in anesthesia and neurology could benefit from a stronger relationship with each other.
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Affiliation(s)
- Anna T Mazzeo
- Department of Surgical Sciences, Anesthesia and Intensive Care, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Molinette, Turin, Italy -
| | - Iacopo Battaglini
- Department of Neurology, Ospedale S. Croce-Moncalieri, Moncalieri, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, Anesthesia and Intensive Care, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Molinette, Turin, Italy
| | - Luciana Mascia
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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9
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Fanelli V, Mazzeo AT, Battaglini I, Caccia S, Boffini M, Ricci D, El Qarra S, Izzo G, Urbino R, Terragni PP, Brazzi L, Rinaldi M, Ranieri VM, Mascia L. Cerebral Autoregulation in Patients Treated With V-Vecmo For Severe Ards. Intensive Care Med Exp 2015. [PMCID: PMC4796076 DOI: 10.1186/2197-425x-3-s1-a509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mazzeo AT, Micalizzi A, Mascia L, Scicolone A, Siracusano L. Brain-heart crosstalk: the many faces of stress-related cardiomyopathy syndromes in anaesthesia and intensive care. Br J Anaesth 2014; 112:803-15. [PMID: 24638232 DOI: 10.1093/bja/aeu046] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neurogenic stress cardiomyopathy (NSC) is a well-known syndrome complicating the early phase after an acute brain injury, potentially affecting outcomes. This article is a review of recent data on the putative role of localization and lateralization of brain lesions in NSC, cardiac innervation abnormalities, and new polymorphisms and other genetic causes of the sympathetic nervous system over-activity. Concerns regarding the management of stress-related cardiomyopathy syndromes during the perioperative period are also discussed. Future clinical research should explore whether specific factors explain different patient susceptibilities to the disease and should be directed towards early identification and stratification of patients at risk, so that such patients can be more carefully monitored and appropriately managed in critical care and during the perioperative period.
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Affiliation(s)
- A T Mazzeo
- Department of Anaesthesia and Intensive Care, University of Torino, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Presidio Molinette, Corso Dogliotti 14, 10126 Torino, Italy
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Mascia L, Mazzeo AT. Is inadequate tissue perfusion a relevant issue during neurosurgery? Minerva Anestesiol 2013; 79:1105-1107. [PMID: 24080546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- L Mascia
- Dipartimento di Anestesiologia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista, Torino, Italia -
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Abstract
Effective monitoring is critical for neurologically compromised patients, and several techniques are available. One of these tools, cerebral microdialysis (MD), was designed to detect derangements in cerebral metabolism. Although this monitoring device began as a research instrument, favorable results and utility have broadened its clinical applications. Combined with other brain monitoring techniques, MD can be used to estimate cerebral vulnerability, to assess tissue outcome, and possibly to prevent secondary ischemic injury by guiding therapy. This article reviews the literature regarding the past, present, and future uses of MD along with its advantages and disadvantages in the intensive care unit setting.
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Affiliation(s)
- Ryan Kitagawa
- Department of Neurosurgery, Lois Pope LIFE Center, Miller School of Medicine, University of Miami, 1095 Northwest 14th Terrace, Miami, FL 33136, USA
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Mazzeo AT, Fanelli V, Mascia L. Brain-lung crosstalk in critical care: how protective mechanical ventilation can affect the brain homeostasis. Minerva Anestesiol 2013; 79:299-309. [PMID: 23254163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The maintenance of brain homeostasis against multiple internal and external challenges occurring during the acute phase of acute brain injury may be influenced by critical care management, especially in its respiratory, hemodynamic and metabolic components. The occurrence of acute lung injury represents the most frequent extracranial complication after brain injury and deserves special attention in daily practice as optimal ventilatory strategy for patients with acute brain and lung injury are potentially in conflict. Protecting the lung while protecting the brain is thus a new target in the modern neurointensive care. This article discusses the essentials of brain-lung crosstalk and focuses on how mechanical ventilation may exert an active role in the process of maintaining or treatening brain homeostasis after acute brain injury, highlighting the following points: 1) the role of inflammation as common pathomechanism of both acute lung and brain injury; 2) the recognition of ventilatory induced lung injury as determinant of systemic inflammation affecting distal organs, included the brain; 3) the possible implication of protective mechanical ventilation strategy on the patient with an acute brain injury as an undiscovered area of research in both experimental and clinical settings.
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Affiliation(s)
- A T Mazzeo
- Department of Anestesia and Intensive Care, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
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Yokobori S, Mazzeo AT, Hosein K, Gajavelli S, Dietrich WD, Bullock MR. Preconditioning for traumatic brain injury. Transl Stroke Res 2012; 4:25-39. [PMID: 24323189 DOI: 10.1007/s12975-012-0226-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/23/2012] [Accepted: 10/29/2012] [Indexed: 12/22/2022]
Abstract
Traumatic brain injury (TBI) treatment is now focused on the prevention of primary injury and reduction of secondary injury. However, no single effective treatment is available as yet for the mitigation of traumatic brain damage in humans. Both chemical and environmental stresses applied before injury have been shown to induce consequent protection against post-TBI neuronal death. This concept termed "preconditioning" is achieved by exposure to different pre-injury stressors to achieve the induction of "tolerance" to the effect of the TBI. However, the precise mechanisms underlying this "tolerance" phenomenon are not fully understood in TBI, and therefore even less information is available about possible indications in clinical TBI patients. In this review, we will summarize TBI pathophysiology, and discuss existing animal studies demonstrating the efficacy of preconditioning in diffuse and focal type of TBI. We will also review other non-TBI preconditioning studies, including ischemic, environmental, and chemical preconditioning, which maybe relevant to TBI. To date, no clinical studies exist in this field, and we speculate on possible future clinical situations, in which pre-TBI preconditioning could be considered.
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Affiliation(s)
- Shoji Yokobori
- Department of Neurosurgery, Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA,
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Mazzeo AT, Di Pasquale R, Settineri N, Bottari G, Granata F, Faragò G, Pitrone A, Longo M, Santamaria LB. Usefulness and limits of near infrared spectroscopy monitoring during endovascular neuroradiologic procedures. Minerva Anestesiol 2012; 78:34-45. [PMID: 21617599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Transcranial cerebral oximetry (TCCO) with near-infrared spectroscopy (NIRS) is a non-invasive, bedside technique, which allows the continuous measurement of regional cerebral oxygenation. The aim of this study was to evaluate TCCO monitoring during endovascular neuroradiologic procedures. METHODS Adult patients undergoing elective endovascular embolization of cerebral aneurysms, arteriovenous malformations, dural arteriovenous fistulas and meningiomas under general anesthesia were included in the study, over a period of 12 months. Twenty-eight procedures in 25 patients were analyzed. RESULTS Regional cerebral oxygenation rSO(2) readings were significantly different according to the different phases of the neuroendovascular procedure. An effect of the underlying cerebral pathology on regional cerebral oxygenation rSO(2) recording, in relation to the different stage of the interventional procedure, was also evident, the more invasive the procedure the greater the impact on rSO(2) reading. NIRS monitoring contributed to a prompt diagnosis and management of two adverse intraoperative events and helped in early evaluation of prognosis. CONCLUSION TCCO with NIRS is a promising monitoring tool to assess the balance between oxygen supply and demand during neuroradiologic procedures. Nevertheless, some limits should be acknowledged, such as the study of the posterior circulation and artefacts related to contrast agent injection. A careful understanding of the undergoing step of the procedure as well of the possible influence of intrinsic and extrinsic factors affecting recording is important for interpretation of data.
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Affiliation(s)
- A T Mazzeo
- Anesthesia and Neurointensive Care Unit, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Italy.
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Abstract
Hepatopulmonary syndrome (HPS) is a pulmonary vascular disorder, complicating hepatic diseases, and is responsible for an increased morbidity and mortality among patients awaiting liver transplantation. Nowadays, it is recognized as an independent risk factor for death in this patient population. The severity of hypoxemia and the advanced stage of the liver dysfunction are determinants for the prognosis. Therefore, the possibility to be successful, thus improving survival, consists of addressing HPS at an earlier stage, giving more attention to moderate evidences of this pathology instead of the severe ones. On the basis of scientific evidence, we suggest a simple scoring system to predict prognosis among patients with HPS, founded on the integration of two main factors: the severity of hepatic disease, expressed as class of Child-Pugh, and the severity of the hypoxemia. This model of prognostic evaluation has the objective of estimating the additional risk of these patients, thereby avoiding a deleterious underestimate of risk and an arbitrariness of management.
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Affiliation(s)
- G Bottari
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences. Section of Anesthesiology, University of Messina, Messina, Italy
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Mazzeo AT, Bottari G, Praticò C, Penna O, Mandolfino T, Santamaria LB. Significance of Hypoxemia Screening in Candidates for Liver Transplantation: Our Experience. Transplant Proc 2006; 38:793-4. [PMID: 16647472 DOI: 10.1016/j.transproceed.2006.01.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hepatopulmonary syndrome (HPS) is recognized as one of the causes of hypoxemia in patients with chronic liver disease. This complication is responsible for increased mortality and increased perioperative risk in liver transplantation candidates. Recent data from the literature suggest extending the screening for HPS to all candidates for liver transplantation. The aim of this retrospective study was to evaluate the incidence of hypoxemia among a population of patients awaiting liver transplantation. Using pulse oximetry as a screening tool for hypoxemia, 39 of 198 patients (20%) were hypoxemic. The results of this study confirmed the importance of screening for hypoxemia among patients awaiting liver transplantation. In these patients, a more accurate evaluation of respiratory function should be performed to confirm or exclude the diagnosis of HPS.
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Affiliation(s)
- A T Mazzeo
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, Section of Anesthesiology, University of Messina, Messina, Italy.
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Fodale V, Praticò C, Lucanto T, Mazzeo AT, Pino G, Santamaria LB. Complete recovery from prolonged cardiac arrest following self-administration of cisatracurium. Eur J Anaesthesiol 2005; 22:73-5. [PMID: 15816581 DOI: 10.1017/s0265021505250147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mazzeo AT, Lucanto T, Santamaria LB. Hepatopulmonary syndrome: a concern for the anesthetist? Pre-operative evaluation of hypoxemic patients with liver disease. Acta Anaesthesiol Scand 2004; 48:178-86. [PMID: 14995940 DOI: 10.1111/j.0001-5172.2004.00282.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Liver cirrhosis and other chronic hepatic diseases are followed in a subset of affected patients by gas exchange abnormalities resulting from a syndrome called hepatopulmonary syndrome (HPS). The structural basis of this clinical entity is an alteration of pulmonary vasculature resulting in abnormal vasodilatation and mismatching of ventilation and perfusion of the lung. Dilatation of the capillary bed near the gas exchange area is the most important factor implicated; it precludes O2 molecules diffusing to the centrum of the dilated vessels to oxygenate venous blood. Contrast (microbubbles) echocardiography and lung perfusion scan are, respectively, the screening tests with the highest sensitivity and specificity for HPS diagnosis. Because of the high morbidity and mortality of HPS, clinicians have been trying to understand the pathophysiology of pulmonary vasodilatation in the hope that the process can be reversed pharmacologically or surgically. An imbalance between production and clearance of vasoactive circulating substances has been implicated in the pathogenesis of HPS with glucagon and nitric oxide among the principal responsible factors. To date various molecules have been implicated for therapy but without definitive positive results. Liver transplantation remains the only real therapy for HPS, and resolution of gas exchange defects outlines the possible functional reversible nature of vascular abnormalities of this syndrome. The need to perform surgery under general anesthesia for hepatic and extrahepatic procedures in patients with HPS is followed by an increased peri-operative risk. The authors emphasize the role of pre-operative clinical evaluation for proper patient management during the peri-operative period.
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Affiliation(s)
- A T Mazzeo
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, Section of Anesthesiology and Intensive Care, University Hospital Policlinico G. Martino, Via Consolare Valeria, 98121 Messina, Italy.
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Barbuscia M, Praticò C, Rizzo AG, Puliatti F, Melita G, Fodale V, Mazzeo AT, Gorgone S. [Treatment of substernal goiter. Our experience]. G Chir 2003; 24:193-7. [PMID: 12945172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Authors, after having reviewed substernal goitre natural history, report their five-year experience with this disease, underlining clinical features, therapeutic management, positive results. They examine the several proposed classifications and stress haemodynamic and respiratory complications. At last they shortly discuss about diagnostics and, mainly, about correct therapeutic approach which has two aims to resolve the symptomatology and to prevent relapses.
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Affiliation(s)
- M Barbuscia
- Cattedra di Chirurgia dell'Apparato Digerente, Università degli Studi di Messina
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Altavilla D, Saitta A, Guarini S, Galeano M, Squadrito G, Cucinotta D, Santamaria LB, Mazzeo AT, Campo GM, Ferlito M, Minutoli L, Bazzani C, Bertolini A, Caputi AP, Squadrito F. Oxidative stress causes nuclear factor-kappaB activation in acute hypovolemic hemorrhagic shock. Free Radic Biol Med 2001; 30:1055-66. [PMID: 11369495 DOI: 10.1016/s0891-5849(01)00492-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nuclear Factor kappaB (NFkappaB) is an ubiquitous rapid response transcription factor involved in inflammatory reactions and exerts its action by expressing cytokines, chemokines, and cell adhesion molecules. We investigated the role of NF-kappaB in acute hypovolemic hemorrhagic (Hem) shock. Hem shock was induced in male anesthetized rats by intermittently withdrawing blood from an iliac catheter over a period of 20 min (bleeding period) until mean arterial blood pressure (MAP) fell and stabilized within the range of 20-30 mmHg. Hemorrhagic shocked rats died in 26.3 +/- 2.1 min following the discontinuance of bleeding, experienced a marked hypotension (mean arterial blood pressure = 20-30 mmHg) and had enhanced plasma levels of Tumor Necrosis Factor-alpha (200 +/- 15 pg/ml, 20 min after the end of bleeding). Furthermore, aortas taken 20 min after bleeding from hemorrhagic shocked rats showed a marked hypo-reactivity to phenylephrine (PE; 1nM to 10 microM) compared with aortas harvested from sham shocked rats. Hem shocked rats also had increased levels of TNF-alpha mRNA in the liver (15-20 min after the end of bleeding) and enhanced plasma levels of 2,5-dihydroxybenzoic acid (2,5-DHBA; 6 +/- 2.2 microm), 2,3-dihydroxybenzoic acid (2,3-DHBA; 13 +/- 2.1 microm), both studied to evaluate OH(*) production. Electrophoretic mobility shift assay showed that liver NF-kappaB binding activity increased in the nucleus 10 min after the end of hemorrhage and remained elevated until the death of animals. Western blot analysis suggested that the levels of inhibitory IkappaBalpha protein in the cytoplasm became decreased at 5 min after the end of bleeding. IRFI-042, a vitamin E analogue (20 mg/kg intraperitoneally 2 min after the end of bleeding), inhibited the loss of IkappaBalpha protein from the cytoplasm and blunted the increase in NF-kappaB binding activity. Furthermore IRFI-042 increased survival time (117.8 +/- 6.51 min; p <.01) and survival rate (vehicle = 0% and IRFI-042 = 80%, at 120 min after the end of bleeding), reverted the marked hypotension, decreased liver mRNA for TNF-alpha, reduced plasma TNF-alpha (21 +/- 4.3 pg/ml), and restored to control values the hypo-reactivity to PE. Our results suggest that acute blood loss (50% of the estimated total blood volume over a period of 20 min) causes early activation of NF-kappaB, likely through an increased production of reactive oxygen species. This experiment indicates that NF-kappaB-triggered inflammatory cascade becomes early activated during acute hemorrhage even in the absence of resuscitation procedures.
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Affiliation(s)
- D Altavilla
- Department of Clinical and Experimental Medicine and Pharmacology, Section of Pharmacology, University of Messina, Policlinico Universitario, Messina, Italy
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Montanini S, Mazzeo AT. [Anesthesiologic problems in candidates for delayed surgery]. Minerva Anestesiol 1998; 64:181-4. [PMID: 9773652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In preparing and maintaining a proper anaesthetic plan in the patient with subarachnoid haemorrhage undergoing delayed surgery, various concerns occur to the anaesthesist and the intensivist. These problems are related to the intracranic pathology but also to the structural, biochemical and functional changes occurring in a lot of organs and systems. Aim of anaesthetic approach is a correct preoperative evaluation and the maintenance of intracranic and systemic homeostasis. Systemically it is frequent the evidence of electrocardiographic abnormalities, due in same instances to myocardial hypoperfusion, of respiratory dysfunctions, of idroelettrolitic and metabolic changes leading to hypovolemia, hyponatremia and hypokalemia, and of coagulation disorders. With regards to the cerebral homeostasis, it is imperative to prevent rebleeding and vasospasm and the related neurologic damage. It is important the preoperative correction of the systemic dysfunctions, the prevention of the secondary neurologic damage, the stabilization of hemodynamic responses to various noxious stimuli, the provision of a good surgical field, and the achievement of a stable recovery; all these with the help of a proper clinical and instrumental monitoring.
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Affiliation(s)
- S Montanini
- Istituto Pluridisciplinare di Anestesiologia, Rianimazione e Terapia Intensiva, Università degli Studi, Messina
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