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A year in review in Minerva Anestesiologica 2021. Anesthesia, analgesia, and perioperative medicine

2022; Edizioni Minerva Medica; Volume: 88; Issue: 3 Linguagem: Inglês

10.23736/s0375-9393.22.16429-1

1827-1596

Franco Cavaliere, Massimo Allegri, Alparslan Apan, Luca Brazzi, Massimiliano Carassiti, Edmond Cohen, Pierangelo Di Marco, Olivier Langeron, Marco Rossi, Peter M. Spieth, David Turnbull, Frank Weber,

Anesthesia and Pain Management

M inerva Anestesiologica published several exciting articles focusing on general anesthesia last year.The first was an expert opinion by Battaglini et al. on the use of Positive end expiratory Pressure (PeeP) in thoracic surgery.the authors stressed that PeeP could help minimize atelectrauma, prevent airway and alveolar closure, and improve the ventilation/perfusion ratio during one-lung ventilation.However, it could also increase pulmonary vascular resistance by compressing blood vessels, divert blood flow to the unventilated lung, and thus worsen the ventilation/perfusion ratio. 1 consequently, it is strategic to individualize PeeP in all patients, aiming at the best respiratory compliance and the lowest driving pressure. 2 second study was carried out by nakasuji and nakasuji to determine which was the main cause of the arterial hypotension observed at anesthetic induction.3 Using clearsight noninvasive Hemodynamic Monitoring system (edwards lifesciences corp., irvine, ca, Usa), 4 these authors demonstrated that the primary hypotensive mechanism was the decrease of cardiac output in elderly patients and systemic vascular resistance in younger ones.two articles dealt with the prevention of postoperative cognitive impairment.current evidence suggests that intraoperative goal-directed therapy may improve outcomes after major surgery. 5in 60 patients who underwent spinal surgery, saka et al. registered that goal-directed therapy was associated with higher intraoperative cerebral oxygen saturation and better postoperative cognitive function scores whether based on cardiac index rather than mean arterial pressure. 6a further study was performed by obara et al. 7 they hypothesized that eeg monitors might un-