Airway control via the Cobrapla™ during percutaneous dilatational tracheotomy in five patients

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Efficacy of a combined technique using the Trachlight™ together with direct laryngoscopy under simulated difficult airway conditions in 350 anesthetized patients

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Temperature Assessment During Radio Frequency Ablation in Ex Vivo Long Bone by Fiber Bragg Grating Sensors

Thermal ablation treatments (TATs) are promising alternatives to traditional surgery for bone cancer eradication. Among several TATs, radio frequency ablation (RFA) has gained considerable ground in treating bone cancer. Therefore, tracking temperature is paramount in ensuring complete tumor destruction without injuring adjacent structures. Despite the widespread use of RFA for bone tumors, investigations on temperature distribution during this procedure are so far lacking. To date, only thermocouples and thermistors have been proposed to measure temperature during RFA in bone. However, these sensors are intended to measure temperature at a single point without information about heat propagation into the tissue during ablation. Within this context, fiber Bragg grating sensors (FBGs) can play a crucial role since their multiplexing capability enables temperature measurement at several locations. This work seeks to fill this gap by providing new insights into RFA effects on bone tissue. Experiments are performed on ex vivo porcine femurs. During trials, two commercial stainless-steel needles equipped with an optical fiber housing six FBGs each were employed to record temperature over time. This solution allowed for monitoring temperature in 12 tissue points inside the bone at a fixed distance from the RF probe, thus gaining information about the thermal distribution in a large tissue area over time. This study paves the way for a more in-depth understanding of the efficacy of RFA in bone tissue, thus providing a powerful method for temperature monitoring, potentially enhancing the treatment outcomes.</p

A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine

Innovations in anesthesia and perioperative pain management have animated the debate the last year

Pancreatitis after percutaneous ethanol injection into HCC: a minireview of the literature

Deaths after percutaneous ethanol injection (PEI) into hepatocellular carcinoma (HCC) may occur within a few hours to a few days following the procedure because of hemoperitoneum and haemorrhage from oesophageal varices or hepatic insufficiency. Pancreatitis has been recently reported as a rare lethal complication of intra-arterial PEI, another modality for treating HCCs. In this minireview, we analyze the literature concerning the development of acute pancreatitis after PEI. Pathogenesis of pancreatitis from opioids and ethanol is also addressed. Treatment with opioids to reduce the patient's abdominal pain after PEI in combination with the PEI itself may lead to direct toxic effects, thus favouring the development of pancreatitis

Epidural Steroid Injections for Low Back Pain: A Narrative Review

Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients&rsquo; quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology

Neurophysiological models of phantom limb pain: what can be learnt

Phantom Limb Pain (PLP) is a dysesthesic painful sensations perceived in the lost limb, resulting from complex interactions between structural and functional nervous systems changes. We analyze its main pathogenetic models and speculate on candidate therapeutic targets. The neuroma model considers PLP to arise from spontaneous activity of residual limb injured axons. Other peripheral-origin models attribute PLP to damage of somatosensory receptors or vascular changes. According to the cortical remapping model, the loss of bidirectional nervous flow and the need to enhance alternative functions trigger reorganization and arm and face skin afferents "invade" the hand territory. On the contrary, the persistent representation model suggests that continued inputs preserve the lost limb representation and that, instead to a shrinkage, PLP is associated with larger representation and stronger cortical activity. In the neuromatrix model, the mismatch between body representation, which remains intact despite limb amputation, and real body appearance generates pain. Another hypothesis is that proprioceptive memories associate specific limb positions with pre-amputation pain and may be recalled by those positions. Finally, the stochastic entanglement model offers a direct relationship between sensorimotor neural reorganization and pain. Amputation disrupts motor and somatosensory circuits, allowing for maladaptive wiring with pain circuits and causing pain without nociception. Relief of PLP depends solely on motor and somatosensory circuitry engagement, making anthropomorphic visual feedback dispensable. Existing and apparently contradicting theories might not be mutually exclusive. All of them involve several intertwined potential mechanisms by which replacing the amputated limb by an artificial one could counteract PLP

Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia and post-operative analgesia: general anesthesia (GA), regional anesthesia (RA), or combined GA and RA. A literature review on online databases was carried out about the different anesthetic approaches for shoulder surgery and their evolution through the years, taking in consideration papers from 1929 to 2021. A comprehensive preoperative assessment of patients undergoing shoulder surgery allows to identify and modify potential risk factors and complications of general anesthesia. Moreover, the use of ultrasound-guided regional blocks could improve the effectiveness of these techniques and bring better postoperative outcomes. Anesthetic management for shoulder surgery has progressed drastically during the last century. More studies are needed to finally standardize anesthetic techniques for specific procedure

Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges

Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes