Postpartum hemorrhage management, the importance of timing.

Postpartum hemorrhage is defined as a blood loss equal to or greater than 500 ml, which can occur from 24 hours to six weeks after delivery. It is a critical event with a rapid and devastating evolution, which can quickly lead to maternal shock and death. Many efforts have been made to create international and multisectoral guidelines that allow to face an event that represents the cause of about one quarter of maternal deaths. It is crucial to create a team able to act promptly in accordance with shared protocols. The availability of shared guidelines and protocols and the organization of periodic simulations and teamwork training are part of the fundamental initiatives that can promote the safety of perinatal care. The purpose of this document is to give clinicians the tools to minimize the risks associated with inadequate management of hemorrhagic emergency, avoiding the risk of “too little or too late” and giving patients maximum safety

Protocols of Anesthesia Management in Parturients with SARS-CoV-2 Infection

Background: Our hospital became a referral center for COVID-19-positive obstetric patients from 1 May 2020. The aim of our study is to illustrate our management protocols for COVID-19-positive obstetric patients, to maintain safety standards for patients and healthcare workers. Methods: Women who underwent vaginal or operative delivery and induced or spontaneous abortion with a SARS-CoV-2-positive nasopharyngeal swab using real-time PCR (RT-PCR) were included in the study. Severity and onset of new symptoms were carefully monitored in the postoperative period. All the healthcare workers received a nasopharyngeal swab for SARS-CoV-2 using RT-PCR serially every five days. Results: We included 152 parturients with COVID-19 infection. None of the included women had general anesthesia, an increase of severe symptoms or onset of new symptoms. The RT-PCR test was “negative” for the healthcare workers. Conclusions: In our study, neuraxial anesthesia for parturients’ management with SARS-CoV-2 infection has been proven to be safe for patients and healthcare workers. Neuraxial anesthesia decreases aerosolization during preoxygenation, face-mask ventilation, endotracheal intubation, oral or tracheal suctioning and extubation. This anesthesia management protocol can be generalizable

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field

Experimental and numerical approach to improve the performance of a small chp wood gasification plant

Currently, biomass gasification for small scale combined heat and power (CHP) plants (< 500 kWe) is attracting increasing interest as a way to provide remote and/or rural districts with electrical-thermal power, also creating a sustainable economy on the territory. In this context, downdraft gasification technology, coupled with reciprocating internal combustion engine (RICE), is characterized by higher conversion efficiencies in comparison with other technologies. However, the exploitation of a syngas from biomass gasification into a RICE is not easy, due to the presence of contaminants and to the composition that mainly affects engine outputs. At the same time, gasification operative parameters, such as equivalence ratio (ER), biomass moisture content, gasification air temperature (GAT), etc., have a significant influence on gas production and composition and, consequently, on its heating value. Therefore, it is not immediate to find the best setting to maximize, at the same time, gasifier and RICE performances.The present work shows the application of an experimental and numerical methodology aimed to study how the gasifier setting influences RICE performances. Using a kinetic model, implemented Aspen Plus ® commercial platform, the syngas production and composition of a wood downdraft gasifier has been predicted varying ER and GAT. After that, the influence of syngas composition on RICE performances has been analysed using the dedicated AVL Boost® commercial code. Both models have been previously tuned using experimental data obtained from a commercial scale wood gasification CHP plant

Sufentanil vs. Dexmedetomidine as Neuraxial Adjuvants in Cesarean Section: A Mono-Centric Retrospective Comparative Study

Spinal anesthesia is the best choice for caesarean delivery. This technique is characterized by a complete and predictable nerve block with a fast onset and few complications. Several intrathecal adjuvants are used in order to improve the quality and duration of anesthesia and reduce its side effects. Sixty-two patients who underwent caesarean delivery under spinal anesthesia were included in this medical records review. In this retrospective study, after adopting exclusion criteria, we assessed 24 patients who received Hyperbaric Bupivacaine 0.5% 10 mg and dexmedetomidine 10 μg (G1), and 28 patients who received an institutional standard treatment with Hyperbaric Bupivacaine 0.5% 10 mg and sufentanil 5 μg (G2). We evaluated the difference in terms of motor and sensory block, postoperative pain, and adverse effects during the first 24 h following delivery and neonatal outcome. Our study found that the sufentanil group had a significantly lower requirement for analgesia than the dexmedetomidine group. Postoperative pain, assessed with the VAS scale, was stronger in G1 than in G2 (4 ± 2 vs. 2 ± 1, p-value < 0.01). Differences between the two groups regarding the intraoperative degree of motor and sensory block, motor recovery time, and neonatal Apgar scores were not noticed. Pruritus and shivering were observed only in G2. Itching and shivering did not occur in the dexmedetomidine group. Postoperative analgesia was superior in the sufentanil group, but the incidence of side effects was higher. Adjuvant dexmedetomidine prevented postoperative shivering

COVID-19 pandemic burnout in an Italian sample of anaesthesiologists: coping strategies, resilience and the capability of tolerating the uncertainty as preventing factors

ABSTRACT The present study aims to explore the prevalence of burnout characteristics and their association with resilience, coping strategies, and the intolerance of uncertainty dimensions. It also aims to explore the predictive effect of these variables on burnout dimensions, separately. Through the SurveyMonkey platform, 1,009 anaesthesiologists completed the Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and the Coping Inventory for Stressful Situations (CISS). According to the MBI cut-off, 39.7% and 25.8% of participants scored high in Emotional Exhaustion and Depersonalization, respectively, and 44.2% scored low in Personal Accomplishment. Several significant correlations between burnout dimensions and resilience, coping strategies, and the intolerance of uncertainty emerged. Regarding the linear regression models tested, coping strategies, resilience, and age showed a significant predictive effect on all three of the burnout dimensions. In conclusion, the results showed that individual levels of resilience and one’s ability to tolerate uncertainty and task-oriented coping strategies represent significant factors for lower burnout levels in Italian anaesthesiologists during COVID-19 pandemic. These findings highlight the importance of intervention aimed at promoting useful coping strategies and enhancing resilience among healthcare workers.ABSTRACT The present study aims to explore the prevalence of burnout characteristics and their association with resilience, coping strategies, and the intolerance of uncertainty dimensions. It also aims to explore the predictive effect of these variables on burnout dimensions, separately. Through the SurveyMonkey platform, 1,009 anaesthesiologists completed the Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and the Coping Inventory for Stressful Situations (CISS). According to the MBI cut-off, 39.7% and 25.8% of participants scored high in Emotional Exhaustion and Depersonalization, respectively, and 44.2% scored low in Personal Accomplishment. Several significant correlations between burnout dimensions and resilience, coping strategies, and the intolerance of uncertainty emerged. Regarding the linear regression models tested, coping strategies, resilience, and age showed a significant predictive effect on all three of the burnout dimensions. In conclusion, the results showed that individual levels of resilience and one’s ability to tolerate uncertainty and task-oriented coping strategies represent significant factors for lower burnout levels in Italian anaesthesiologists during COVID-19 pandemic. These findings highlight the importance of intervention aimed at promoting useful coping strategies and enhancing resilience among healthcare workers

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

Objectives: the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. Methods: women in the carbetocin group (group A) received a bolus of 100 μg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% Na- Cl solution IV (150 mL/ hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results: regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). Conclusions: a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect