New Paradigms in Anesthesia and Intensive Care

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Critical Care".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 35607

Special Issue Editors


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Guest Editor
1. Department of Anesthesiology, Critical Care and Pain Medicine, General University Hospital Consortium of Valencia, Valencia, Spain
2. Department of Surgery, University of Valencia, Valencia, Spain
Interests: thoracic anesthesia; airway management; difficult airway; lung separation/isolation; mechanical ventilation; robotic surgery; postoperative pain
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Guest Editor
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
Interests: opioids; opioid-free anesthesia; cancer progression; cancer survival; cancer recurrence; postoperative acute pain; chronic postoperative pain; robotic surgery
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
1. Anesthesiology and Resuscitation Service, University Clinical Hospital of Valladolid (HCUV), Valladolid, Spain
2. Department of Surgery, Ophthalmology, Other Nose Throat and Physiotherapy, University of Valladolid, Valladolid, Spain
Interests: intensive care; emergency medicine; sepsis; acute kidney injury; cytokines; biomarkers; COVID-19; immunological dysfunction; cerebral oximetry; pediatric anesthesia; postoperative behavioral changes; precision medicine

Special Issue Information

Dear Colleagues,

At present, new paradigms have emerged in modern anesthesiology and critical care that have revolutionized the way of clinical work in our hospitals from empiricism to evidence-based medicine.

Advances in anesthesiology and critical care have been fundamental to improving surgical outcomes in many processes that have evolved from conventional open surgery to minimally invasive surgery, and currently with the implementation of robotic surgery.

Protective mechanical ventilation applications have been very important in different types of surgery, from open surgery to laparoscopic/thoracoscopic surgery, and currently the new robotic surgery applied in normal patients. There have also been improvements in ventilation outcomes in patients at high risk of postoperative pulmonary complications, such as obese patients or patients with chronic obstructive pulmonary disease (COPD), among other pathological conditions.

The incorporation of new airway management methods adapted to the surgical complexity and physical condition of these surgical patients has been fundamental to improving the clinical safety in our operating rooms and critical care units. Among these advances, it is worth highlighting the implementation of new protocols for difficult airway patients. In the field of airway intubation, new protocols for COVID-19 patients are particularly relevant due to the risk of disease transmission to healthcare professionals and the critical condition of many of these patients. This has led to the post-pandemic use of video laryngoscopes, which are more frequently selected as the device of first choice for the intubation of standard patients undergoing any surgical procedure.

Intraoperative analgesia without opioids (opioid-free anesthesia) and new locoregional blocks (e.g., paravertebral block, erector spinae block) has been a subject of study and discussion.

On the other hand, knowledge of the etiopathogenic mechanisms related to the appearance of chronic pain has been very important, and has led to the promotion of more personalized prevention and treatment of perioperative pain.

At present, advanced monitoring methods and biomarkers as prognostic predictors and/or guides for therapy are very important as components of personalized medicine.

Prof. Dr. Manuel Granell
Dr. Juan P. Cata
Prof. Dr. Eduardo Tamayo
Guest Editors

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Keywords

  • new paradigms
  • anesthesia and critical care
  • protective mechanical ventilation
  • airway management
  • video laryngoscopes
  • lung separation/isolation
  • perioperative analgesia
  • opioid-free analgesia
  • minimally invasive surgery/robotic surgery
  • monitoring
  • biomarkers
  • personalized medicine

Published Papers (15 papers)

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Research

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13 pages, 3187 KiB  
Article
Impact of Stepwise Recruitment Maneuvers on Cerebral Hemodynamics: Experimental Study in Neonatal Model
by Teresa Torre Oñate, Antonio Romero Berrocal, Federico Bilotta, Rafael Badenes, Martin Santos Gonzalez, Laura de Reina Perez and Javier Garcia Fernandez
J. Pers. Med. 2023, 13(8), 1184; https://doi.org/10.3390/jpm13081184 - 25 Jul 2023
Viewed by 935
Abstract
Background: Lung recruitment maneuvers (LRMs) have been demonstrated to be effective in avoiding atelectasis during general anesthesia in the pediatric population. Performing these maneuvers is safe at the systemic hemodynamic and respiratory levels. Aims: We aimed to evaluate the impact of a stepwise [...] Read more.
Background: Lung recruitment maneuvers (LRMs) have been demonstrated to be effective in avoiding atelectasis during general anesthesia in the pediatric population. Performing these maneuvers is safe at the systemic hemodynamic and respiratory levels. Aims: We aimed to evaluate the impact of a stepwise LRM and individualized positive end-expiratory pressure (PEEP) on cerebral hemodynamics in an experimental neonatal model. Methods: Eleven newborn pigs (less than 72 h old, 2.56 ± 0.18 kg in weight) were included in the study. The LRM was performed under pressure-controlled ventilation with a constant driving pressure (15 cmH2O) in a stepwise increasing PEEP model. The target peak inspiratory pressure (PIP) was 30 cmH2O and the PEEP was 15 cmH2O. The following hemodynamic variables were monitored using the PICCO® system: mean arterial pressure (MAP), central venous pressure (CVP), and cardiac output (CO). The cerebral hemodynamics variables monitored were intracranial pressure (ICP) (with an intraparenchymal Camino® catheter) and cerebral oxygen saturation (rSO2) (with the oximetry monitor INVOS 5100® system). The following respiratory parameters were monitored: oxygen saturation, fraction of inspired oxygen, partial pressure of oxygen, end-tidal carbon dioxide pressure, Pmean, PEEP, static compliance (Cstat), and dynamic compliance (Cdyn). Results: All LRMs were safely performed as scheduled without any interruptions. Systemic hemodynamic stability was maintained during the lung recruitment maneuver. No changes in ICP occurred. We observed an improvement in rSO2 after the maneuver (+5.8%). Conclusions: Stepwise LRMs are a safe tool to avoid atelectasis. We did not observe an impairment in cerebral hemodynamics but an improvement in cerebral oxygenation. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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15 pages, 2164 KiB  
Article
Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial
by Sara Martínez-Castro, Berta Monleón, Jaume Puig, Carolina Ferrer Gomez, Marta Quesada, David Pestaña, Alberto Balvis, Emilio Maseda, Alejandro Suárez de la Rica, Ana Monero Feijoo and Rafael Badenes
J. Pers. Med. 2023, 13(6), 925; https://doi.org/10.3390/jpm13060925 - 31 May 2023
Viewed by 1495
Abstract
Background: Acute respiratory distress syndrome (ARDS) related to COVID-19 (coronavirus disease 2019) led to intensive care units (ICUs) collapse. Amalgams of sedative agents (including volatile anesthetics) were used due to the clinical shortage of intravenous drugs (mainly propofol and midazolam). Methods: A multicenter, [...] Read more.
Background: Acute respiratory distress syndrome (ARDS) related to COVID-19 (coronavirus disease 2019) led to intensive care units (ICUs) collapse. Amalgams of sedative agents (including volatile anesthetics) were used due to the clinical shortage of intravenous drugs (mainly propofol and midazolam). Methods: A multicenter, randomized 1:1, controlled clinical trial was designed to compare sedation using propofol and sevoflurane in patients with ARDS associated with COVID-19 infection in terms of oxygenation and mortality. Results: Data from a total of 17 patients (10 in the propofol arm and 7 in the sevoflurane arm) showed a trend toward PaO2/FiO2 improvement and the sevoflurane arm’s superiority in decreasing the likelihood of death (no statistical significance was found). Conclusions: Intravenous agents are the most-used sedative agents in Spain, even though volatile anesthetics, such as sevoflurane and isoflurane, have shown beneficial effects in many clinical conditions. Growing evidence demonstrates the safety and potential benefits of using volatile anesthetics in critical situations. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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10 pages, 2073 KiB  
Article
High Dosage of Patient-Controlled Epidural Analgesia (PCEA) with Low Background Infusion during Labor: A Randomized Controlled Trial
by Yu Wei, Yilong Wang, Yanhong Zhao, Chaomin Wu, Henry Liu and Zeyong Yang
J. Pers. Med. 2023, 13(4), 600; https://doi.org/10.3390/jpm13040600 - 29 Mar 2023
Viewed by 2138
Abstract
Background: Patient-controlled epidural analgesia (PCEA) is well documented; however, it is unclear whether a high dosage of PCEA with a low dosage of background infusion during labor can be a safe and effective application. Methods: Group LH was administered a continuous infusion (CI) [...] Read more.
Background: Patient-controlled epidural analgesia (PCEA) is well documented; however, it is unclear whether a high dosage of PCEA with a low dosage of background infusion during labor can be a safe and effective application. Methods: Group LH was administered a continuous infusion (CI) of 0.084 mL/kg/h with PCEA of 5 mL every 40 min. Group HL was given a CI of 0.028 mL/kg/h and PCEA of 10 mL every 40 min; Group HH was given a CI of 0.084 mL/kg/h and PCEA of 10 mL every 40 min. The primary outcomes were VAS pain score, the number of supplemental boluses, incidence of pain outbreaks, drug dose for pain outbreaks, PCA times, effective PCA times, anesthetic consumption, duration of analgesia, duration of labor and delivery outcome. Secondary outcomes included adverse reactions such as itching, nausea and vomiting during analgesia and neonatal Apgar scores 1 min and 5 min after birth. Results: A total of 180 patients, 60 in each group were randomly assigned to one of three groups included group LH, group HL or group HH. The VAS scores were obviously decreased in HL group and HH group in comparison with LL group at 2 h after analgesia and the time point of full cervical dilation and delivery of baby. The time for third stage of labor in HH group was increased compared with LH group and HL group. Incidence of pain outbreaks in LH group was obviously increased compared with HL and HH group. The effective PCA times in HL group and HH group were remarkably reduced compared with those in LH group. Conclusions: High dose of PCEA with a low background infusion can reduce effective PCA times, incidence of outbreak pain and the total amount of anesthetics without diminishing analgesia effects. However, high dose of PCEA with a high background infusion can enhance analgesia effect but increase the third stage of labor, instrumental delivery ratio and the total amount of anesthetics. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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10 pages, 255 KiB  
Article
Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study
by Juan P. Cata, Jian Hu, Lei Feng, Caroline Chung, Scott E. Woodman and Larissa A. Meyer
J. Pers. Med. 2023, 13(2), 274; https://doi.org/10.3390/jpm13020274 - 31 Jan 2023
Cited by 2 | Viewed by 1384
Abstract
Introduction: Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with [...] Read more.
Introduction: Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with a history of COVID-19 could have an exaggerated risk of developing postoperative delirium after undergoing major elective oncologic surgery. Methods: We conducted a retrospective study to determine the association between COVID-19 status and antipsychotic drugs during postsurgical hospitalization as a surrogate of delirium. Secondary outcomes included 30 days of postoperative complications, length of stay, and mortality. Patients were grouped into pre-pandemic non-COVID-19 and COVID-19-positive groups. A 1:2 propensity score matching was used to minimize bias. A multivariable logistic regression model estimated the effects of important covariates on the use of postoperative psychotic medication. Results: A total of 6003 patients were included in the study. Pre- and post-propensity score matching demonstrated that a history of preoperative COVID-19 did not increase the risk of antipsychotic medications postoperatively. However, respiratory and overall 30-day complications were higher in COVID-19 individuals than in pre-pandemic non-COVID-19 patients. The multivariate analysis showed that the odds of using postoperative antipsychotic medication use for the patients who had COVID-19 compared to those who did not have the infection were not significantly different. Conclusion: A preoperative diagnosis of COVID-19 did not increase the risk of postoperative antipsychotic medication use or neurological complications. More studies are needed to reproduce our results due to the increased concern of neurological events post-COVID-19 infection. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
10 pages, 866 KiB  
Article
Comparisons of Mechanical Power and Respiratory Mechanics in Pressure-Controlled Ventilation and Volume-Controlled Ventilation during Laparoscopic Cholecystectomy in Elderly Patients
by Youn Yi Jo, Young Jin Chang, Dongchul Lee, Yong Beom Kim, Junsu Jung and Hyun Jeong Kwak
J. Pers. Med. 2023, 13(2), 201; https://doi.org/10.3390/jpm13020201 - 23 Jan 2023
Cited by 3 | Viewed by 1585
Abstract
We compared the effects of pressure-controlled volume-guaranteed ventilation (PCV) and volume-controlled ventilation (VCV) on respiratory mechanics and mechanical power (MP) in elderly patients undergoing laparoscopy. Fifty patients aged 65–80 years scheduled for laparoscopic cholecystectomy were randomly assigned to either the VCV group ( [...] Read more.
We compared the effects of pressure-controlled volume-guaranteed ventilation (PCV) and volume-controlled ventilation (VCV) on respiratory mechanics and mechanical power (MP) in elderly patients undergoing laparoscopy. Fifty patients aged 65–80 years scheduled for laparoscopic cholecystectomy were randomly assigned to either the VCV group (n = 25) or the PCV group (n = 25). The ventilator had the same settings in both modes. The change in MP over time was insignificant between the groups (p = 0.911). MP significantly increased during pneumoperitoneum in both groups compared with anesthesia induction (IND). The increase in MP from IND to 30 min after pneumoperitoneum (PP30) was not different between the VCV and PCV groups. The change in driving pressure (DP) over time were significantly different between the groups during surgery, and the increase in DP from IND to PP30 was significantly higher in the VCV group than in the PCV group (both p = 0.001). Changes in MP during PCV and VCV were similar in elderly patients, and MP increased significantly during pneumoperitoneum in both groups. However, MP did not reach clinical significance (≥12 J/min). In contrast, the PCV group had a significantly lower increase in DP after pneumoperitoneum than the VCV group. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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12 pages, 2914 KiB  
Article
Anesthetic Technique and Functional Outcomes in Modified Montgomery Thyroplasty
by Manuel Granell, Ana Martín, Natsuki Oishi, Mar Gimeno Coret and Enrique Zapater
J. Pers. Med. 2023, 13(2), 194; https://doi.org/10.3390/jpm13020194 - 21 Jan 2023
Viewed by 1747
Abstract
Background: Montgomery thyroplasty type I is a surgical technique indicated in vocal cord paralysis which consists of the paralyzed cord medialization, improving the voice quality. The objective of the study is to describe in detail the anesthetic method to obtain optimal post-medialization voice [...] Read more.
Background: Montgomery thyroplasty type I is a surgical technique indicated in vocal cord paralysis which consists of the paralyzed cord medialization, improving the voice quality. The objective of the study is to describe in detail the anesthetic method to obtain optimal post-medialization voice results. Methodology: Retrospective case series study including patients who underwent medialization thyroplasty using the modified Montgomery technique at the General University Hospital of Valencia between 2011 and 2021. The anesthetic technique consisted of general anesthesia with neuromuscular relaxation and a laryngeal mask. Pre- and post-surgical vocal functional data of maximum phonation times (MPT), G score, and Voice Handicap Index-30 (VHI-30) were evaluated. Results: All the patients presented an improvement in voice results, increasing MPT after surgery and a decrease in VHI-30 and G score postoperatively, with statistically significant differences between the pre- and post-surgical results (p-value < 0.05). There were no complications related to anesthesia or surgery. Conclusions: The use of general anesthesia with muscle relaxation in modified Montgomery thyroplasty may be a good option to consider. The use of a laryngeal mask for ventilation combined with a fiberoptic check allows direct visualization of the vocal cords intraoperatively, providing good functional voice results. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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10 pages, 1428 KiB  
Article
Postoperative Nausea and Vomiting According to Target-Controlled or Manual Remifentanil Infusion in Gynecological Patients Undergoing Pelviscopic Surgery: A Randomized Controlled Trial
by Sangho Lee, Ann Hee You, Miyun Kim and Hee Yong Kang
J. Pers. Med. 2023, 13(2), 176; https://doi.org/10.3390/jpm13020176 - 19 Jan 2023
Viewed by 1322
Abstract
Background: We compared the incidence of postoperative nausea and vomiting (PONV) and postoperative outcomes, according to the remifentanil infusion method, during surgery in patients with a high-risk of PONV. Methods: Ninety patients undergoing elective gynecological pelviscopic surgery were randomly allocated to either target-controlled [...] Read more.
Background: We compared the incidence of postoperative nausea and vomiting (PONV) and postoperative outcomes, according to the remifentanil infusion method, during surgery in patients with a high-risk of PONV. Methods: Ninety patients undergoing elective gynecological pelviscopic surgery were randomly allocated to either target-controlled infusion (TCI, T) or manual (M) infusion. The primary outcome was the incidence of PONV until postoperative day (POD) 2. The secondary outcomes were perioperative heart rate (HR), blood pressure (BP), numerical rating scale pain scores up to POD2, and postoperative hospital length of stay. Results: Forty-four patients in the T group and 45 patients in the M group were analyzed. The total dose of remifentanil infusion was significantly higher in the T group (T group: 0.093 (0.078–0.112) μg/kg/min; M group: 0.062 (0.052–0.076) µg/kg/min, p < 0.001). Within POD2, the overall PONV was not significantly different (27 (61.4%) vs. 27 (60.0%), p = 0.895). The HR (82 ± 11.5/min vs. 87 ± 11.1/min, p = 0.046) and mean BP (83 ± 17.2 mmHg vs. 90 ± 16.7 mmHg, p = 0.035) were significantly lower in the T group after tracheal intubation. The other postoperative outcomes were comparable between the two groups. Conclusions: Although the total remifentanil infusion dose was higher in the T group than in the M group, the postoperative outcomes were similar. If stable vital signs are desired during tracheal intubation, remifentanil infusion with TCI should be considered. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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Review

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18 pages, 2617 KiB  
Review
Airway Management: The Current Role of Videolaryngoscopy
by Sophie A. Saul, Patrick A. Ward and Alistair F. McNarry
J. Pers. Med. 2023, 13(9), 1327; https://doi.org/10.3390/jpm13091327 - 29 Aug 2023
Cited by 5 | Viewed by 2443
Abstract
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including [...] Read more.
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over “de-skilling” at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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18 pages, 1310 KiB  
Review
Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review
by Jenna Goff, Morgan Hina, Nayaab Malik, Hannah McLardy, Finley Reilly, Matthew Robertson, Louis Ruddy, Faith Willox and Patrice Forget
J. Pers. Med. 2023, 13(3), 500; https://doi.org/10.3390/jpm13030500 - 10 Mar 2023
Cited by 5 | Viewed by 3868
Abstract
Background: A significant amount of evidence suggests that Opioid-Free Anaesthesia (OFA) may provide better outcomes for patients undergoing surgery, sparing patients who are particularly vulnerable to adverse side effects of opioids. However, to what extent personalizing OFA is feasible and beneficial has not [...] Read more.
Background: A significant amount of evidence suggests that Opioid-Free Anaesthesia (OFA) may provide better outcomes for patients undergoing surgery, sparing patients who are particularly vulnerable to adverse side effects of opioids. However, to what extent personalizing OFA is feasible and beneficial has not been adequately described. Methods: We conducted a narrative literature review aiming to provide a comprehensive understanding of nociception and pain and its context within the field of OFA. Physiological (including monitoring), pharmacological, procedural (type of surgery), genetical and phenotypical (including patients’ conditions) were considered. Results: We did not find any monitoring robustly associated with improved outcomes. However, we found evidence supporting particular OFA indications, such as bariatric and cancer surgery. We found that vulnerable patients may benefit more from OFA, with an interesting field of research in patients suffering from vascular disease. We found a variety of techniques and medications making it impossible to consider OFA as a single technique. Our findings suggest that a vast field of research remains unexplored. In particular, a deeper understanding of nociception with an interest in its genetic and acquired contributors would be an excellent starting point paving the way for personalised OFA. Conclusion: Recent developments in OFA may present a more holistic approach, challenging the use of opioids. Understanding better nociception, given the variety of OFA techniques, may help to maximize their potential in different contexts and potential indications. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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27 pages, 419 KiB  
Review
Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence
by Rosa Méndez Hernández and Fernando Ramasco Rueda
J. Pers. Med. 2023, 13(2), 333; https://doi.org/10.3390/jpm13020333 - 15 Feb 2023
Cited by 17 | Viewed by 4121
Abstract
A biomarker is a molecule that can be measured in a biological sample in an objective, systematic, and precise way, whose levels indicate whether a process is normal or pathological. Knowing the most important biomarkers and their characteristics is the key to precision [...] Read more.
A biomarker is a molecule that can be measured in a biological sample in an objective, systematic, and precise way, whose levels indicate whether a process is normal or pathological. Knowing the most important biomarkers and their characteristics is the key to precision medicine in intensive and perioperative care. Biomarkers can be used to diagnose, in assessment of disease severity, to stratify risk, to predict and guide clinical decisions, and to guide treatments and response to them. In this review, we will analyze what characteristics a biomarker should have and how to ensure its usefulness, and we will review the biomarkers that in our opinion can make their knowledge more useful to the reader in their clinical practice, with a future perspective. These biomarkers, in our opinion, are lactate, C-Reactive Protein, Troponins T and I, Brain Natriuretic Peptides, Procalcitonin, MR-ProAdrenomedullin and BioAdrenomedullin, Neutrophil/lymphocyte ratio and lymphopenia, Proenkephalin, NefroCheck, Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin 6, Urokinase-type soluble plasminogen activator receptor (suPAR), Presepsin, Pancreatic Stone Protein (PSP), and Dipeptidyl peptidase 3 (DPP3). Finally, we propose an approach to the perioperative evaluation of high-risk patients and critically ill patients in the Intensive Care Unit (ICU) based on biomarkers. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
14 pages, 325 KiB  
Review
Evaluation of Nociception during Pediatric Surgery: A Topical Review
by Gianluca Bertolizio, Marta Garbin and Pablo M. Ingelmo
J. Pers. Med. 2023, 13(2), 260; https://doi.org/10.3390/jpm13020260 - 30 Jan 2023
Cited by 3 | Viewed by 2719
Abstract
The association between intraoperative nociception and increased patient’s morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to [...] Read more.
The association between intraoperative nociception and increased patient’s morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to “reliably” detect intraoperative nociception. Since the direct measure of nociception is impractical during surgery, these monitors measures nociception surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate variability, pupillometry, skin conductance), electroencephalographic changes, and muscular reflex arc. Each monitor carries its own advantages and disadvantages. The manuscript aims to give an overview of the most up-to-date information available in the literature on current nociceptor monitors available in clinical practice, with particular focus on their applications in pediatrics. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
20 pages, 1379 KiB  
Review
Cerebral Oxygen Delivery and Consumption in Brain-Injured Patients
by Dorota Siwicka-Gieroba, Chiara Robba, Jakub Gołacki, Rafael Badenes and Wojciech Dabrowski
J. Pers. Med. 2022, 12(11), 1763; https://doi.org/10.3390/jpm12111763 - 25 Oct 2022
Cited by 7 | Viewed by 3383
Abstract
Organism survival depends on oxygen delivery and utilization to maintain the balance of energy and toxic oxidants production. This regulation is crucial to the brain, especially after acute injuries. Secondary insults after brain damage may include impaired cerebral metabolism, ischemia, intracranial hypertension and [...] Read more.
Organism survival depends on oxygen delivery and utilization to maintain the balance of energy and toxic oxidants production. This regulation is crucial to the brain, especially after acute injuries. Secondary insults after brain damage may include impaired cerebral metabolism, ischemia, intracranial hypertension and oxygen concentration disturbances such as hypoxia or hyperoxia. Recent data highlight the important role of clinical protocols in improving oxygen delivery and resulting in lower mortality in brain-injured patients. Clinical protocols guide the rules for oxygen supplementation based on physiological processes such as elevation of oxygen supply (by mean arterial pressure (MAP) and intracranial pressure (ICP) modulation, cerebral vasoreactivity, oxygen capacity) and reduction of oxygen demand (by pharmacological sedation and coma or hypothermia). The aim of this review is to discuss oxygen metabolism in the brain under different conditions. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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Other

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7 pages, 236 KiB  
Brief Report
The Impact of the Need for Language Assistance Services on the Use of Regional Anesthesia, Postoperative Pain Scores and Opioid Administration in Surgical Oncology Patients
by Ravish Kapoor, Pascal Owusu-Agyemang, Lei Feng and Juan P. Cata
J. Pers. Med. 2023, 13(3), 481; https://doi.org/10.3390/jpm13030481 - 07 Mar 2023
Cited by 1 | Viewed by 1223
Abstract
Language barriers can negatively impact the quality of healthcare. In surgical patients, limited English proficiency (LEP) can lead to disparities in acute postoperative pain management. Interpreters are often used for communication with LEP patients to help alleviate these disparities. We aimed to investigate [...] Read more.
Language barriers can negatively impact the quality of healthcare. In surgical patients, limited English proficiency (LEP) can lead to disparities in acute postoperative pain management. Interpreters are often used for communication with LEP patients to help alleviate these disparities. We aimed to investigate the impact of the need for language assistance services (LAS) in acute postoperative pain management in patients undergoing oncologic surgery. We retrospectively collected data on adult patients undergoing open abdominal oncologic surgery between March 2016 and August 2021. The need for LAS, patient demographics, treatment and clinical outcomes were obtained from the patient’s electronic medical record. The primary endpoint was pain intensity, while secondary endpoints included opioid use in PACU and regional anesthesia. Post-matching analysis (n = 590) demonstrated no significant difference in preoperative variables between patients needing LAS and those not needing LAS. The rate of regional use was slightly lower but not statistically significant in patients needing LAS. Patients needing LAS had significantly lower opioid consumption and reported lower pain intensity in PACU than subjects not requiring translation. In this study, LAS may have aided in the patient decision process regarding the acceptance of regional anesthesia. Although the need for LAS was associated with statistically significant lower pain intensity scores and a corresponding lesser opioid use than no LAS, the margin of differences, especially in pain intensity scores, may not be clinically significant. This may suggest that LAS allowed for better patient-provider communication and appropriate pain management. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
7 pages, 402 KiB  
Viewpoint
Emergence from General Anaesthesia: Can We Discriminate between Emergence Delirium and Postoperative Pain?
by Marta Somaini, Thomas Engelhardt and Pablo Ingelmo
J. Pers. Med. 2023, 13(3), 435; https://doi.org/10.3390/jpm13030435 - 28 Feb 2023
Cited by 2 | Viewed by 1462
Abstract
Unsettled behaviors characterize the early phase after general anaesthesia in the pediatric population in up to 80% of cases. Emergence delirium (ED) and acute pain are the two most relevant sources of this phenomenon. Research and clinical guidelines are difficult to implement due [...] Read more.
Unsettled behaviors characterize the early phase after general anaesthesia in the pediatric population in up to 80% of cases. Emergence delirium (ED) and acute pain are the two most relevant sources of this phenomenon. Research and clinical guidelines are difficult to implement due to the variability of the definition of unsettled behavior and measurement of the different components. The most probable incidence of ED is between 10% and 20%, and the potential risk factors could be summarized as young age, male gender, preoperative anxiety, baseline sleep-disordered breathing, volatile anaesthesia and ENT or ophthalmologic surgery. Self-reporting behavioral and observational scales are unable to reliably differentiate between ED and pain in a child who is not fully awake, making correct treatment choices difficult. This may lead to an undertreatment of pain in agitated children or to the overuse of opioids for self-limiting ED. This paper considers the current knowledge on the identification and treatment of ED and pain and provides a pragmatic approach for daily practice. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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9 pages, 630 KiB  
Commentary
Sugammadex in Emergency Situations
by Cyrus Motamed
J. Pers. Med. 2023, 13(1), 159; https://doi.org/10.3390/jpm13010159 - 15 Jan 2023
Cited by 1 | Viewed by 3165
Abstract
Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced [...] Read more.
Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion. Full article
(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)
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