Comparison between surgical and percutaneous tracheostomy effects on procalcitonin kinetics in critically ill patients

Available evidence from randomized controlled trials including adult critically ill patients tends to show that percutaneous dilatational tracheostomy (PDT) techniques are performed faster and reduce stoma inflammation and infection but are associated with increased technical difficulties compared with surgical tracheostomy (ST). A recent meta-analysis found that PDT was superior to reduce risk of periprocedural stoma inflammation and infection compared with ST. WE found no differences in procalcitonin, C-reactive protein, SOFA, and SAPS II between critically ill patients with ST or PDT

Implementations and strategies of telehealth during COVID-19 outbreak: a systematic review

Telehealth is an effective option to fight the outbreak of COVID-19. This review aims to systematically characterize the utilization and applications of telehealth during the COVID-19 pandemic focusing mainly on technology implementations

A comparison of videolaryngoscopes for tracheal intubation in predicted difficult airway: a feasibility study

Videolaryngoscopy has become increasingly attractive for the routine management of the difficult airway. Glidescope® is well studied in the literature while imago V-Blade® is a recent videolaryngoscope. This is a feasibility study with 1:1 case-control sequential allocation comparing Imago V-Blade ® and Glidescope® in predicted difficult airway settings

Outcomes after non-cardiac surgery: Mortality, complications, disability, and rehospitalization

In the last 25 years, the number of patients aged ≥75 years undergoing non-cardiac surgery has greatly increased. In elderly patients, frailty is significantly associated with an increased risk of adverse events, functional decline, procedural complications, prolonged hospitalization, and mortality. The relationship between frailty and increased mortality and morbidity requires an appropriate tool of assessment to accurately quantify the patient's clinical and perioperative conditions. The preoperative evaluation of elderly patients candidate for non-cardiac surgery should include assessment of frailty, sarcopenia and malnutrition, as these are related to high surgical risk. For colon-rectal surgery as also for gastric cancer surgery, especially early gastric cancer, the introduction of laparoscopy has yielded considerable benefits in terms of short-term postsurgical outcomes, e.g. lower rate of intraprocedural bleeding and reduced length of hospital stay. Despite the progress made in preoperative assessment, surgical procedures and postoperative management, the improvement of outcomes after non-cardiac surgery in elderly patients remains a challenge and calls for future, well-designed clinical studies.</p

Preoperative anxiety during COVID-19 pandemic: A single-center observational study and comparison with a historical cohort

Background: Preoperative anxiety is a common sensation experienced by patients undergoing surgical interventions. It can influence intraoperative and postoperative management through the activation of the neuroendocrine system, leading to tachycardia, hypertension, pulmonary complications, higher consumption of anesthetic drugs, and increased postoperative pain. Our aim was to investigate the level of preoperative anxiety during the COVID-19 pandemic; we also compared it to the preoperative anxiety of a historical cohort before the outbreak. Methods: This is a single-center observational study. We enrolled 314 patients during the pandemic from May 2021 to November 2021, and our historical cohort consisted of 122 patients enrolled from July 2015 to May 2016 in the university hospital "Federico II" of Naples. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI) were used to evaluate preoperative anxiety. In particular, APAIS measures preoperative anxiety and the need for information, and STAI assesses state and trait anxiety through STAI-Y1 and STAI-Y2, respectively. We analyzed APAIS and STAI scores in our population stratified on the basis of age, gender, marital status, previous surgical experiences, and type of surgery, and we compared them to our historical cohort. Statistical analysis was performed through a t-test and ANOVA for parametric data, and the Mann-Whitney and Kruskal-Wallis tests for non-parametric data. Linear regression was used to investigate the correlation between demographic data and the scores of STAI and APAIS in both groups. Results: Our results showed that state and preoperative anxiety remained stable, whereas trait anxiety increased in all the subgroups analyzed. Discussion: Even if state anxiety is considered a variable characteristic of the emotional sphere and trait anxiety a stable element, our findings suggested that COVID-19 deeply influenced trait anxiety, thus altering the patients' psychological foundations

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