Francesco Giunta - Academia.edu (original) (raw)
Papers by Francesco Giunta
Blood Purification, 2011
dating a unified web-based data collection and data management tool based on the most recent AKI ... more dating a unified web-based data collection and data management tool based on the most recent AKI definition/classification system. The interactive database is designed to elucidate the epidemiology of AKI in a critically ill population. As a test, we performed a prospective observational multicenter study designed to prospectively evaluate all incident admissions in ten ICUs in Italy and the relevant epidemiology of AKI. Thus, a simple user-friendly web-based data collection tool was created with the scope to serve for this study and to facilitate future multicenter collaborative efforts. We enrolled 601 consecutive incident patients into the study; 25 patients with end-stage renal disease were excluded, leaving 576 patients for analysis. The median age was 66 (IQR 53-76) years, 59.4% were male, while median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II scores were 43 (IQR 35-54) and 18 (IQR 13-24), respectively. The most common diagnostic catego-Key Words Acute kidney injury, epidemiology ؒ Acute renal failure ؒ Intensive care unit ؒ Renal replacement therapy ؒ Sepsis
Recenti progressi in medicina, 2012
We describe the case of a 8 year-old child with acute respiratory distress syndrome (ARDS) during... more We describe the case of a 8 year-old child with acute respiratory distress syndrome (ARDS) during H1N1 swine flu. Lung ultrasound performed at the time of admission showed a typical ARDS ultrasound pattern, with multiple sonographic signs of interstitial oedema (also known as B-lines or ultrasound lung comets), and diffuse bilateral sub-pleural lung consolidations. After five days of anti-viral therapy, lung ultrasound showed a reduction of the dimension of consolidations, not clearly visible at chest X-ray, helping in the management of the patient.
Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to d... more Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic.
Obesity Surgery, 2008
Background Morbid obesity, compromising cardiovascular and respiratory function, may increase the... more Background Morbid obesity, compromising cardiovascular and respiratory function, may increase the risk of anesthesia and was initially considered a contraindication to laparoscopy. The aim of this study was to investigate hemodynamic effects induced by pneumoperitoneum in superobese patients, assessed by arterial pulse contour method. Methods We prospectively studied 10 obese patients (BMI 53±9 kg/m 2 ), scheduled for laparoscopic gastric bypass. After anesthesia induction, patients were intubated and mechanically ventilated. A radial artery was cannulated to obtain hemodynamic data implemented by means of a new pulse contour analysis method-the pressure recording analytical method (PRAM). Data were recorded after anesthesia induction (Tbas), at peritoneal insufflation (T0), at 1, 3, 5, 10, 30, and 60 min after pneumoperitoneum induction (T1, T3, T5, T10, T15, T30, T60), at abdominal desufflation (Tdef) and 5 min after desufflation (T5def). Results MAP increased after pneumoperitoneum, returning to its baseline after deflation (79±7 Tbas, 81±6 mmHg T5def). HR remained unchanged. Systemic vascular resistance index (SVRI) increased after pneumoperitoneum induction and progressively returned to baseline (3,903± 330 Tbas, 4,596±148 T1, and 3,786±202 dyn s m 2 cm −5 T5def). Stroke volume index (SVI) and cardiac index (CI) increased after pneumoperitoneum and remained elevated. Stroke volume variation (SVV) decreased after insufflation remaining lower than the basal value (28±4% Tbas, 15± 5% T5des). Cardiac Cycle Efficiency (CCE) transient decreased after insufflation and subsequently increased (0.029±0.146 Tbas, 0.008±0.178 T5def). Aortic dP/dt max increased after insufflation, returning to baseline only after desufflation (0.68±0.07 Tbas, 0.94±0.08 T30 and 0.86±0.06 mmHg s −1 T5def). Conclusion As assessed by PRAM, this study showed no deterioration in hemodynamic indices or ventricular performance during laparoscopic gastric bypass.
Obesity Surgery, 2012
Background Thromboelastography is a technique that surveys the properties of viscoelastic blood c... more Background Thromboelastography is a technique that surveys the properties of viscoelastic blood clot. The purpose of this paper was to evaluate the hypercoagulability state and the effect of antithrombotic prophylaxis on thromboelastogram (TEG) results in bariatric surgery. Methods Twenty-five patients enrolled received 0.8 ml of nodraparin starting on the day before surgery and continuing postoperatively. TEG profile was collected before induction of anesthesia, on the first and third postoperative days. Each sample was run also in a cup added with heparinase to eliminate the interference of antithrombotic prophylaxis. Results TEG analysis with heparinase showed a tendency to reduce the r-time (rate of initial fibrin formation) and k-time (time to clot firmness) and increase the alpha angle (rate of clot growth), while an increase of maximal amplitude (MA, a measure of maximal stiffness of the clot; p = 0.01) and GI or shear elastic modules strength (p = 0.03)was observed from basal to postoperative day 3 (POD3). TEG without heparinase evidenced and increase of r-time (p = 0.02) and k-time (p = 0.05), a reduction of the alpha angle (p = 0.03), and an increase of MA (p = 0.01) and GI (p = 0.03) from basal to POD3. The comparison of TEG techniques showed that normal TEGs had lower values of r-time and k-time and higher values of alpha angles and MA than TEG with heparinase. No differences were evident for basal and POD1 samples and the G values comparing the two TEG technique. No correlation was observed between the variation of normal TEG parameters and dosage of anticoagulant used in each patient. Conclusions Our patients presented a tendency to hypercoagulability determined most by MA and GI. Comparison between TEGs indicates that low-molecular-weight heparin not titrated on weight is able to determine a reduction of hypercoabulable tendency in the early postoperative period with few effects on increasing MA and GI.
Critical Care Medicine, 1992
To compare a method of measuring energy expenditure and gas exchange using the Fick principle wit... more To compare a method of measuring energy expenditure and gas exchange using the Fick principle with the standard indirect calorimetry technique. Prospective study of a consecutive sample of postoperative patients. Oxygen consumption (VO2), CO2 production (VCO2), respiratory quotient, and energy expenditure were derived from measurements of variables, including oxygen content and cardiac output. Energy expenditure and gas exchange were measured simultaneously by continuous indirect calorimetry over a 60-min period. Surgical ICU in a university hospital. Twenty-six consecutive patients (45 to 80 yrs) who underwent sustained surgical trauma. Excluded from the study entry were patients with time-related fluctuations of hemodynamic variables, poor cooperation, patients who required supplemental oxygen, or mechanical ventilation. None. While the measurements of VO2 and VCO2 by calorimetry and thermodilution were significantly correlated with one another (for VO2, r2 = .93, p less than .001; for VCO2, r2 = .26, p less than .01), VO2 and VCO2 values by indirect calorimetry were consistently greater than VO2 and VCO2 values by the Fick method (p less than .01). The respiratory quotient calorimetric measurements ranged between 0.69 and 0.99, whereas the corresponding thermodilution measurements spread to impossible values, from 0.24 to 1.30 (0.821 +/- 0.07 vs. 0.740 +/- 0.24, p less than .05). There was an insignificant relationship (r2 = .06, p = .21) between the values of respiratory quotient by the two methods. A strong, positive correlation between energy expenditure measured by indirect calorimetry and energy expenditure measured by the Fick method was observed (r2 = .92, p less than .001). The limit of agreement between the two methods was -0.24 +/- 73 kcal/day/m2 (-1.00 +/- 305 kJ/day/m2). In postoperative patients, while VO2 and energy expenditure measurements by thermodilution are easy to perform and accurate for clinical purposes, VCO2, and respiratory quotient measurements are too imprecise and inaccurate to serve any useful function. Therefore, in those clinical situations in which an evaluation of respiratory quotient and substrate utilization may be useful for purposes of metabolic care of the surgical patient, precise measurements of gas exchange with indirect calorimetry are mandatory.
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Minerva anestesiologica, 2010
Animal studies suggest that neuronal cell death often results from anesthetic administration duri... more Animal studies suggest that neuronal cell death often results from anesthetic administration during synaptogenesis. Volatile anesthetics are strongly involved in triggering neuronal apoptosis, whereas other inhalational agents (xenon) demonstrate protective effects. Nitrous oxide (N2O) has modest pro-apoptotic effects on its own and potent, synergistic toxic effects when combined with volatile agents. Recent findings suggest that, during periods of rapid brain development, the enhanced neurodegeneration triggered by anesthetic drugs may be caused by a compensatory increase in intracellular free calcium, a potent activator of neuronal nitric oxide synthase (nNOS). Anesthesia-induced neuro-apoptosis is also activated via the intrinsic and the extrinsic apoptotic pathways because both pathways involve p53, a key regulatory gene. The molecular events related to neuronal cell apoptosis are not completely understood. To gain further insight into the events underlying neuro-apoptosis, we a...
Anaesthesia and intensive care, 2006
ISRN Anesthesiology, 2011
ABSTRACT Xenon can induce cell and organ protection through different molecular mechanisms relate... more ABSTRACT Xenon can induce cell and organ protection through different molecular mechanisms related to oxygen level. We explored the effect of xenon on oxygen-related signalling in the central nervous system via hypoxia inducible factor 1 alpha (HIF-1α) and mammalian target of rapamycin (mTOR). Methods. Postnatal day 7 (P7) Sprague Dawley rats were exposed to 25% oxygen/75% nitrogen (air group) or 25% oxygen/75% xenon (treatment group) for 120 min. Brains were collected immediately (transcript analysis—relative real-time polymerase chain reaction) or 24 hours (protein analysis—immunohistochemistry) after the 120-minute exposure period; peak anesthetic preconditioning has been previously identified at 24 hours post-exposure. Results. HIF-1α transcript and protein levels were found to be increased in xenon-exposed compared to air-exposed brains. Sustained nuclear translocation of the protein, accounting for an increased activity of HIF-1α, was also noted. mTOR transcript analysis revealed no significant difference between xenon-exposed and air-exposed brains immediately after the 120-minute exposure. Conclusion. Our data suggest that xenon induces the upregulation of HIF-1α transcription and translation, which may contribute to xenon's neuroprotective preconditioning effect. However, given that xenon exposure did not affect mTOR transcription, further investigation into other signalling cascades mediating xenon’s effects on HIF-1α in developing brain is warranted.
Contributions to Nephrology, 2010
Bibliographic Indices. This publication is listed in bibliographic services, including Current Co... more Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and Index Medicus.
Obesity Surgery, 2012
Background Anesthesia is able to modulate the balance between proinflammatory and anti-inflammato... more Background Anesthesia is able to modulate the balance between proinflammatory and anti-inflammatory cytokine production during surgery. The aim of this study is to assess the effect of three anesthesia approaches, total intravenous anesthesia (TIVA), inhalation anesthesia, and xenon anesthesia, on sieric levels of nitric oxide (NO), IL6, IL10, and TNFα in obese patients undergoing Roux-en-Y laparoscopic gastric bypass. Methods Thirty adult morbidly obese patients (BMI>35) scheduled for Roux-en-Y laparoscopic gastric bypass were randomly recruited and allocated to TIVA (N=10), inhalation anesthesia (SEV, N=10), and xenon anesthesia (XE, N=10). Exclusion criteria were ASA IV, age <18 or >60 years, and Mallampati IV. Opioid dosage and ventilation parameters were standardized. Sieric levels of NO, IL6, IL10, and TNFα were assessed at T0 (before induction of anesthesia), T1 (end of surgery), and T2 (12 h after the end of surgery). We compared the relative cytokine level variations (delta) at T1 and T2 and the cytokine exposure levels calculated as the area under the curve (AUC) between T0 and T2 in the XE and non-XE (SEV+TIVA) groups. Results At T1, we found a significant ΔIL10 (reduction) and ΔTNFα (reduction) between XE and SEV (p<0.05) and XE and TIVA (p<0.05) groups. At T2, ΔIL10 was still significant. Furthermore, we found a reduced AUC value for TNFα in the XE group. Conclusions Xenon anesthesia seems able to inhibit postoperative proinflammatory cytokine imbalance in morbidly obese patients undergoing Roux-en-Y laparoscopic gastric bypass; the reduced ΔTNFα at T1 and the reduced global exposition to TNFα in the XE group may explain the reduced ΔIL10 at T1 and T2.
Neuroscience, 2010
Xenon preconditioning induces tolerance to the consequences of an injurious stimulus such as cere... more Xenon preconditioning induces tolerance to the consequences of an injurious stimulus such as cerebral ischaemia. There have been surprisingly few studies investigating gender difference in the efficacy of pharmacological preconditioning, despite the known ability of oestradiol to exert neuroprotectant activity. We explored this paradigm using a mouse model of transient middle cerebral artery occlusion. C57BL/6 mice both male and female received either 2 h of 70% xenon (preconditioning) or 70% nitrogen (control) balanced with oxygen. Twenty-four hours later animals underwent 1 h of middle cerebral artery occlusion and then allowed to recover. After a further 24 h, functional neurological outcome and cerebral infarct size were evaluated. Western blotting was used to detect activity of signalling pathways involving hypoxia-inducible factor (HIF)-1␣ and phospho-Akt for the preconditioning effect. Both xenon preconditioned male and females showed improved functional outcome on focal deficit scales (P<0.05). Cerebral infarct volumes were significantly reduced in both xenon treated male and females (P<0.01). There was no significant difference between the male and female cohorts. HIF-1␣ and phospho-Akt were quantitatively upregulated in both sexes. Our data suggested that xenon preconditioning improved histological and neurological functional outcome in both gender in a stroke model of mice. (D. Ma). Abbreviations: Akt, protein kinases B; AUC, area under curve; CREB, cyclic AMP, responsive element binding protein; HIF-1␣, hypoxiainducible factor-1␣; mTOR, mammalian target of rapamycin; NMDA, N-methyl-D-aspartic acid; PI3K, phosphoinositide 3-kinases; tMCAO, transient middle cerebral artery occlusion.
Nutrition in Clinical Practice, 2014
Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine de... more Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine deficiency and increased mortality due to potentially irreversible consequences. The aim of this study was to show the impact of thiamine deficiency in a series of patients and the rapid response to thiamine replacement, showing the changes in clinical and metabolic conditions over time. We described 3 cases of hospitalized patients who had received parenteral nutrition (PN) without vitamin supplementation. All the patients were admitted to the ICU between 2010 and 2011 with a severe form of lactic acidosis, an unstable circulatory state, and a different neurological disorder (a lethargic state, a severe form of impaired near-coma consciousness, and Wernicke encephalopathy). Intravenous (IV) administration of thiamine was associated with a rapid and marked restoration of acid-base balance, hemodynamic stability and the disappearance of neurological disturbances, and normalization of the clinical and biochemical conditions of all the patients within the following hours. The 3 cases demonstrated the rapidity of the reversal of severe thiamine deficiency, achieved by appropriate replacement in different hospitalized patients. The regression of clinical and biochemical disorders requires a prompt diagnosis and treatment based on the IV administration of thiamine and magnesium sulfate. In hospitalized patients at risk, thiamine deficiency is prevented by the integration of thiamine supplementation into PN and other forms of nutrition support.
Journal of Neurosurgical Anesthesiology, 2008
Anesthesia & Analgesia, 2007
In this multicenter prospective study, we identified factors associated with satisfaction with an... more In this multicenter prospective study, we identified factors associated with satisfaction with anesthesia in patients staying in hospital at least 24 h after surgery. The study was performed in six centers. Inpatients aged more than 18 yr, who underwent a wide range of common surgical procedures, were asked to answer a 10-item instrument to measure patient satisfaction with anesthesia (mean score range, 0-10) and some specific questions, and to rate their perceived health (score, 0-10). Anesthesia staff members were invited to self-compile a Maslach Burnout Inventory. The satisfaction evaluation questionnaire was returned by 1290 patients (mean age, 61 +/- 16 yr; males, 54.4%). The mean global satisfaction score was 8.7 (95% CI: 8.7-8.8), being &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9 in 632 (49%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =9 in 658 (51%) patients. The Maslach Burnout Inventory was returned by 55 anesthesiologists and 68 nurses. Multivariate regression identified five variables as significant predictors of a mean global satisfaction of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=9: 1) having been treated in a service with perioperative nurses specifically dedicated only to anesthesia; 2) having been treated where anesthesia information leaflets were provided preoperatively; 3) having received more than two anesthesiologist visits after surgery; 4) having a perceived health score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;8.5; and 5) being older that 70 yr. No relationship was found between staff burnout and patient satisfaction. Inpatient satisfaction can be improved by an organization in which surgical suite nurses are dedicated only to anesthesia, a written anesthesia information leaflet is given during the preoperative visit and postoperative visits are enhanced.
Blood Purification, 2011
dating a unified web-based data collection and data management tool based on the most recent AKI ... more dating a unified web-based data collection and data management tool based on the most recent AKI definition/classification system. The interactive database is designed to elucidate the epidemiology of AKI in a critically ill population. As a test, we performed a prospective observational multicenter study designed to prospectively evaluate all incident admissions in ten ICUs in Italy and the relevant epidemiology of AKI. Thus, a simple user-friendly web-based data collection tool was created with the scope to serve for this study and to facilitate future multicenter collaborative efforts. We enrolled 601 consecutive incident patients into the study; 25 patients with end-stage renal disease were excluded, leaving 576 patients for analysis. The median age was 66 (IQR 53-76) years, 59.4% were male, while median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II scores were 43 (IQR 35-54) and 18 (IQR 13-24), respectively. The most common diagnostic catego-Key Words Acute kidney injury, epidemiology ؒ Acute renal failure ؒ Intensive care unit ؒ Renal replacement therapy ؒ Sepsis
Recenti progressi in medicina, 2012
We describe the case of a 8 year-old child with acute respiratory distress syndrome (ARDS) during... more We describe the case of a 8 year-old child with acute respiratory distress syndrome (ARDS) during H1N1 swine flu. Lung ultrasound performed at the time of admission showed a typical ARDS ultrasound pattern, with multiple sonographic signs of interstitial oedema (also known as B-lines or ultrasound lung comets), and diffuse bilateral sub-pleural lung consolidations. After five days of anti-viral therapy, lung ultrasound showed a reduction of the dimension of consolidations, not clearly visible at chest X-ray, helping in the management of the patient.
Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to d... more Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic.
Obesity Surgery, 2008
Background Morbid obesity, compromising cardiovascular and respiratory function, may increase the... more Background Morbid obesity, compromising cardiovascular and respiratory function, may increase the risk of anesthesia and was initially considered a contraindication to laparoscopy. The aim of this study was to investigate hemodynamic effects induced by pneumoperitoneum in superobese patients, assessed by arterial pulse contour method. Methods We prospectively studied 10 obese patients (BMI 53±9 kg/m 2 ), scheduled for laparoscopic gastric bypass. After anesthesia induction, patients were intubated and mechanically ventilated. A radial artery was cannulated to obtain hemodynamic data implemented by means of a new pulse contour analysis method-the pressure recording analytical method (PRAM). Data were recorded after anesthesia induction (Tbas), at peritoneal insufflation (T0), at 1, 3, 5, 10, 30, and 60 min after pneumoperitoneum induction (T1, T3, T5, T10, T15, T30, T60), at abdominal desufflation (Tdef) and 5 min after desufflation (T5def). Results MAP increased after pneumoperitoneum, returning to its baseline after deflation (79±7 Tbas, 81±6 mmHg T5def). HR remained unchanged. Systemic vascular resistance index (SVRI) increased after pneumoperitoneum induction and progressively returned to baseline (3,903± 330 Tbas, 4,596±148 T1, and 3,786±202 dyn s m 2 cm −5 T5def). Stroke volume index (SVI) and cardiac index (CI) increased after pneumoperitoneum and remained elevated. Stroke volume variation (SVV) decreased after insufflation remaining lower than the basal value (28±4% Tbas, 15± 5% T5des). Cardiac Cycle Efficiency (CCE) transient decreased after insufflation and subsequently increased (0.029±0.146 Tbas, 0.008±0.178 T5def). Aortic dP/dt max increased after insufflation, returning to baseline only after desufflation (0.68±0.07 Tbas, 0.94±0.08 T30 and 0.86±0.06 mmHg s −1 T5def). Conclusion As assessed by PRAM, this study showed no deterioration in hemodynamic indices or ventricular performance during laparoscopic gastric bypass.
Obesity Surgery, 2012
Background Thromboelastography is a technique that surveys the properties of viscoelastic blood c... more Background Thromboelastography is a technique that surveys the properties of viscoelastic blood clot. The purpose of this paper was to evaluate the hypercoagulability state and the effect of antithrombotic prophylaxis on thromboelastogram (TEG) results in bariatric surgery. Methods Twenty-five patients enrolled received 0.8 ml of nodraparin starting on the day before surgery and continuing postoperatively. TEG profile was collected before induction of anesthesia, on the first and third postoperative days. Each sample was run also in a cup added with heparinase to eliminate the interference of antithrombotic prophylaxis. Results TEG analysis with heparinase showed a tendency to reduce the r-time (rate of initial fibrin formation) and k-time (time to clot firmness) and increase the alpha angle (rate of clot growth), while an increase of maximal amplitude (MA, a measure of maximal stiffness of the clot; p = 0.01) and GI or shear elastic modules strength (p = 0.03)was observed from basal to postoperative day 3 (POD3). TEG without heparinase evidenced and increase of r-time (p = 0.02) and k-time (p = 0.05), a reduction of the alpha angle (p = 0.03), and an increase of MA (p = 0.01) and GI (p = 0.03) from basal to POD3. The comparison of TEG techniques showed that normal TEGs had lower values of r-time and k-time and higher values of alpha angles and MA than TEG with heparinase. No differences were evident for basal and POD1 samples and the G values comparing the two TEG technique. No correlation was observed between the variation of normal TEG parameters and dosage of anticoagulant used in each patient. Conclusions Our patients presented a tendency to hypercoagulability determined most by MA and GI. Comparison between TEGs indicates that low-molecular-weight heparin not titrated on weight is able to determine a reduction of hypercoabulable tendency in the early postoperative period with few effects on increasing MA and GI.
Critical Care Medicine, 1992
To compare a method of measuring energy expenditure and gas exchange using the Fick principle wit... more To compare a method of measuring energy expenditure and gas exchange using the Fick principle with the standard indirect calorimetry technique. Prospective study of a consecutive sample of postoperative patients. Oxygen consumption (VO2), CO2 production (VCO2), respiratory quotient, and energy expenditure were derived from measurements of variables, including oxygen content and cardiac output. Energy expenditure and gas exchange were measured simultaneously by continuous indirect calorimetry over a 60-min period. Surgical ICU in a university hospital. Twenty-six consecutive patients (45 to 80 yrs) who underwent sustained surgical trauma. Excluded from the study entry were patients with time-related fluctuations of hemodynamic variables, poor cooperation, patients who required supplemental oxygen, or mechanical ventilation. None. While the measurements of VO2 and VCO2 by calorimetry and thermodilution were significantly correlated with one another (for VO2, r2 = .93, p less than .001; for VCO2, r2 = .26, p less than .01), VO2 and VCO2 values by indirect calorimetry were consistently greater than VO2 and VCO2 values by the Fick method (p less than .01). The respiratory quotient calorimetric measurements ranged between 0.69 and 0.99, whereas the corresponding thermodilution measurements spread to impossible values, from 0.24 to 1.30 (0.821 +/- 0.07 vs. 0.740 +/- 0.24, p less than .05). There was an insignificant relationship (r2 = .06, p = .21) between the values of respiratory quotient by the two methods. A strong, positive correlation between energy expenditure measured by indirect calorimetry and energy expenditure measured by the Fick method was observed (r2 = .92, p less than .001). The limit of agreement between the two methods was -0.24 +/- 73 kcal/day/m2 (-1.00 +/- 305 kJ/day/m2). In postoperative patients, while VO2 and energy expenditure measurements by thermodilution are easy to perform and accurate for clinical purposes, VCO2, and respiratory quotient measurements are too imprecise and inaccurate to serve any useful function. Therefore, in those clinical situations in which an evaluation of respiratory quotient and substrate utilization may be useful for purposes of metabolic care of the surgical patient, precise measurements of gas exchange with indirect calorimetry are mandatory.
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed... more all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%
Minerva anestesiologica, 2010
Animal studies suggest that neuronal cell death often results from anesthetic administration duri... more Animal studies suggest that neuronal cell death often results from anesthetic administration during synaptogenesis. Volatile anesthetics are strongly involved in triggering neuronal apoptosis, whereas other inhalational agents (xenon) demonstrate protective effects. Nitrous oxide (N2O) has modest pro-apoptotic effects on its own and potent, synergistic toxic effects when combined with volatile agents. Recent findings suggest that, during periods of rapid brain development, the enhanced neurodegeneration triggered by anesthetic drugs may be caused by a compensatory increase in intracellular free calcium, a potent activator of neuronal nitric oxide synthase (nNOS). Anesthesia-induced neuro-apoptosis is also activated via the intrinsic and the extrinsic apoptotic pathways because both pathways involve p53, a key regulatory gene. The molecular events related to neuronal cell apoptosis are not completely understood. To gain further insight into the events underlying neuro-apoptosis, we a...
Anaesthesia and intensive care, 2006
ISRN Anesthesiology, 2011
ABSTRACT Xenon can induce cell and organ protection through different molecular mechanisms relate... more ABSTRACT Xenon can induce cell and organ protection through different molecular mechanisms related to oxygen level. We explored the effect of xenon on oxygen-related signalling in the central nervous system via hypoxia inducible factor 1 alpha (HIF-1α) and mammalian target of rapamycin (mTOR). Methods. Postnatal day 7 (P7) Sprague Dawley rats were exposed to 25% oxygen/75% nitrogen (air group) or 25% oxygen/75% xenon (treatment group) for 120 min. Brains were collected immediately (transcript analysis—relative real-time polymerase chain reaction) or 24 hours (protein analysis—immunohistochemistry) after the 120-minute exposure period; peak anesthetic preconditioning has been previously identified at 24 hours post-exposure. Results. HIF-1α transcript and protein levels were found to be increased in xenon-exposed compared to air-exposed brains. Sustained nuclear translocation of the protein, accounting for an increased activity of HIF-1α, was also noted. mTOR transcript analysis revealed no significant difference between xenon-exposed and air-exposed brains immediately after the 120-minute exposure. Conclusion. Our data suggest that xenon induces the upregulation of HIF-1α transcription and translation, which may contribute to xenon's neuroprotective preconditioning effect. However, given that xenon exposure did not affect mTOR transcription, further investigation into other signalling cascades mediating xenon’s effects on HIF-1α in developing brain is warranted.
Contributions to Nephrology, 2010
Bibliographic Indices. This publication is listed in bibliographic services, including Current Co... more Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and Index Medicus.
Obesity Surgery, 2012
Background Anesthesia is able to modulate the balance between proinflammatory and anti-inflammato... more Background Anesthesia is able to modulate the balance between proinflammatory and anti-inflammatory cytokine production during surgery. The aim of this study is to assess the effect of three anesthesia approaches, total intravenous anesthesia (TIVA), inhalation anesthesia, and xenon anesthesia, on sieric levels of nitric oxide (NO), IL6, IL10, and TNFα in obese patients undergoing Roux-en-Y laparoscopic gastric bypass. Methods Thirty adult morbidly obese patients (BMI>35) scheduled for Roux-en-Y laparoscopic gastric bypass were randomly recruited and allocated to TIVA (N=10), inhalation anesthesia (SEV, N=10), and xenon anesthesia (XE, N=10). Exclusion criteria were ASA IV, age <18 or >60 years, and Mallampati IV. Opioid dosage and ventilation parameters were standardized. Sieric levels of NO, IL6, IL10, and TNFα were assessed at T0 (before induction of anesthesia), T1 (end of surgery), and T2 (12 h after the end of surgery). We compared the relative cytokine level variations (delta) at T1 and T2 and the cytokine exposure levels calculated as the area under the curve (AUC) between T0 and T2 in the XE and non-XE (SEV+TIVA) groups. Results At T1, we found a significant ΔIL10 (reduction) and ΔTNFα (reduction) between XE and SEV (p<0.05) and XE and TIVA (p<0.05) groups. At T2, ΔIL10 was still significant. Furthermore, we found a reduced AUC value for TNFα in the XE group. Conclusions Xenon anesthesia seems able to inhibit postoperative proinflammatory cytokine imbalance in morbidly obese patients undergoing Roux-en-Y laparoscopic gastric bypass; the reduced ΔTNFα at T1 and the reduced global exposition to TNFα in the XE group may explain the reduced ΔIL10 at T1 and T2.
Neuroscience, 2010
Xenon preconditioning induces tolerance to the consequences of an injurious stimulus such as cere... more Xenon preconditioning induces tolerance to the consequences of an injurious stimulus such as cerebral ischaemia. There have been surprisingly few studies investigating gender difference in the efficacy of pharmacological preconditioning, despite the known ability of oestradiol to exert neuroprotectant activity. We explored this paradigm using a mouse model of transient middle cerebral artery occlusion. C57BL/6 mice both male and female received either 2 h of 70% xenon (preconditioning) or 70% nitrogen (control) balanced with oxygen. Twenty-four hours later animals underwent 1 h of middle cerebral artery occlusion and then allowed to recover. After a further 24 h, functional neurological outcome and cerebral infarct size were evaluated. Western blotting was used to detect activity of signalling pathways involving hypoxia-inducible factor (HIF)-1␣ and phospho-Akt for the preconditioning effect. Both xenon preconditioned male and females showed improved functional outcome on focal deficit scales (P<0.05). Cerebral infarct volumes were significantly reduced in both xenon treated male and females (P<0.01). There was no significant difference between the male and female cohorts. HIF-1␣ and phospho-Akt were quantitatively upregulated in both sexes. Our data suggested that xenon preconditioning improved histological and neurological functional outcome in both gender in a stroke model of mice. (D. Ma). Abbreviations: Akt, protein kinases B; AUC, area under curve; CREB, cyclic AMP, responsive element binding protein; HIF-1␣, hypoxiainducible factor-1␣; mTOR, mammalian target of rapamycin; NMDA, N-methyl-D-aspartic acid; PI3K, phosphoinositide 3-kinases; tMCAO, transient middle cerebral artery occlusion.
Nutrition in Clinical Practice, 2014
Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine de... more Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine deficiency and increased mortality due to potentially irreversible consequences. The aim of this study was to show the impact of thiamine deficiency in a series of patients and the rapid response to thiamine replacement, showing the changes in clinical and metabolic conditions over time. We described 3 cases of hospitalized patients who had received parenteral nutrition (PN) without vitamin supplementation. All the patients were admitted to the ICU between 2010 and 2011 with a severe form of lactic acidosis, an unstable circulatory state, and a different neurological disorder (a lethargic state, a severe form of impaired near-coma consciousness, and Wernicke encephalopathy). Intravenous (IV) administration of thiamine was associated with a rapid and marked restoration of acid-base balance, hemodynamic stability and the disappearance of neurological disturbances, and normalization of the clinical and biochemical conditions of all the patients within the following hours. The 3 cases demonstrated the rapidity of the reversal of severe thiamine deficiency, achieved by appropriate replacement in different hospitalized patients. The regression of clinical and biochemical disorders requires a prompt diagnosis and treatment based on the IV administration of thiamine and magnesium sulfate. In hospitalized patients at risk, thiamine deficiency is prevented by the integration of thiamine supplementation into PN and other forms of nutrition support.
Journal of Neurosurgical Anesthesiology, 2008
Anesthesia & Analgesia, 2007
In this multicenter prospective study, we identified factors associated with satisfaction with an... more In this multicenter prospective study, we identified factors associated with satisfaction with anesthesia in patients staying in hospital at least 24 h after surgery. The study was performed in six centers. Inpatients aged more than 18 yr, who underwent a wide range of common surgical procedures, were asked to answer a 10-item instrument to measure patient satisfaction with anesthesia (mean score range, 0-10) and some specific questions, and to rate their perceived health (score, 0-10). Anesthesia staff members were invited to self-compile a Maslach Burnout Inventory. The satisfaction evaluation questionnaire was returned by 1290 patients (mean age, 61 +/- 16 yr; males, 54.4%). The mean global satisfaction score was 8.7 (95% CI: 8.7-8.8), being &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9 in 632 (49%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =9 in 658 (51%) patients. The Maslach Burnout Inventory was returned by 55 anesthesiologists and 68 nurses. Multivariate regression identified five variables as significant predictors of a mean global satisfaction of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=9: 1) having been treated in a service with perioperative nurses specifically dedicated only to anesthesia; 2) having been treated where anesthesia information leaflets were provided preoperatively; 3) having received more than two anesthesiologist visits after surgery; 4) having a perceived health score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;8.5; and 5) being older that 70 yr. No relationship was found between staff burnout and patient satisfaction. Inpatient satisfaction can be improved by an organization in which surgical suite nurses are dedicated only to anesthesia, a written anesthesia information leaflet is given during the preoperative visit and postoperative visits are enhanced.