A year in review in Minerva Anestesiologica 2018
2019; Edizioni Minerva Medica; Volume: 85; Issue: 2 Linguagem: Inglês
10.23736/s0375-9393.19.13597-3
ISSN1827-1596
AutoresFranco Cavaliere, Massimo Allegri, Alparslan Apan, Edoardo Calderini, Massimiliano Carassiti, Flaminia Coluzzi, Pierangelo Di Marco, Olivier Langeron, Marco Rossi, Peter M. Spieth,
Tópico(s)Anesthesia and Pain Management
ResumoP ulmonary complications are a significant cause of postoperative morbidity and mortality.the modality of intraoperative mechanical ventilation may damage or protect the lung so that protective ventilation with low tidal volumes and high positive end-expiratory pressure (PeeP) utilized in icUs has been applied in the operatory theatre. 1, 2 atelectasis is a major concern for the anesthetist for its relationship with postoperative pulmonary complications (PPc). 3in the February issue, a Pro/con was published, in which two distinguished authors in this field, Goran Hedenstierna and Paolo Pelosi, debated the effective role of PeeP in decreasing atelectasis and PPc and improving the outcome of surgical patients. 4readers will draw their conclusions, but PeeP is undoubtedly a vital element of a strategy to optimize driving and transpulmonary pressures. 5in this context, the best PeeP in anesthesia should not be regarded as a fixed number but should be tailored to each patient and surgical setting. in the april issue, a study by Wei et al. investigated the effectiveness of alveolar recruitment maneuvers with and without PeeP on obese patients scheduled for bariatric surgery. 6recruitment maneuvers alone caused lower driving pressure and better arterial oxygenation during pneumoperitoneum and affected less the hemodynamics.the authors stressed the importance to give the right attention to the circulatory effects of mechanical ventilation.Finally, a systematic review by Pang et al. on thoracic surgery and one-lung ventilation, pointed out that inhalation anesthesia can preserve intraoperative cardiac function and reduce postoperative pulmonary complications better than intravenous anesthesia. 7the authors hypothesized that the anti-inflammatory properties of volatile agents could have a protective action despite the inhibition of hypoxic pulmonary vasoconstriction.volatile anesthetics can have a positive preconditioning effect on cardiac damage during cardiac surgery.according to experimental studies, remote ischemic preconditioning may have
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