Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies

Postoperative pain management in non-traumatic emergency general surgery : WSES-GAIS-SIAARTI-AAST guidelines

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.Peer reviewe

Trasporto tattico ai tempi del coronavirus: il C-27 J tra flessibilità operativa e proactive management

La pandemia ha minato fortemente il comparto del traporto aereo. Con un prevedibile effetto domino il tracollo dei trasporti ha trascinato a cascata quello della produzione di aeromobili e neppure il settore della difesa, relativamente stabile, in virtù del legame forte con i clienti istituzionali - gli Stati - pare sufficiente per frenare una regressione che accomuna l’intero comparto aeronautico. In questo quadro di stasi generale, che i media hanno esaltato per mesi con le immagini di aerei a terra, aeroporti chiusi e produzione manifatturiera ferma, si stagliano le operazioni aeree umanitarie e di soccorso, che la comunità internazionale ha posto in essere per fronteggiare la minaccia del Coronavirus. L’Italia ha offerto, mediante l’azienda a partecipazione statale Leonardo S.p.A., i propri velivoli da trasporto tattico (C-27 J) per la gestione dell’emergenza sanitaria in un pervasivo slancio di solidarietà civile. Ciò è stato possibile grazie alle peculiarità di questi airlifter, in particolare la flessibilità d’impiego, ma anche grazie ad un management attento e proattivo, che ha saputo mostrare doti di change management, resilienza organizzativa e, soprattutto, valori etici

Trasporto tattico ai tempi del coronavirus: il C-27 J tra flessibilità operativa e proactive management

La pandemia ha minato fortemente il comparto del traporto aereo. Con un prevedibile effetto domino il tracollo dei trasporti ha trascinato a cascata quello della produzione di aeromobili e neppure il settore della difesa, relativamente stabile, in virtù del legame forte con i clienti istituzionali - gli Stati - pare sufficiente per frenare una regressione che accomuna l’intero comparto aeronautico. In questo quadro di stasi generale, che i media hanno esaltato per mesi con le immagini di aerei a terra, aeroporti chiusi e produzione manifatturiera ferma, si stagliano le operazioni aeree umanitarie e di soccorso, che la comunità internazionale ha posto in essere per fronteggiare la minaccia del Coronavirus. L’Italia ha offerto, mediante l’azienda a partecipazione statale Leonardo S.p.A., i propri velivoli da trasporto tattico (C-27 J) per la gestione dell’emergenza sanitaria in un pervasivo slancio di solidarietà civile. Ciò è stato possibile grazie alle peculiarità di questi airlifter, in particolare la flessibilità d’impiego, ma anche grazie ad un management attento e proattivo, che ha saputo mostrare doti di change management, resilienza organizzativa e, soprattutto, valori etici

Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma

We reported the case of a 36 years old woman involved in a car accident and admitted to the Emergency Room with critical conditions. A CT scan showed hemopericardium, pneumomediastinum and D2 unstable vertebral fracture; then a sternotomy was promptly performed. After admittance to Intensive Care Unit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption of the left main bronchus with a 2 cm gap beetwen two consecutive cartilage rings. D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture. On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy. The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope. Postoperative course was uneventful and the patient was transferred to the Physical Rehabilitation Unit after 23 d. The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions. The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption

Effect of Hemoadsorption for Cytokine Removal in Pneumococcal and Meningococcal Sepsis

Bacterial meningitis and septicemia are invasive bacterial diseases, representing a significant cause of morbidity and mortality worldwide. Both conditions are characterized by an impressive inflammatory response, resulting rapidly in cerebral edema, infarction, hydrocephalus, and septic shock with multiple organ failure. Despite advances in critical care, outcome and prognosis remain critical. Available adjunctive treatments to control the inflammatory response have shown encouraging results in the evolution of patients with sepsis and systemic inflammation, but meningococcal or pneumococcal infection has not been investigated. We herein report five patients with similar critical pathological conditions, characterized by pneumococcal or meningococcal sepsis and treated with hemoadsorption for cytokine removal. All patients showed a progressive stabilization in hemodynamics along with a rapid and marked reduction of catecholamine dosages, a stabilization in metabolic disorders, and less-than-expected loss of extremities. Therapy proved to be safe and well tolerated. From this first experience, extracorporeal cytokine removal seems to be a valid and safe therapy in the management of meningococcal and pneumococcal diseases and may contribute to the patient stabilization and prevention of severe sequelae. Further studies are required to confirm efficacy in a larger context