Roberta Meroni | Università Vita-Salute San Raffaele (original) (raw)

Papers by Roberta Meroni

Journal of Cardiothoracic and Vascular Anesthesia, 2017

Adequate maintenance of hypnosis during anesthesia throughout surgery using sevoflurane alone was... more Adequate maintenance of hypnosis during anesthesia throughout surgery using sevoflurane alone was investigated. In addition, sevoflurane pharmacokinetics during cardiopulmonary bypass were analyzed. Design: This was a pilot pharmacokinetic study. Setting: Tertiary care university hospital. Participants: The study comprised 10 patients aged between 18 and 75 years who underwent elective mitral valve surgery. Interventions: The end-tidal and sevoflurane plasma concentrations were measured throughout cardiac surgery procedures involving cardiopulmonary bypass. The sevoflurane plasma concentration was measured using gas chromatography. In addition, the ratio between sevoflurane alveolar concentration and inspired concentration over time (F A /F I) was analyzed to describe wash-in and wash-out curves. Measurements and Main Results: Hypnosis was maintained adequately throughout surgery using sevoflurane alone. The bispectral index was maintained between 40 and 60 during cardiopulmonary bypass. The end-tidal sevoflurane was significantly different before and during cardiopulmonary bypass (1.86%70.54% v 1.30%70.58%, respectively; po0.001). However, the sevoflurane plasma concentration was not significantly different before and after cardiopulmonary bypass start-up (40.55 mg/mL [76.62-125.33] before cardiopulmonary bypass and 36.24 mg/mL [56.49-81-42] during cardiopulmonary bypass). This mismatch possibly can be explained by changes that occured after cardiopulmonary bypass start-up, such as reductions of body temperature (36.331C 70.461C v 32.981C 72.381C, respectively; po0.001) and hematocrit (35.62%7 3.98% v 25.5%7 3.08%, respectively; p o0.001). The sevoflurane alveolar concentration varied according to sevoflurane plasma concentration and bispectral index values. No adverse events regarding sevoflurane administration during cardiopulmonary bypass were observed. Conclusions: Sevoflurane end-tidal values were reliable indicators of adequate anesthesia during all cardiac surgery procedures involving cardiopulmonary bypass.

Clinical Nutrition ESPEN, 2016

Annals of Cardiac Anaesthesia, 2015

Annals of cardiac anaesthesia

NGAL is one of the most promising AKI biomarkers in cardiac surgery. However, the best timing to ... more NGAL is one of the most promising AKI biomarkers in cardiac surgery. However, the best timing to dose it and the reference values are still matter of discussion. We performed a uNGAL perioperative time course, to better understand its perioperative kinetics and its role in AKI diagnosis. San Raffaele University Hospital, cardiac surgery department. We enrolled in this prospective observational study 19 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Based on preoperative characteristics, they were divided in low-risk and high-risk patients. uNGAL measurements were collected at pre-defined times before, during, and up to 24 hours after surgery. Data were analysed by use of SAS 1999-2001 program or IBM SPSS Statistics. In low-risk patients, uNGAL had the highest value immediately after general anesthesia induction (basal dosage: uNGAL: 12.20ng×ml -1 , IQR 14.00). It later decreased significantly (3.40 ng×ml -1 , IQR 4.80; P = 0.006) during CPB, and finally retur...

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2014

Acute kidney injury (AKI) is an important complication of cardiac surgery. Recently, elevated lev... more Acute kidney injury (AKI) is an important complication of cardiac surgery. Recently, elevated levels of endogenous ouabain (EO), an adrenal stress hormone with haemodynamic and renal effects, have been associated with worse renal outcome after cardiac surgery. Our aim was to develop and evaluate a new risk model of AKI using simple preoperative clinical parameters and to investigate the utility of EO. The primary outcome was AKI according to Acute Kidney Injury Network stage II or III. We selected the Northern New England Cardiovascular Disease Study Group (NNECDSG) as a reference model. We built a new internal predictive risk model considering common clinical variables (CLIN-RISK), compared this model with the NNECDSG model and determined whether the addition of preoperative plasma EO improved prediction of AKI. All models were tested on >800 patients admitted for elective cardiac surgery in our hospital. Seventy-nine patients developed AKI (9.9%). Preoperative EO levels were st...

Journal of Cardiothoracic and Vascular Anesthesia, 2014

Objective: To investigate the ability of early urinary neutrophil gelatinase-associated lipocalin... more Objective: To investigate the ability of early urinary neutrophil gelatinase-associated lipocalin to predict postoperative complications in adult patients with ventricular dysfunction undergoing cardiac surgery.

Journal of Cardiac Surgery, 2014

Following cardiac surgery, patients can develop acute respiratory failure. We present the case of... more Following cardiac surgery, patients can develop acute respiratory failure. We present the case of a 66-year-old male successfully treated with extracorporeal venovenous membrane oxygenation (vvECMO) for acute respiratory failure postsurgery and review the literature on vvECMO in this specific setting.

Annals of Cardiac Anaesthesia, 2012

Intra-aortic balloon pump (IABP) is an established tool in the management of cardiac dysfunction ... more Intra-aortic balloon pump (IABP) is an established tool in the management of cardiac dysfunction in cardiac surgery. The best timing for IABP weaning is unknown and varies greatly among cardiac centers. The authors investigated the differences in IABP management among 66 cardiac surgery centers performing 40,675 cardiac surgery procedures in the 12-month study period. The centers were contacted through email, telephone, or in person interview. IABP management was very heterogeneous in this survey: In 43% centers it was routinely removed on the first postoperative day, and in 34% on the second postoperative day. In 50% centers, it was routinely removed after extubation of the patients whereas in 15% centers it was removed while the patients were sedated and mechanically ventilated. In 66% centers, patients were routinely receiving pharmacological inotropic support at the time of removal of IABP. The practice of decreasing IABP support was also heterogeneous: 57% centers weaned by reducing the ratio of beat assistance whereas 34% centers weaned by reducing balloon volume. We conclude that the management of IABP is heterogeneous and there is a need for large prospective studies on the management of IABP in cardiac surgery.