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Carron M, Tamburini E, Linassi F, Pettenuzzo T, Boscolo A, Navalesi P. Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:2100. [PMID: 38610865 PMCID: PMC11012569 DOI: 10.3390/jcm13072100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Background/Objectives: Managing postoperative pain in patients with obesity is challenging. Although using a combination of pain relief methods is recommended for these patients, the true effectiveness of various intravenous non-opioid analgesics and adjuvants in multimodal anesthesia needs to be better defined. Methods: A systematic review and network meta-analysis was performed to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ketamine, α-2 agonists, lidocaine, magnesium, and oral gabapentinoids in adult surgical patients with obesity. The analysis aimed to compare these treatments to a placebo/no treatment or alternative analgesics, with a primary focus on postoperative pain and secondary endpoints including rescue analgesia, postoperative nausea and vomiting (PONV), and recovery quality. English-language randomized controlled trials across PubMed, Scopus, Web of Science, CINAHL, and EMBASE were considered. Quality and evidence certainty were assessed with the RoB 2 tool and GRADE, and data was analyzed with R software. Results: NSAIDs, along with acetaminophen, lidocaine, α-2 agonists, ketamine, and oral gabapentinoids, effectively reduce early postoperative pain. NSAIDs, particularly ibuprofen, as well as acetaminophen, ketamine, and lidocaine, also show benefits in later postoperative stages. Intravenous non-opioid analgesics and adjuvants show some degree of benefit in reducing PONV and the need for rescue analgesic therapy when using α-2 agonists alone or combined with oral gabapentinoids, notably decreasing the likelihood of PONV. Ketamine, lidocaine, and α-2 agonists are shown to enhance postoperative recovery and care quality. Conclusions: Intravenous non-opioid analgesics and adjuvants are valuable in multimodal anesthesia for pain management in adult surgical patients suffering from obesity.
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Affiliation(s)
- Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Gallucci V. St. 13, 35121 Padova, Italy
| | - Enrico Tamburini
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Giustiniani St. 2, 35128 Padova, Italy
| | - Federico Linassi
- Department of Anesthesia and Intensive Care, Ca' Foncello Treviso Regional Hospital, Hospital Sq. 1, 31100 Treviso, Italy
| | - Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Giustiniani St. 2, 35128 Padova, Italy
| | - Annalisa Boscolo
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Gallucci V. St. 13, 35121 Padova, Italy
| | - Paolo Navalesi
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Gallucci V. St. 13, 35121 Padova, Italy
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Linassi F, Zanatta P, Spano L, Burelli P, Farnia A, Carron M. Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison. Life (Basel) 2023; 13:2065. [PMID: 37895446 PMCID: PMC10608783 DOI: 10.3390/life13102065] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Various pharmacokinetic/pharmacodynamic (PK/PD) models have been developed to accurately dose propofol administration during total intravenous anesthesia with target-controlled infusion (TIVA-TCI). We aim to clinically compare the performance of the Schnider model and the new and general-purpose Eleveld PK/PD model during TIVA-TCI. METHODS We conducted a prospective observational study at a single center, enrolling 78 female patients, including 37 adults (aged < 65 years) and 41 elderly patients (aged ≥ 65 years). These patients underwent breast surgery with propofol-remifentanil TIVA-TCI guided by the bispectral index (BIS) for depth of anesthesia monitoring (target value 40-60) and the surgical plethysmographic index (SPI) for antinociception monitoring (target value 20-50) without neuromuscular blockade. The concentration at the effect site of propofol (CeP) at loss of responsiveness (LoR) during anesthesia maintenance (MA) and at return of responsiveness (RoR), the duration of surgery and anesthesia (min), the time to RoR (min), the propofol total dose (mg), the deepening of anesthesia events (DAEs), burst suppression events (BSEs), light anesthesia events (LAEs) and unwanted spontaneous responsiveness events (USREs) were considered to compare the two PK/PD models. RESULTS Patients undergoing BIS-SPI-guided TIVA-TCI with the Eleveld PK/PD model showed a lower CeP at LoR (1.7 (1.36-2.25) vs. 3.60 (3.00-4.18) μg/mL, p < 0.001), higher CePMA (2.80 (2.55-3.40) vs. 2.30 (1.80-2.50) μg/mL, p < 0.001) and at RoR (1.48 (1.08-1.80) vs. 0.64 (0.55-0.81) μg/mL, p < 0.001) than with the Schnider PK/PD model. Anesthetic hysteresis was observed only in the Schnider PK/PD model group (p < 0.001). DAEs (69.2% vs. 30.8%, p = 0.001) and BSEs (28.2% vs. 5.1%, p = 0.013) were more frequent with the Eleveld PK/PD model than with the Schnider PK/PD model in the general patient population. DAEs (63.2% vs. 27.3%, p = 0.030) and BSEs (31.6% vs. 4.5%, p = 0.036) were more frequent with the Eleveld PK/PD model than with the Schnider PK/PD model in the elderly. CONCLUSIONS The Schnider and Eleveld PK/PD models impact CePs differently. A greater incidence of DAEs and BSEs in the elderly suggests more attention is necessary in this group of patients undergoing BIS-SPI-guided TIVA-TCI with the Eleveld PK/PD than with the Schnider model.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, Università Degli Studi di Padova, Via Marzolo 5, 35131 Padova, Italy
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Paolo Zanatta
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Leonardo Spano
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, 35100 Padova, Italy
| | - Paolo Burelli
- Department of Breast Oncologic Surgery, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Antonio Farnia
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, 35100 Padova, Italy
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De Cassai A, Paganini G, Pettenuzzo T, Zarantonello F, Boscolo A, Tulgar S, Carron M, Munari M, Navalesi P. Single-Shot Regional Anesthesia for Bariatric Surgery: a Systematic Review and Network Meta-Analysis. Obes Surg 2023; 33:2687-2694. [PMID: 37498489 DOI: 10.1007/s11695-023-06737-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Laparoscopic bariatric surgeries can cause intense postoperative pain. Opioid medication can alleviate the pain but can have harmful side effects especially in patients with obstructive sleep apnea. To promote early recovery, enhanced recovery after surgery guideline advises minimizing opioid use and opting for alternative analgesics. This paper aims to investigate the effect of regional anesthesia techniques through a systematic review and network meta-analysis. Primary outcome is postoperative morphine equivalent consumption at 24 h. METHODS Search was conducted in the following databases: PubMed, CENTRAL, Scopus, and EMBASE, from the inception until 10 January 2023. The eligibility criteria were determined by PICOS, including postoperative opioid consumption, pain scores, time to ambulate, use of additional analgesics, and adverse events. The quality assessment was performed using the Risk of Bias 2 Tool, and the certainty of evidence was assessed using the GRADE approach. Funnel plots were used to evaluate publication bias. RESULTS We included 22 studies in quantitative synthesis. A review of 12 studies found that all techniques had a lower mean consumption of opioids compared to placebo or no intervention, with TAP block having the greatest reduction. The quality of evidence for postoperative pain, PONV, time to deambulate, and use of rescue analgesics, was rated as moderate, with TAP block being the most effective intervention. There was no publication bias in any outcome. CONCLUSIONS TAP block is superior to other regional anesthesia techniques in reducing opioid consumption, pain, PONV, and use of rescue analgesics in bariatric surgery. However, further research is needed.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
| | - Greta Paganini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Turkey
| | - Michele Carron
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- UOC Anesthesia and Intensive Care Unit Sant'Antonio, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
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Linassi F, Kreuzer M, Kratzer S, Olivieri S, Zanatta P, Schneider G, Carron M. Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial. J Clin Anesth 2023; 86:111045. [PMID: 36680980 DOI: 10.1016/j.jclinane.2022.111045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/14/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI). DESIGN Observational, prospective, single-center study. SETTINGS Operating room. PATIENTS 107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery. INTERVENTIONS Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40-60) and SPI for antinociception monitoring (target value 20-50) without neuromuscular blockade. MEASUREMENTS Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit. MAIN RESULTS During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046). CONCLUSIONS The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, via Marzolo 5, 35131, Padova, Italy; Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy.
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Stephan Kratzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Sara Olivieri
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Piazzale Aristide Stefani 1, Verona 37121, Italy
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Carron M, Tamburini E, Ieppariello G, Linassi F. Reversal of neuromuscular block with sugammadex compared with neostigmine and postoperative pulmonary complications in obese patients: meta-analysis and trial sequential analysis. Br J Anaesth 2023; 130:e461-e463. [PMID: 37028987 DOI: 10.1016/j.bja.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padova, Padova, Italy.
| | - Enrico Tamburini
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Giovanna Ieppariello
- Institute of Anaesthesia and Intensive Care - Azienda Ospedale Università Padova, Padova, Italy
| | - Federico Linassi
- Department of Anaesthesia and Intensive Care, Ca' Foncello Treviso Regional Hospital, Treviso, Italy
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Carron M, Tamburini E, Safaee Fakhr B, De Cassai A, Linassi F, Navalesi P. High-flow nasal oxygenation during gastrointestinal endoscopy. Systematic review and meta-analysis. BJA Open 2022; 4:100098. [PMID: 37588780 PMCID: PMC10430836 DOI: 10.1016/j.bjao.2022.100098] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/14/2022] [Indexed: 08/18/2023]
Abstract
Background The use of high-flow nasal oxygen (HFNO) has the potential to improve patient safety by limiting hypoxaemia during gastrointestinal endoscopy. The degree of benefit is not adequately established. Methods English language literature searches of PubMed, Scopus, Web of Science, and Cochrane Library electronic databases were performed to identify randomised controlled trials comparing HFNO and conventional oxygen therapy (COT) for patients undergoing gastrointestinal endoscopy under deep sedation. The primary endpoint was the incidence of hypoxic events observed during endoscopic procedures. The secondary endpoints were the incidence of recourse to rescue manoeuvres, procedure interruption, and adverse events. A meta-analysis and a post hoc trial sequence analysis were performed. Results A total of 2867 patients from six randomised controlled trials were considered. Desaturation was observed in 5.2% and 27.2% of patients receiving HFNO and COT, respectively. Desaturation <90% was observed in 1.8% and 12.6% of the patients receiving HFNO and COT, respectively. In the subgroup analysis, desaturation occurrence was lower during HFNO than during COT in non-obese patients (2.2% vs 25.2%) and obese patients (22.9% vs 43.3%). Desaturation occurrence was lower during maximum (3.6% vs 26.9%) and minimum (15.9% vs 29.8%) HFNO therapy than during COT. HFNO showed a lower recurrence to rescue manoeuvres rate (4.7% vs 34.3%), a lower procedure interruption rate (0.4% vs 6.7%), and a lower adverse events rate (18.7% vs 21%) than COT. A high level of heterogeneity between the studies precluded confidence in drawing inference from the meta-analysis. Conclusions The evidence reviewed suggests that compared with COT, HFNO has fewer hypoxaemic events during gastrointestinal endoscopy, but this may not apply to all patients and clinical scenarios.
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Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Enrico Tamburini
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Bijan Safaee Fakhr
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anaesthesia and Intensive Care - Azienda Ospedale Università Padova, Padua, Italy
| | - Federico Linassi
- Department of Anaesthesia and Intensive Care, Ca’ Foncello Treviso Regional Hospital, Piazzale Ospedale 1,Treviso, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
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Marinari G, Foletto M, Nagliati C, Navarra G, Borrelli V, Bruni V, Fantola G, Moroni R, Tritapepe L, Monzani R, Sanna D, Carron M, Cataldo R. Enhanced recovery after bariatric surgery: an Italian consensus statement. Surg Endosc 2022; 36:7171-7186. [PMID: 35953683 PMCID: PMC9485178 DOI: 10.1007/s00464-022-09498-y] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/31/2021] [Indexed: 12/03/2022]
Abstract
Background Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS. Methods To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus. Results Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items). Conclusions ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.
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Affiliation(s)
- Giuseppe Marinari
- Bariatric Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedale Università Padova, Padua, Italy
| | - Carlo Nagliati
- Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Vincenzo Bruni
- Bariatric Surgery Unit, Campus Bio Medico University of Rome, Rome, Italy
| | - Giovanni Fantola
- Bariatric Surgery Unit, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Roberto Moroni
- Bariatric Surgery Unit, Policlinico Sassarese, Sassari, Italy
| | - Luigi Tritapepe
- Department of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Monzani
- Department of Anesthesia and Intensive Care Units, Humanitas Research Hospital, Humanitas University Milan, Rozzano, Milan, Italy
| | - Daniela Sanna
- Emergency Department, Section of Anesthesiology and Intensive Care, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Via V. Gallucci, 13, 35121, Padua, Italy.
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio Medico University of Rome, Rome, Italy
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Linassi F, De Laurenzis A, Maran E, Gadaldi A, Spano' L, Gerosa G, Pittarello D, Zanatta P, Carron M. Influence of Previous General Anesthesia on Cognitive Impairment: An Observational Study Among 151 Patients. Front Hum Neurosci 2022; 16:810046. [PMID: 35652004 PMCID: PMC9148968 DOI: 10.3389/fnhum.2022.810046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Preoperative neurocognitive disorder (preO-NCD) is a common condition affecting 14–51. 7% of the elderly population. General anesthesia has already been associated with the one-year post-operative neurocognitive disorder (PostO-NCD), specifically, a deficit in executive function, measured by the Trail Making Test B (TMT-B), but its long-term effects on cognitive function have not been investigated. We aimed to detect preO-NCD prevalence in patients scheduled for cardiac surgery and further investigate the possible role of previous general anesthesia (pGA) in general preoperative cognitive status [measured via the Montreal Cognitive Assessment (MoCA)] and/or in executive functioning (measured via TMT-B). Methods In this observational, prospective study, 151 adult patients scheduled for elective cardiac surgery underwent MoCA and TMT-B. Data on age, education, pGA, comorbidities, and laboratory results were collected. Results We discovered a general cognitive function impairment of 79.5% and an executive function impairment of 22%. Aging is associated with an increased likelihood (OR 2.99, p = 0.047) and education with a decreased likelihood (OR 0.35, p = 0.0045) of general cognitive impairment, but only education was significantly associated with a decreased likelihood (OR 0.22, p = 0.021) of executive function impairment. While pGA did not significantly affect preO-NCD, a noteworthy interaction between aging and pGA was found, resulting in a synergistic effect, increasing the likelihood of executive function impairment (OR 9.740, p = 0.0174). Conclusion We found a high prevalence of preO-NCD in patients scheduled for cardiac surgery. General cognitive function impairment is highly associated with advancing age (not pGA). However, older patients with at least one pGA appeared to be at an increased risk of preO-NCD, especially executive function impairment, suggesting that TMT-B should be associated with MoCA in the preoperative cognitive evaluation in this population.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
- *Correspondence: Federico Linassi
| | - Alessandro De Laurenzis
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Eleonora Maran
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandra Gadaldi
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Leonardo Spano'
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Demetrio Pittarello
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Verona, Italy
| | - Michele Carron
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
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Linassi F, Maran E, Spano L, Zanatta P, Carron M. Anaesthetic depth and delirium after major surgery. Comment on Br J Anaesth 2022; 127: 704–12. Br J Anaesth 2022; 129:e33-e35. [DOI: 10.1016/j.bja.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
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Basso C, Gennaro N, Dotto M, Ferroni E, Noale M, Avossa F, Schievano E, Aceto P, Tommasino C, Crucitti A, Incalzi RA, Volpato S, Petrini F, Carron M, Pace MC, Bettelli G, Chiumiento F, Corcione A, Montorsi M, Trabucchi M, Maggi S, Corti MC. Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes. Updates Surg 2022; 74:609-617. [PMID: 34115323 PMCID: PMC8995267 DOI: 10.1007/s13304-021-01086-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022]
Abstract
There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.
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Affiliation(s)
- Cristina Basso
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy.
| | - Nicola Gennaro
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Matilde Dotto
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Eliana Ferroni
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Francesco Avossa
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Elena Schievano
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Paola Aceto
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Concezione Tommasino
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Anaesthesia and Intensive Care, Polo Universitario Ospedale San Paolo, Milan, Italy
| | - Antonio Crucitti
- SICG, Società Italiana di Chirurgia Geriatrica, Naples, Italy
- Cristo Re Hospital, Catholic University Rome, Rome, Italy
| | - Raffaele Antonelli Incalzi
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Cattedra di Medicina Interna e Geriatria, Università Campus Bio-Medico, Rome, Italy
| | - Stefano Volpato
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Flavia Petrini
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, Chieti-Pescara University, Pescara, Italy
| | - Michele Carron
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padua, Italy
| | - Maria Caterina Pace
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontostomatologiche, Università di Milano, Milan, Italy
| | - Gabriella Bettelli
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- University of San Marino, San Marino, San Marino
- Department of Anaestesia, Intensive Care, Day Surgery and Pain Therapy and Geriatric Surgery Area, IRCCS INRCA, Italian National Research Centres on Aging, Ancona, Italy
| | - Fernando Chiumiento
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Dipartimento Area Critica, ASL Salerno, Salerno, Italy
| | - Antonio Corcione
- Dipartimento di Area Critica UOC Anestesia e TIPO, AORN dei Colli-Monaldi, Naples, Italy
| | - Marco Montorsi
- SIC, Società Italiana di Chirurgia, Rome, Italy
- Humanitas University and Research Hospital IRCCS, Milan, Italy
| | | | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Maria Chiara Corti
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
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Carron M, Andreatta G, Pesenti E, De Cassai A, Feltracco P, Linassi F, Sergi M, Di Bella C, Di Bello M, Neri F, Silvestre C, Furian L, Navalesi P. Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study. Perioper Med (Lond) 2022; 11:3. [PMID: 35022076 PMCID: PMC8756660 DOI: 10.1186/s13741-021-00231-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation. Methods A single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anesthetic and surgical times, post-anesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications. Results No significant differences in patient or, with the exception of drugs involved in NMB management, anesthetic, and surgical characteristics, were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p = 0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p = 0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p = 0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significantly lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p = 0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p < 0.001), and reduced ICU admissions (0.6% vs 8.0%, p = 0.001). Conclusions Compared to cisatracurium-neostigmine, the rocuronium-sugammadex strategy for reversal of NMB showed a better recovery profile in patients undergoing kidney transplantation.
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Affiliation(s)
- M Carron
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy.
| | - G Andreatta
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
| | - E Pesenti
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
| | - A De Cassai
- Institute of Anesthesia and Intensive Care, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - P Feltracco
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
| | - F Linassi
- Department of Anesthesia and Intensive Care, Ca' Foncello Treviso Regional Hospital, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - M Sergi
- Institute of Anesthesia and Intensive Care, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - C Di Bella
- Department of Surgical, Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplantation Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - M Di Bello
- Department of Surgical, Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplantation Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - F Neri
- Department of Surgical, Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplantation Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - C Silvestre
- Kidney and Pancreas Transplantation Unit, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - L Furian
- Department of Surgical, Oncological and Gastroenterological Sciences, Kidney and Pancreas Transplantation Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - P Navalesi
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
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12
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Carron M, Tessari I, Linassi F. Sugammadex compared with neostigmine in reducing postoperative pulmonary complications in older patients: a meta-analysis. Br J Anaesth 2022; 128:e259-e262. [DOI: 10.1016/j.bja.2021.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 12/20/2022] Open
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13
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Browne G, Carron M, Cassimatis M, Fyffe A, Orr R. Greater symptom burden results in reduced exercise tolerance in children and adolescents following concussion. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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De Cassai A, Geraldini F, Pasin L, Boscolo A, Zarantonello F, Tocco M, Pretto C, Perona M, Carron M, Navalesi P. Safety in training for ultrasound guided internal jugular vein CVC placement: a propensity score analysis. BMC Anesthesiol 2021; 21:241. [PMID: 34625054 PMCID: PMC8499568 DOI: 10.1186/s12871-021-01460-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Central venous catheter (CVC) placement is a routine procedure but is potentially associated with severe complications. Relatively small studies investigated if the use of ultrasound is effective in bridging the skill gap between proficient and not proficient operators, while patient safety during training remains a controversial topic. The first aim of this study was to evaluate if resident proficiency affects the failure rate in CVC positioning under ultrasound guidance. In addition, it aimed to investigate the different rate of complications between proficient and non proficient residents. Methods We conducted a cohort study including CVC placed by residents at the University Hospital of Padova, from November 1, 2012 to July 9, 2020 comparing proficient and non proficient residents. To avoid bias the two cohorts were matched using propensity score. Results A total of 356 residents positioned 2310 CVC during the 8 year study period. Among them, two groups of 1060 CVCs each were matched with a propensity score analysis. There was no difference in the failure rate among the groups (2.8 vs 2.7%, p-value 0.895). Moreover, cohorts had the same rate of hematomas, catheter tip malposition, arterial puncture and pneumothorax. No cases of hemothorax were reported. Conclusions We found the same rate of success and incidence of adverse complications among cohorts, meaning that the process of skill acquisition is safe as long as appropriate training and direct supervision by a senior consultant are available.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Federico Geraldini
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Laura Pasin
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy.
| | - Annalisa Boscolo
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Francesco Zarantonello
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Martina Tocco
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Chiara Pretto
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Matteo Perona
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy
| | - Michele Carron
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy.,UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, 13, Gallucci St., 35121, Padua, Italy.,UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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15
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Linassi F, Obert DP, Maran E, Tellaroli P, Kreuzer M, Sanders RD, Carron M. Implicit Memory and Anesthesia: A Systematic Review and Meta-Analysis. Life (Basel) 2021; 11:850. [PMID: 34440594 PMCID: PMC8400596 DOI: 10.3390/life11080850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 12/01/2022] Open
Abstract
General anesthesia should induce unconsciousness and provide amnesia. Amnesia refers to the absence of explicit and implicit memories. Unlike explicit memory, implicit memory is not consciously recalled, and it can affect behavior/performance at a later time. The impact of general anesthesia in preventing implicit memory formation is not well-established. We performed a systematic review with meta-analysis of studies reporting implicit memory occurrence in adult patients after deep sedation (Observer's Assessment of Alertness/Sedation of 0-1 with spontaneous breathing) or general anesthesia. We also evaluated the impact of different anesthetic/analgesic regimens and the time point of auditory task delivery on implicit memory formation. The meta-analysis included the estimation of odds ratios (ORs) and 95% confidence intervals (CIs). We included a total of 61 studies with 3906 patients and 119 different cohorts. For 43 cohorts (36.1%), implicit memory events were reported. The American Society of Anesthesiologists (ASA) physical status III-IV was associated with a higher likelihood of implicit memory formation (OR:3.48; 95%CI:1.18-10.25, p < 0.05) than ASA physical status I-II. Further, there was a lower likelihood of implicit memory formation for deep sedation cases, compared to general anesthesia (OR:0.10; 95%CI:0.01-0.76, p < 0.05) and for patients receiving premedication with benzodiazepines compared to not premedicated patients before general anesthesia (OR:0.35; 95%CI:0.13-0.93, p = 0.05).
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Affiliation(s)
- Federico Linassi
- Department of Anaesthesia and Intensive Care, Ca’ Foncello Treviso Regional Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy;
| | - David Peter Obert
- Department of Anaesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Muenchen, Germany; (D.P.O.); (M.K.)
| | - Eleonora Maran
- Department of Anaesthesia and Intensive Care, Ca’ Foncello Treviso Regional Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy;
| | - Paola Tellaroli
- Department of Developmental Psychology and Socialisation, University of Padova, Via Venezia 8, 35121 Padova, Italy;
| | - Matthias Kreuzer
- Department of Anaesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Muenchen, Germany; (D.P.O.); (M.K.)
| | - Robert David Sanders
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
| | - Michele Carron
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Via C. Battisti 267, 35121 Padova, Italy;
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Vaschetto R, Pecere A, Perkins GD, Mistry D, Cammarota G, Longhini F, Ferrer M, Pletsch-Assunção R, Carron M, Moretto F, Qiu H, Della Corte F, Barone-Adesi F, Navalesi P. Correction to: Effects of early extubation followed by noninvasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in hypoxemic non-hypercapnic patients: a systematic review and individual patient data meta-analysis of randomized controlled trials. Crit Care 2021; 25:272. [PMID: 34344418 PMCID: PMC8330173 DOI: 10.1186/s13054-021-03692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rosanna Vaschetto
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy. .,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy.
| | - Alessandro Pecere
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK
| | - Gianmaria Cammarota
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Federico Longhini
- Anestesia E Rianimazione, Dipartimento Di Scienze Mediche E Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Miguel Ferrer
- RIICU, Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, CibeRes (CB/06/06/0028), University of Barcelona, Barcelona, Spain
| | - Renata Pletsch-Assunção
- Department of Physiotherapy, Centro Universitário Padre Anchieta, UNIANCHIETA, Jundiaí, SP, Brazil
| | - Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Francesca Moretto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Francesco Della Corte
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Francesco Barone-Adesi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Padua, Italy
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Carron M, Ieppariello G, Linassi F. Enhanced Recovery After Bariatric Surgery and Obstructive Sleep Apnea: an Undervalued Relationship. Obes Surg 2021; 31:5044-5046. [PMID: 34132997 DOI: 10.1007/s11695-021-05519-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy.
| | - Giovanna Ieppariello
- Institute of Anesthesia and Intensive Care, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Federico Linassi
- Department of Anesthesia and Intensive Care, Ca' Foncello Treviso Regional Hospital, Piazzale Ospedale 1, 31100, Treviso, Italy
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18
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Vaschetto R, Pecere A, Perkins GD, Mistry D, Cammarota G, Longhini F, Ferrer M, Pletsch-Assunção R, Carron M, Moretto F, Qiu H, Della Corte F, Barone-Adesi F, Navalesi P. Effects of early extubation followed by noninvasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in hypoxemic non-hypercapnic patients: a systematic review and individual patient data meta-analysis of randomized controlled trials. Crit Care 2021; 25:189. [PMID: 34074314 PMCID: PMC8169383 DOI: 10.1186/s13054-021-03595-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
Background Usefulness of noninvasive ventilation (NIV) in weaning patients with non-hypercapnic hypoxemic acute respiratory failure (hARF) is unclear. The study aims to assess in patients with non-hypercapnic hARF, the efficacy of NIV after early extubation, compared to standard weaning. Methods In this individual patient data meta-analysis, we searched EMBASE, Medline and Cochrane Central Register of Controlled Trials to identify potentially eligible randomized controlled trials published from database inception to October 2020. To be eligible, studies had to include patients treated with NIV after early extubation and compared to conventional weaning in adult non-hypercapnic hARF patients. Anonymized individual patient data from eligible studies were provided by study investigators. Using one-step and two-step meta-analysis models we tested the difference in total days spent on invasive ventilation. Results We screened 1605 records. Six studies were included in quantitative synthesis. Overall, 459 participants (mean [SD] age, 62 [15] years; 269 [59%] males) recovering from hARF were included in the analysis (233 in the intervention group and 226 controls). Participants receiving NIV had a shorter duration of invasive mechanical ventilation compared to control group (mean difference, − 3.43; 95% CI − 5.17 to − 1.69 days, p < 0.001), a shorter duration of total days spent on mechanical ventilation (mean difference, − 2.04; 95% CI − 3.82 to − 0.27 days, p = 0.024), a reduced risk of ventilatory associated pneumonia (odds ratio, 0.24; 95% CI 0.08 to 0.71, p = 0.014), a reduction of time spent in ICU (time ratio, 0.81; 95% CI 0.68 to 0.96, p = 0.015) and in-hospital (time ratio, 0.81; 95% CI 0.69 to 0.95, p = 0.010), with no difference in ICU mortality. Conclusions Although primary studies are limited, using an individual patient data metanalysis approach, NIV after early extubation appears useful in reducing total days spent on invasive mechanical ventilation. Trial registration The protocol was registered to PROSPERO database on 12/06/2019 and available at PROSPERO website inserting the study code i.e., CRD42019133837. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03595-5.
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Affiliation(s)
- Rosanna Vaschetto
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy. .,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy.
| | - Alessandro Pecere
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK
| | - Gianmaria Cammarota
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy
| | - Federico Longhini
- Anestesia e Rianimazione, Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Miguel Ferrer
- RIICU, Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, CibeRes (CB/06/06/0028), University of Barcelona, Barcelona, Spain
| | - Renata Pletsch-Assunção
- Department of Physiotherapy, Centro Universitário Padre Anchieta, UNIANCHIETA, Jundiaí, SP, Brazil
| | - Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Francesca Moretto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Francesco Della Corte
- Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Francesco Barone-Adesi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Padua, Italy
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Carron M, Ieppariello G, Linassi F. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in obese adults: A meta-analysis. J Clin Anesth 2021; 71:110216. [PMID: 33676297 DOI: 10.1016/j.jclinane.2021.110216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121 Padova, Italy.
| | - Giovanna Ieppariello
- Institute of Anesthesia and Intensive Care, Azienda Ospedale Università Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Federico Linassi
- Department of Anesthesia and Intensive Care, Ca' Foncello Treviso Regional Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy
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Linassi F, Kreuzer M, Maran E, Farnia A, Zanatta P, Navalesi P, Carron M. Age influences on Propofol estimated brain concentration and entropy during maintenance and at return of consciousness during total intravenous anesthesia with target-controlled infusion in unparalyzed patients: An observational prospective trial. PLoS One 2020; 15:e0244145. [PMID: 33351856 PMCID: PMC7755218 DOI: 10.1371/journal.pone.0244145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Aging affects pharmacodynamics/pharmacokinetics of anesthetics, but age effects on Entropy-guided total intravenous anesthesia with target-controlled infusions (TIVA-TCI) are not fully characterized. We compared aging effects on effective estimated brain concentration of Propofol (CeP) during TIVA-TCI Entropy-guided anesthesia, without neuromuscular blockade (NMB). METHODS We performed an observational, prospective, single-center study enrolling 75 adult women undergoing Entropy-guided Propofol-Remifentanil TIVA-TCI for breast surgery. Primary endpoint was the relationship between age and CeP at maintenance of anesthesia (MA) during Entropy-guided anesthesia. Secondary endpoints were relationships between age and CeP at arousal reaction (AR), return of consciousness (ROC) and explicit recall evenience. We calculated a linear model to evaluate the age's impact on observational variable and performed pairwise tests to compare old (≥65 years, n = 50) and young (<65 years, n = 25) patients or patients with and without an AR. RESULTS We did not observe age-related differences in CeP during MA, but CeP significantly (p = 0,01) decreased with age at ROC. Entropy values during MA increased with age and were significantly higher in the elderly (RE: median 56[IQR49.3-61] vs 47.5[42-52.5],p = 0.001; SE: 51.6[45-55.5] vs 44[IQR40-50],p = 0.005). 18 patients had an AR, having higher maximum RE (92.5[78-96.3] vs 65[56.5-80.5],p<0.001), SE (79[64.8-84] vs 61[52.5-69],p = 0.03, RE-SE (12.5[9.5-16.5] vs 6 [3-9],p<0.001. CONCLUSION Older age was associated with lower CeP at ROC, but not during MA in unparalysed patients undergoing breast surgery. Although RE and SE during MA, at comparable CeP, were higher in the elderly, Entropy, and in particular an increasing RE-SE, is a reliable index to detect an AR.
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Affiliation(s)
- Federico Linassi
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Eleonora Maran
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Antonio Farnia
- Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Piazzale Ospedale, Treviso, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Piazzale Aristide Stefani, Verona, Italy
| | - Paolo Navalesi
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Michele Carron
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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21
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Carron M, Ieppariello G, DE Cassai A, Lambertini C, Linassi F, Navalesi P. Corrected versus total body weight for dosage of sugammadex in morbidly obese patients. A randomized, double-blind, controlled trial. Minerva Anestesiol 2020; 87:371-373. [PMID: 33325220 DOI: 10.23736/s0375-9393.20.15038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michele Carron
- Section of Anesthesiology and Intensive Care, Department of Medicine DIMED, University of Padua, Padua, Italy -
| | - Giovanna Ieppariello
- Section of Anesthesiology and Intensive Care, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Alessandro DE Cassai
- Section of Anesthesiology and Intensive Care, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Chiara Lambertini
- Section of Anesthesiology and Intensive Care, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Federico Linassi
- Section of Anesthesiology and Intensive Care, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Paolo Navalesi
- Section of Anesthesiology and Intensive Care, Department of Medicine DIMED, University of Padua, Padua, Italy
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22
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Linassi F, Maran E, Kreuzer M, Zanatta P, Carron M. Intraoperative electroencephalographic burst suppression may help to identify patients at risk for long-term adverse outcome: Findings from a case of homozygous twins. Anaesth Crit Care Pain Med 2020; 39:629-630. [DOI: 10.1016/j.accpm.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022]
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Aceto P, Antonelli Incalzi R, Bettelli G, Carron M, Chiumiento F, Corcione A, Crucitti A, Maggi S, Montorsi M, Pace MC, Petrini F, Tommasino C, Trabucchi M, Volpato S. Correction to: Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2020; 32:1907. [PMID: 32910423 PMCID: PMC7508731 DOI: 10.1007/s40520-020-01701-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article Perioperative Management of Elderly patients (PriME).
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Affiliation(s)
- Paola Aceto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gabriella Bettelli
- Past Director Geriatric Surgery Area and Anaesthesia Dpt., INRCA, Italian National Research Centre on Aging, Ancona, Italy
| | | | | | | | - Antonio Crucitti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Maggi
- CNR, Institute of Neuroscience, Aging Branch, Padua, Italy
| | - Marco Montorsi
- Humanitas University and Research Hospital IRCCS, Milan, Italy
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Carron M, Linassi F, De Cassai A, Navalesi P. Exploratory analysis of POPULAR data: learning to improve. Comment on Br J Anaesth 2020; 124: 63–72. Br J Anaesth 2020; 125:e222-e223. [DOI: 10.1016/j.bja.2020.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 12/18/2022] Open
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25
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Carron M, Linassi F, De Cassai A. Role of sugammadex in accelerating postoperative discharge: An updated meta-analysis. J Clin Anesth 2020; 65:109895. [PMID: 32464475 DOI: 10.1016/j.jclinane.2020.109895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/19/2020] [Accepted: 05/19/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
| | - Federico Linassi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandro De Cassai
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy.
| | - Giovanna Ieppariello
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
| | - Federico Linassi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Via V. Gallucci, 13, 35121, Padova, Italy
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De Cassai A, Bonanno C, Andreatta G, Marchet A, Barbieri S, Feltracco P, Carron M. PECS II may reduce chronic pain after breast surgery: A propensity score based secondary analysis of the BREAST trial. J Clin Anesth 2020; 64:109851. [PMID: 32361689 DOI: 10.1016/j.jclinane.2020.109851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy.
| | - Claudio Bonanno
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Giulio Andreatta
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alberto Marchet
- Day Surgery Multidisciplinare, Surgical Department, Azienda Ospedaliera Padova, Padova, Italy
| | - Stefania Barbieri
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Paolo Feltracco
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Carron M, Ieppariello G, Safaee Fakhr B, Foletto M. Perioperative care of the obese patient: a successful approach. Br J Surg 2020; 107:772-773. [DOI: 10.1002/bjs.11541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Affiliation(s)
- M Carron
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - G Ieppariello
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - B Safaee Fakhr
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - M Foletto
- Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padua, Padua, Italy
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Carron M, De Cassai A, Linassi F, Navalesi P. Multimodal analgesia in bariatric surgery: not just an intravenous approach. Surg Obes Relat Dis 2020; 16:2133-2135. [PMID: 32327322 DOI: 10.1016/j.soard.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandro De Cassai
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Federico Linassi
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Paolo Navalesi
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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De Cassai A, Boscolo A, Rose K, Carron M, Navalesi P. Predictive parameters of difficult intubation in thyroid surgery: a meta-analysis. Minerva Anestesiol 2020; 86:317-326. [DOI: 10.23736/s0375-9393.19.14127-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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De Cassai A, Ferrarese B, Boscolo A, Munari M, Carron M. Comparison of two needles for ultrasound guided interfascial plane block by inexperienced operators. Minerva Anestesiol 2020; 86:574-575. [PMID: 32100515 DOI: 10.23736/s0375-9393.19.14271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro De Cassai
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy -
| | - Bianca Ferrarese
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Annalisa Boscolo
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Marina Munari
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Michele Carron
- Section of Anesthesiology and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy
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Cortese G, Carron M, Montrucchio G, Brazzi L. Sugammadex-induced bronchospasm during desflurane anaesthesia: an open question. Br J Anaesth 2020; 124:e17-e18. [DOI: 10.1016/j.bja.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022] Open
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Carron M, Safaee Fakhr B, Ieppariello G, Foletto M. Perioperative care of the obese patient. Br J Surg 2020; 107:e39-e55. [DOI: 10.1002/bjs.11447] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients.
Methods
A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta-analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non-obese populations were used.
Results and conclusion
Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.
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Affiliation(s)
- M Carron
- Department of Medicine – DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - B Safaee Fakhr
- Department of Medicine – DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - G Ieppariello
- Department of Medicine – DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - M Foletto
- Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padua, Padua, Italy
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Carron M, De Cassai A, Linassi F. Sugammadex in the management of myasthenic patients undergoing surgery: beyond expectations. Ann Transl Med 2019; 7:S307. [PMID: 32016026 DOI: 10.21037/atm.2019.10.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandro De Cassai
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Federico Linassi
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Stratton J, Tagliaro E, Weaver J, Sherman DM, Carron M, Di Giacinto A, Sharandak V, Caya F. Performance of Veterinary Services Pathway evolution and One Health aspects. REV SCI TECH OIE 2019; 38:291-302. [PMID: 31564721 DOI: 10.20506/rst.38.1.2961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Animals, and the health systems which ensure their protection, play a vital role in the security and economic and social well-being of humanity, and are therefore a key component of the One Health concept. For global and national health security, prevention is better than cure, and targeting 'risk at source' in animal populations is a vital strategy in safeguarding the planet from risks of emerging zoonoses and antimicrobial resistance (AMR). Neglected zoonoses - such as rabies and brucellosis - continue to have a significant global impact on human health and are also best managed at their animal source. The World Organisation for Animal Health (OIE) has built international consensus on the principles of good governance and the quality of Veterinary Services, which are incorporated within its international standards. The OIE has a proven track record in the provision of Member Country support based on these standards, especially since the advent of its flagship Performance of Veterinary Services (PVS) Pathway programme in 2006-2007. To date, approximately 140 countries have benefited from the structured and sustainable process of animal health systems evaluation and planning afforded by the PVS Pathway. The PVS Tool, the basic methodology upon which the PVS Pathway is based, addresses One Health by evaluating the Veterinary Authority's ability to coordinate with other Competent Authorities that have a role to play in One Health, most notably public health, food safety, and environmental authorities. Despite the undoubted success of the PVS Pathway, the OIE felt that it was time to consider how the programme might be developed to adapt to new challenges. Consequently, during 2017-2018, the OIE embarked on a process of PVS evolution, during which it carried out extensive consultation and further tailored the PVS Pathway to a changing global context. These improvements, which include both fundamental adaptations to the PVS Pathway methods and the development of new PVS Pathway activities targeting topics such as multisectoral collaboration, rabies and AMR, have further strengthened and embedded the One Health approach within the PVS Pathway.
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Pelican K, Salyer SJ, Barton Behravesh C, Belot G, Carron M, Caya F, De La Rocque S, Errecaborde KM, Lamielle G, Latronico F, Macy KW, Mouille B, Mumford E, Shadomy S, Sinclair JR, Dutcher T. Synergising tools for capacity assessment and One Health operationalisation. REV SCI TECH OIE 2019; 38:71-89. [PMID: 31564739 DOI: 10.20506/rst.38.1.2942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Multisectoral, One Health collaboration is essential for addressing national and international health threats that arise at the human-animal-environment interface. Thanks to the efforts of multiple organisations, countries now have an array of One Health tools available to assess capacities within and between sectors, plan and prioritise activities, and strengthen multisectoral, One Health coordination, communication, and collaboration. By doing so, they are able to address health threats at the human-animal-environment interface, including emerging zoonotic and infectious diseases, more efficiently. However, to ensure optimal outcomes for the countries using these One Health tools, the partners responsible for implementation should regularly collaborate and share information such as implementation timelines, results and lessons learned, so that one process can inform the next. This paper presents a consensus framework on how commonly implemented One Health tools might align to best support countries in strengthening One Health systems. Twelve One Health tools were selected based on their high implementation rates, authors' experience with these tools and their focus on multisectoral, One Health coordination. Through a four-step process, the authors: a) jointly carried out a landscape analysis of One Health tools, using a Cloudbased spreadsheet to share the unique characteristics and applications of each tool; b) performed an implementation analysis to identify and share implementation dynamics and identify respective outcomes and synergies; c) jointly created a consensus conceptual model of how the authors suggest the tools might logically work together; and d) extrapolated from steps 1-3 an agreed-upon overarching conceptual framework for how current and future One Health tools could be categorised to best support One Health system strengthening at the national level. Highlighted One Health tools include the States Parties Annual Reporting Tool under the International Health Regulations (IHR), the World Organisation for Animal Health Performance of Veterinary Services (PVS) Pathway, the Joint External Evaluation process, IHR/PVS National Bridging Workshops, the Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization Tool, the Food and Agriculture Organization (FAO) Laboratory Mapping Tool, the FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance Systems, the FAO Surveillance Evaluation Tool, the One Health Systems Mapping and Analysis Resource Toolkit, the National Action Plan for Health Security, and IHR Monitoring and Evaluation Framework tools for After Action Reviews and Simulation Exercises. A new guidance document entitled, Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries was also included as a framework that provides guidance to support the implementation of the outputs of the tools described.
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De La Rocque S, Caya F, El Idrissi AH, Mumford L, Belot G, Carron M, Sreedharan R, Suryantoro L, Stelter R, Copper F, Isla N, Mayigane LN, Bell A, Huda Q, Stratton J, Di Giacinto A, Corning S, Pinto J, Ormel HJ, Chungong S. One Health operations: a critical component in the International Health Regulations Monitoring and Evaluation Framework. REV SCI TECH OIE 2019; 38:303-314. [PMID: 31564720 DOI: 10.20506/rst.38.1.2962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Under the International Health Regulations (IHR, 2005), a legally binding document adopted by 196 States Parties, countries are required to develop their capacity to rapidly detect, assess, notify and respond to unusual health events of potential international concern. To support countries in monitoring and enhancing their capacities and complying with the IHR (2005), the World Health Organization (WHO) developed the IHR Monitoring and Evaluation Framework (IHR MEF). This framework comprises four complementary components: the State Party Annual Report, the Joint External Evaluation, after-action reviews and simulation exercises. The first two are used to review capacities and the second two to help to explore their functionality. The contribution of different disciplines, sectors, and areas of work, joining forces through a One Health approach, is essential for the implementation of the IHR (2005). Therefore, WHO, in partnership with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and other international and national partners, has actively worked on facilitating the inclusion of the relevant sectors, in particular the animal health sector, in each of the four components of the IHR MEF. Other tools complement the IHR MEF, such as the WHO/OIE IHR-PVS [Performance of Veterinary Services] National Bridging Workshops, which facilitate the optimal use of the results of the IHR MEF and the OIE Performance of Veterinary Services Pathway and create an opportunity for stakeholders from animal health and human health services to work on the coordination of their efforts. The results of these various tools are used in countries' planning processes and are incorporated in their National Action Plan for Health Security to accelerate the implementation of IHR core capacities. The present article describes how One Health is incorporated in all components of the IHR MEF.
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De Cassai A, Bonanno C, Sandei L, Finozzi F, Carron M, Marchet A. PECS II block is associated with lower incidence of chronic pain after breast surgery. Korean J Pain 2019; 32:286-291. [PMID: 31569921 PMCID: PMC6813900 DOI: 10.3344/kjp.2019.32.4.286] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 01/25/2023] Open
Abstract
Background Breast cancer is complicated by a high incidence of chronic postoperative pain (25%–60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. Methods We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). Results The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl 1.61 μg/kg/hr vs. 3.3 μg/kg/hr, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). Conclusions The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.
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Affiliation(s)
- Alessandro De Cassai
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Claudio Bonanno
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Ludovica Sandei
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Francesco Finozzi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alberto Marchet
- Day Surgery Multidisciplinare, Surgical Department, Azienda Ospedaliera Padova, Padova, Italy
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De Cassai A, Carron M, Veronese S, Ieppariello G, Cillo U, Feltracco P. Propofol target controlled infusion as an early marker of liver function after transplantation: A case series. J Clin Anesth 2019; 59:114-115. [PMID: 31362201 DOI: 10.1016/j.jclinane.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Alessandro De Cassai
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, via Giustiniani 2, 35128 Padova, Italy.
| | - Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Stefano Veronese
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Giovanna Ieppariello
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Center, Padua University Hospital, Padua, Italy
| | - Paolo Feltracco
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, via Giustiniani 2, 35128 Padova, Italy
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Carron M, De Cassai A, Ieppariello G. Reversal of rocuronium-induced neuromuscular block: is it time for sugammadex to replace neostigmine? Br J Anaesth 2019; 123:e157-e159. [PMID: 31104759 DOI: 10.1016/j.bja.2019.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
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Simonini A, Brogi E, Calevo MG, Carron M. Sugammadex for reversal of neuromuscular blockade in paediatric patients: A two-year single-centre retrospective study. Anaesth Crit Care Pain Med 2019; 38:529-531. [PMID: 30818070 DOI: 10.1016/j.accpm.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- A Simonini
- Department of Anaesthesiology and Intensive Care, IRCCS Istituto Giannina Gaslini, L.go G. Gaslini 5, 16147 Genova, Italy
| | - E Brogi
- Department of Anaesthesiology and Intensive Care, University of Pisa, via Paradisa 2, 56124 Pisa, Italy
| | - M G Calevo
- Department of Epidemiology and Biostatistic, IRCCS Istituto Giannina Gaslini, L.go G. Gaslini 5, 16147 Genova, Italy
| | - M Carron
- Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padova, via V. Gallucci 13, 35121 Padova, Italy.
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Carron M, Ieppariello G. Benefit of sugammadex in a morbidly obese patient with multiple sclerosis and severe respiratory dysfunction. J Clin Anesth 2018; 52:119-120. [PMID: 30245284 DOI: 10.1016/j.jclinane.2018.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
| | - Giovanna Ieppariello
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Gabellini G, Graziano A, Carron M. Hepatotoxicity after desflurane anesthesia in a morbidly obese patient. J Clin Anesth 2018; 51:55-56. [PMID: 30096519 DOI: 10.1016/j.jclinane.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Giulia Gabellini
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandro Graziano
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Michele Carron
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
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Carron M, Ieppariello G, Martelli G, Gabellini G, Foletto M, Perissinotto E, Ori C. Dual effects of leptin in perioperative gas exchange of morbidly obese patients. PLoS One 2018; 13:e0199610. [PMID: 29975721 PMCID: PMC6033419 DOI: 10.1371/journal.pone.0199610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 06/11/2018] [Indexed: 11/18/2022] Open
Abstract
Leptin has shown positive effects on respiratory function in experimental settings. The role of leptin on perioperative respiratory function in morbidly obese patients has not been established. We performed a retrospective analysis of morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Fasting serum leptin and interleukin (IL)-6 were measured preoperatively, and arterial blood gases were obtained pre- and postoperatively. Outcome variables were arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and differences in PaO2 and PaCO2 between pre- and postoperative values (ΔPaO2, ΔPaCO2; postoperative minus preoperative). Patients with lower (<40 μg/L) and higher (≥40 μg/L) leptin levels were compared. Bravais-Pearson’s correlation, multiple linear regression, and logistic regression analysis were performed. A total of 112 morbidly obese patients were included. Serum leptin was significantly higher in females than in males (42.86±12.89 vs. 30.67±13.39 μg/L, p<0.0001). Leptin was positively correlated with body mass index (r = 0.238; p = 0.011), IL-6 (r = 0.473; p<0.0001), and ΔPaO2 (r = 0.312; p = 0.0008). Leptin was negatively correlated with preoperative PaO2 (r = -0.199; p = 0.035). Preoperative PaO2 was lower, ΔPaCO2 was smaller, and ΔPaO2 was greater in the high leptin group than in the low leptin group. In multiple regression analysis, leptin was negatively associated with preoperative PaO2 (estimate coefficient = -0.147; p = 0.023). In logistic regression analysis, leptin was associated with improved ΔPaO2 (odds ratio [OR] = 1.104; p = 0.0138) and ΔPaCO2 (OR = 0.968; p = 0.0334). Leptin appears to have dual effects related to perioperative gas exchange in obese patients undergoing bariatric surgery. It is associated with worse preoperative oxygenation but improved respiratory function after surgery.
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Affiliation(s)
- Michele Carron
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
- * E-mail:
| | - Giovanna Ieppariello
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Gabriele Martelli
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Giulia Gabellini
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Mirto Foletto
- Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padova, Padova, Italy
| | - Egle Perissinotto
- Department of Cardiac, Thoracic and Vascular, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Carlo Ori
- Department of Medicine—DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Abstract
The incidence and prevalence of obesity continues to increase globally. Physicians will therefore provide care for an increasing number of obese patients in their clinical practice. Optimal management of these patients is required to minimize the risk of perioperative complications that increase morbidity and mortality. Obesity affects the respiratory function. It is generally associated with reduced lung volume with increased atelectasis, decreased lung and chest wall compliance, increased airway resistance, and moderate to severe hypoxemia. These physiologic alterations are generally more pronounced in obesity complicated by obstructive sleep apnea syndrome or obesity hypoventilation syndrome. Anesthesia and surgery can profoundly impair respiratory function, increasing the risk of postoperative respiratory complications and acute respiratory failure. Certain comorbidities associated with obesity (e.g., metabolic syndrome, obstructive sleep apnea, pulmonary disease) further increase the risk of perioperative complications. Non-invasive ventilation (NIV) is emerging as an important strategy to minimize perioperative complications. It may ameliorate obesity-related comorbidities, counteract upper airway obstruction, reduce hypoventilation and atelectasis, improve gas exchange and respiratory function, relieve dyspnea, and decrease breathing effort in obese patients in the perioperative period. Thus, NIV may lower the risk of acute respiratory failure after bariatric surgery. Selecting the appropriate interface and type of NIV is fundamental for increasing the likelihood of NIV success in such high-risk patients. NIV is a safe therapy, which should be considered in the perioperative period to help optimize the management of obese patients undergoing bariatric surgery and improve their postoperative course.
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Affiliation(s)
- Michele Carron
- Department of Medicine, Anesthesiology and Intensive Care, University of Padua, Padua, Italy -
| | - Francesco Zarantonello
- Department of Medicine, Anesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Giovanna Ieppariello
- Department of Medicine, Anesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - Carlo Ori
- Department of Medicine, Anesthesiology and Intensive Care, University of Padua, Padua, Italy
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Carron M. Positive end-expiratory pressure in obese patients during general anaesthesia. The role of intra-abdominal pressure. Br J Anaesth 2018; 120:409-410. [PMID: 29406193 DOI: 10.1016/j.bja.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M Carron
- Department of Medicine, Anaesthesiology and Intensive Care - University of Padova, Italy.
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Abstract
The number of elderly patients is increasing worldwide. This will have a significant impact on the practice of anesthesia in future decades. Anesthesiologists must provide care for an increasing number of elderly patients, who have an elevated risk of perioperative morbidity and mortality. Complications related to postoperative residual neuromuscular blockade, such as muscle weakness, airway obstruction, hypoxemia, atelectasis, pneumonia, and acute respiratory failure, are more frequent in older than in younger patients. Therefore, neuromuscular blockade in the elderly should be carefully monitored and completely reversed before awakening patients at the end of anesthesia. Acetylcholinesterase inhibitors are traditionally used for reversal of neuromuscular blockade. Although the risk of residual neuromuscular blockade is reduced by reversal with neostigmine, it continues to complicate the postoperative course. Sugammadex represents an innovative approach to reversal of neuromuscular blockade induced by aminosteroid neuromuscular-blocking agents, particularly rocuronium, with useful applications in clinical practice. However, aging is associated with certain changes in the pharmacokinetics of sugammadex, and to date there has been no thorough evaluation of the use of sugammadex in elderly patients. The aim of this review was to perform an analysis of the use of sugammadex in older adults based on the current literature. Major issues surrounding the physiologic and pharmacologic effects of aging in elderly patients and how these may impact the routine use of sugammadex in elderly patients are discussed.
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Affiliation(s)
- Michele Carron
- Department of Medicine, Anesthesiology, and Intensive Care, University of Padova, Padua, Italy
| | - Francesco Bertoncello
- Department of Medicine, Anesthesiology, and Intensive Care, University of Padova, Padua, Italy
| | - Giovanna Ieppariello
- Department of Medicine, Anesthesiology, and Intensive Care, University of Padova, Padua, Italy
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Carron M, Bertini D, Prandini T, Fanton F, Foletto M, Ori C, Perissinotto E, Simioni P. Effect of sugammadex on coagulation as detected by rotational thromboelastometry in morbidly obese patients. Minerva Anestesiol 2017; 84:178-188. [PMID: 28714298 DOI: 10.23736/s0375-9393.17.11856-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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
BACKGROUND Sugammadex, which is used to reverse rocuronium-induced neuromuscular blockade, has a limited and transient effect on activated partial thromboplastin time and prothrombin time. However, no data are available on the effects of sugammadex on coagulation in morbidly obese patients, as assessed by rotational thromboelastometry (ROTEM®). METHODS Sixty patients received sugammadex 2 mg/kg or 4 mg/kg to reverse moderate or deep rocuronium-induced neuromuscular blockade (N.=30/group) at the end of surgery under desflurane anesthesia. Arterial blood samples were collected before and 3 min and 30 min after sugammadex administration for ROTEM® analysis, including measurements of clotting time (CT), clot formation time, α angle, and maximum clot firmness in INTEM, EXTEM, and FIBTEM assays. Major and minor bleeding events were also monitored during the postoperative period. RESULTS Sugammadex 2 and 4 mg/kg has a limited and transient (<30 min) effect on INTEM CTs of 7.7% (P=0.04) and 10.7% (P<0.0001), respectively. There were no relevant effects on other ROTEM® parameters. A multivariate analysis indicated a significant effect of total sugammadex dose (<250, 250-500, >500 mg) on the INTEM CT (P=0.002). A regression analysis showed a positive relationship between sugammadex dose and INTEM CT value at 3 min after administration (coefficient = 0.052 s; 95% CI: 0.005-0.098 s; P=0.03). No major or minor bleeding events were observed in either group during the postoperative period. CONCLUSIONS Sugammadex produces a slight effect on coagulation in morbidly obese patients, without increasing the risk for postoperative bleeding.
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Affiliation(s)
- Michele Carron
- Section of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padua, Padua, Italy -
| | - Diana Bertini
- Section of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Tancredi Prandini
- Section of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Francesca Fanton
- Section of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Mirto Foletto
- Section of Surgery, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Carlo Ori
- Section of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Egle Perissinotto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Paolo Simioni
- Unit of Thrombotic and Hemorrhagic Diseases, Department of Medicine - DIMED, University of Padua, Padua, Italy
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Carron M, Zarantonello F, Lazzarotto N, Tellaroli P, Ori C. Role of sugammadex in accelerating postoperative discharge: A meta-analysis. J Clin Anesth 2017; 39:38-44. [DOI: 10.1016/j.jclinane.2017.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 12/17/2022]
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Carron M, Zarantonello F, Tellaroli P, Ori C. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. J Clin Anesth 2016; 35:1-12. [DOI: 10.1016/j.jclinane.2016.06.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 12/17/2022]
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