1,721,004 research outputs found
Complications of Mechanical Ventilation
No full textMechanical ventilation is a life support measure that is frequently needed in cases of respiratory failure. Its purposes are many, including amelioration of gas exchange, the decrease of oxygen consumption of respiratory muscles (thus increasing the oxygen available to vital organs) and the reversal of respiratory muscles fatigue. Unfortunately, mechanical ventilation itself can be a source of complications, and among others we cite ventilator induced lung injury, ventilator associated pneumonia and diaphragm dysfunction
Noninvasive ventilation in patients with severe community-acquired pneumonia: What have we learned? Key response determinants and practical implications
No full textSevere community-acquired pneumonia leads to acute respiratory failure, which may require tracheal intubation and mechanical ventilation while proper antibiotic therapy is being established. In an appropriate setting, noninvasive ventilation may be considered for patients with severe community-acquired pneumonia following careful patient selection according to the available guidelines. These patients require constant assessment, evaluating the risk factors for noninvasive ventilation failure
Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials
No full textBackground and objective Sugammadex has been introduced for reversal of rocuronium (or vecuronium)–induced neuromuscular blockade (NMB). Although its efficacy has been established, data are conflicting whether it is safer than neostigmine traditionally used for reversing NMB. Design Meta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology. Setting University medical hospital. Methods A comprehensive search was conducted using PubMed, Web of Science, and Cochrane Library electronic databases to identify English-language randomized controlled trials. Two reviewers independently selected the trials; extracted data on reversal times, incomplete reversals of NMB, and adverse events (AEs); and assessed the trials' methodological quality and evidence level. Only AEs that were related to study drug by a blinded safety assessor were considered for meta-analysis. Patients A total of 1384 patients from 13 articles were included in this meta-analysis. Main results Compared to neostigmine, sugammadex was faster in reversing NMB (P < .0001) and more likely to be associated with higher train-of-four ratio values at extubation (mean difference, 0.18; 95% confidence interval [CI], 0.14-0.22; P < .0001) and lower risk of postoperative residual curarization after extubation (odds ratio [OR], 0.05; 95% CI, 0.01-0.43; P = .0068). Compared to neostigmine, sugammadex was associated with a significantly lower likelihood of global AEs (OR, 0.47; 95% CI, 0.34-0.66; P < .0001), respiratory AEs (OR, 0.36; 95% CI, 0.14-0.95; P = .0386), cardiovascular AEs (OR, 0.23; 95% CI, 0.08-0.61; P = .0036), and postoperative weakness (OR, 0.45; 95% CI, 0.21-0.97; P = .0409). Sugammadex and neostigmine were associated with a similar likelihood of postoperative nausea and vomiting (OR, 1.23; 95% CI, 0.70-2.15; P = .4719), pain (OR, 1.06; 95% CI, 0.15-7.36; P = .9559), neurologic AEs (OR, 1.47; 95% CI, 0.52-4.17; P = .4699), general AEs (OR, 0.75; 95% CI, 0.47-1.21; P = .2448), and changes in laboratory tests' values (OR, 0.57; 95% CI, 0.18-1.78; P = .3368). Conclusions Results from this meta-analysis suggest that sugammadex is superior to neostigmine, as it reverses NMB faster and more reliably, with a lower risk of AE
Perioperative noninvasive ventilation in obese patients: a qualitative review and meta-analysis
No full textPerioperative noninvasive ventilation (NIV) has been proposed to reduce postoperative morbidity and improve perioperative outcomes in patients undergoing general anesthesia. Whether it is advantageous to apply NIV just before and after general anesthesia in obese patients has not been yet established
Sugammadex for reversal of neuromuscular blockade: A retrospective analysis of clinical outcomes and cost-effectiveness in a single center
Full text linkOBJECTIVE:
The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen for neuromuscular block (NMB) management.
METHODS:
We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium-sugammadex) and as rescue therapy after neostigmine reversal (rocuronium-neostigmine-sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen was carried out. To such purpose, two periods were compared: 2011-2012, without sugammadex available; 2013-2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective.
RESULTS:
The introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium-neostigmine-sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013-2014 period was estimated at an average value of €13,548 (€9,316-€23,845).
CONCLUSION:
Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost
Prone Position and Lung Ventilation/Perfusion Matching in Acute Respiratory Failure Due to COVID-19
Full text linkObesity and perioperative noninvasive ventilation in bariatric surgery
No full textThe 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
Respiratory function after sugammadex and neostigmine administration for reversal of moderate rocuronium-induced neuromuscular blockade in morbidly obese patients
No full textRole of sugammadex in accelerating postoperative discharge: A meta-analysis
No full textSTUDY OBJECTIVE:
Sugammadex has been introduced for reversal of neuromuscular blockade (NMB) induced by rocuronium (or vecuronium). Although its efficacy and safety have been established, data are conflicting as to whether it accelerates discharge to the surgical ward compared with neostigmine, which is traditionally used for reversing NMB. The object of this systematic review and meta-analysis was to review the research comparing sugammadex and neostigmine in the context of patient discharge after general anesthesia.
DESIGN:
Systematic review and meta-analysis.
SETTING:
University medical hospital.
PATIENTS:
Five-hundred eighteen patients from six studies were included.
METHODS:
A comprehensive search was conducted using PubMed, Web of Science, Google Scholar, and Cochrane Library electronic databases to identify randomized controlled trials written in English. Two reviewers independently selected the studies, extracted data regarding postoperative discharge, and assessed the trials' methodological quality and evidence level. Postoperative discharge time was determined from the operating room (OR) to the postanesthesia care unit (PACU) and from the PACU to the surgical ward. This study was conducted using PRISMA methodology.
MEASUREMENTS:
Time to discharge after NMB reversal with sugammadex or neostigmine.
MAIN RESULTS:
Compared with neostigmine, sugammadex was associated with a significantly faster discharge from the OR to the PACU (mean difference [MD]=22.14min, 95% CI (14.62, 29.67), P<0.0001, I2=0%) and from the PACU to the surgical ward (MD=16.95min, 95% CI (0.23, 33.67), P=0.0469, I2=98.4%). Similarly, discharge-readiness was shorter for sugammadex than for neostigmine from the OR to the PACU (MD=5.58min, 95% CI (3.03, 8.14), P≤0.0001, I2=0%). However, discharge-readiness was similar in both groups for patients moving from the PACU to the surgical ward (MD=-1.10min, 95% CI (-5.69, 3.50), P=0.6394, I2=25.3%).
CONCLUSIONS:
Results from this meta-analysis suggest that sugammadex accelerates postoperative discharge of patients after general anesthesia compared with neostigmine
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