Minerva Anestesiologica 

About: Minerva Anestesiologica is an academic journal published by Edizioni Minerva Medica. The journal publishes majorly in the area(s): Medicine & Intensive care. It has an ISSN identifier of 0375-9393. Over the lifetime, 4766 publications have been published receiving 49696 citations.

Review of local anaesthetic agents.

Abstract: The currently available local anaesthetic agents are capable of providing high quality nerve blockade in a wide variety of clinical circumstances. Our understanding of the mechanisms and consequences of toxicity is increasing rapidly. Knowledge of the chemistry of local anaesthetics has enabled clinicians to exploit the increased safety of single isomer agents. However, the extent, if any, of this improvement in toxicity has yet to be proven. Established toxicity may be very difficult to treat and no specific reversing therapy is yet available. Until this occurs it is essential that practitioners of regional anaesthesia maintain their knowledge base and skill in techniques of administration of local anaesthetic, are able to recognise impending disaster, and constantly update their skills in resuscitation.

Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis.

Abstract: Prone positioning has been used for over 30 years in the management of patients with acute respiratory distress syndrome (ARDS). This maneuver has consistently proven capable of improving oxygenation in patients with acute respiratory failure. Several mechanisms can explain this observation, including possible intervening net recruitment and more homogeneously distributed alveolar inflation. It is also progressively becoming clear that prone positioning may reduce the nonphysiological stress and strain associated with mechanical ventilation, thus decreasing the risk of ventilator-induced lung injury, which is known to adversely impact patient survival. The available randomized clinical trials, however, have failed to demonstrate that prone positioning improves the outcomes of patients with ARDS overall. In contrast, the individual patient meta-analysis of the four major clinical trials available clearly shows that with prone positioning, the absolute mortality of severely hypoxemic ARDS patients may be reduced by approximately 10%. On the other hand, all data suggest that long-term prone positioning may expose patients with less severe ARDS to unnecessary complications.

Recommendations for airway control and difficult airway management.

Abstract: Members A. ACCORSI, E. ADRARIO, F. AGRÒ, G. AMICUCCI, M. ANTONELLI, F. AZZERI, S. BARONCINI, G. BETTELLI, C. CAFAGGI, D. CATTANO, E. CHINELLI, U. CORBANESE, R. CORSO, A. DELLA PUPPA, A. DI FILIPPO, E. FACCO, R. FAVARO, R. FAVERO, G. FROVA, F. GIUNTA, G. GIURATI, F. GIUSTI, A. GUARINO, E. IANNUZZI, G. IVANI, D. MAZZON, M. MENARINI, G. MERLI, E. MONDELLO, S. MUTTINI, G. NARDI, A. PIGNA, G. PITTONI, D. RIPAMONTI, G. ROSA, R. ROSI, I. SALVO, A. SARTI, G. SERAFINI, G. SERVADIO, A. SGANDURRA, M. SORBELLO, F. TANA, R. TUFANO, S. VESCONI, A. VILLANI, M. ZAULI

Clinical and experimental findings in humans and animals with chemotherapy-induced peripheral neuropathy.

Abstract: Pain arises from numerous causes in cancer patients. Well known to cancer care providers, but perhaps less well so to others, is that the main causes of pain in cancer patients in fact arise due to cancer treatments more so than the disease itself. In this paper clinical and laboratory findings on the characteristics of chemotherapy-induced neuropathic pain are reviewed and a scheme for the underlying mechanisms is outlined.

Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support.

Abstract: The role of spontaneous breathing among patients with acute hypoxemic respiratory failure and ARDS is debated: while avoidance of intubation with noninvasive ventilation (NIV) or high-flow nasal cannula improves clinical outcome, treatment failure worsens mortality. Recent data suggest patient self-inflicted lung injury (P-SILI) as a possible mechanism aggravating lung damage in these patients. P-SILI is generated by intense inspiratory effort yielding: (A) swings in transpulmonary pressure (i.e. lung stress) causing the inflation of big volumes in an aerated compartment markedly reduced by the disease-induced aeration loss; (B) abnormal increases in transvascular pressure, favouring negative-pressure pulmonary edema; (C) an intra-tidal shift of gas between different lung zones, generated by different transmission of muscular force (i.e. pendelluft); (D) diaphragm injury. Experimental data suggest that not all subjects are exposed to the development of P-SILI: patients with a PaO2/FiO2 ratio below 200 mmHg may represent the most at risk population. For them, current evidence indicates that high-flow nasal cannula alone may be superior to intermittent sessions of low-PEEP NIV delivered through face mask, while continuous high-PEEP helmet NIV likely promotes treatment success and may mitigate lung injury. The optimal initial noninvasive treatment of hypoxemic respiratory failure/ARDS remains however uncertain; high-flow nasal cannula and high-PEEP helmet NIV are promising tools to enhance success of the approach, but the best balance between these techniques has yet to be identified. During noninvasive support, careful clinical monitoring remains mandatory for prompt detection of treatment failure, in order not to delay intubation and protective ventilation.