Acute Pain Service: A 10-Year Experience.

Background: Pain management after surgery is crucial to decrease perioperative morbidity and mortality. Acute pain services (APS) are multidisciplinary teams that represent a modern strategy to address pain inside hospitals. The APS defines and applies pain treatment protocols specific for each surgery.

The clinical and biological impacts of the implementation of fast-track perioperative programs in complex liver resections: A propensity score-based analysis between the open and laparoscopic approaches.

Background: The aim of this study was to evaluate the impact of the fast-track approach in patients undergoing complex liver procedures and to analyse factors that influence morbidity and functional recovery.

Methods: Hepatic resections (2014-2016) were stratified according to difficulty score, obtaining a group of 215 complex resections (102 laparoscopic, 163 open). The laparoscopic group was matched by propensity score with open patients to obtain the minimally invasive liver surgery group (n = 102) and the open group (n = 102).

Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma.

Background And Aim: Aim of the study was to assess the impact of ERAS approach ("fluid restrictive and drainless") on open liver resections for HCC comparing their outcome with open resections in pre-ERAS period and with laparoscopic surgery.

Study Design: 207 patients undergoing minor liver resection for HCC were divided into three groups: Group A, open minor resections in pre-ERAS period (95 patients); Group B, laparoscopic ERAS resections (55 patients); Group C, open ERAS resections (57 patients).

Results: Blood loss was lower in group C and B compared with group A.

Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial.

Background: Central venous pressure (CVP) is used as a marker of cardiac preload to control intraoperative blood loss in open hepatectomies, while its reliability in laparoscopy is less certain. The aim of this randomized prospective trial was to evaluate the outcome of laparoscopic resections performed with stroke volume variation (SVV) or CVP monitoring.

Methods: All candidates for laparoscopic liver resection were assigned randomly to SVV or to CVP groups.

Laparoscopic liver resection without portal clamping: a prospective evaluation.

Background: Previous comparative studies have demonstrated that laparoscopic liver resection is associated with more frequent use and longer duration of portal camping than open liver resection, a fact that may partially explain the improvement in operative blood loss reported by most series of laparoscopic liver resection. The aim of this prospective study was to evaluate the real need for portal clamping in laparoscopic liver surgery.

Study Design: Surgical outcomes of 40 consecutive patients who underwent laparoscopic liver resection for benign and malignant lesions from September 2005 to August 2007 were evaluate.

A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy.

Background: Left lateral sectionectomy is one of the most commonly performed laparoscopic liver resections, but limited clinical data are actually available to support the advantage of laparoscopic versus open-liver surgery. The present study compared the short-term outcomes of laparoscopic versus open surgery in a case-matched analysis.

Materials And Methods: Surgical outcome of 20 patients who underwent left lateral sectionectomy by laparoscopic approach (LHR group) from September 2005 to January 2007 were compared in a case-control analysis with those of 20 patients who underwent open left lateral sectionectomy (OHR group).

Preoperative methylprednisolone administration maintains coagulation homeostasis in patients undergoing liver resection: importance of inflammatory cytokine modulation.

Alterations in hemostatic parameters are a common finding after major hepatic resection. There is growing evidence that inflammation has a significant role in inducing coagulation disarrangement that follows major surgery. To determine whether preoperative methylprednisolone administration has a protective effect against the development of coagulation disorders, we evaluated the effect of preoperative steroids administration on changes in hemostatic parameters and plasma levels of inflammatory cytokines in patients undergoing liver surgery.

Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: a prospective randomized study.

Hepatic injury secondary to warm ischemia-reperfusion (I/R) injury and alterations in haemostatic parameters are often unavoidable events after major hepatic resection. The release of inflammatory mediator is believed to play a significant role in the genesis of these events. It has been suggested that preoperative steroid administration may reduce I/R injury and improve several aspects of the surgical stress response.

Impact of age on the outcome of liver resections.

The purpose of this study was to evaluate the influence of age on the outcome of liver resections. One hundred five consecutive hepatic resections were divided into two groups: > or = 65 years old [old group (O-group)] and < 65 years old [young group (Y-group)]. The two groups were first compared to evaluate the distribution of the variables potentially affecting the postoperative course, including primary diagnosis, concomitant diseases, previous upper abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation.

Impact of advanced age on the outcome of liver resection.

The aim of this retrospective study was to evaluate the influence of age on the outcome of liver resection. A total of 129 consecutive liver resections were divided into two groups: > or = 70 years old [old group (O-group)] and < 70 years old [young group (Y-group)]. The two groups were first compared for the variables potentially affecting the postoperative course, including diagnosis, concomitant diseases, previous abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation.

Wash-in and wash-out curves of sevoflurane and isoflurane in morbidly obese patients.

Background: The aim of this prospective, randomized study is to compare sevoflurane and isoflurane pharmacokinetics in morbidly obese patients.

Methods: With Ethical Committee approval and written informed consent, 14 obese patients (BMI >35 kg/m2), ASA physical status II, undergoing laparoscopic, silicone-adjustable gastric banding were randomly allocated to receive either sevoflurane (n=7) or isoflurane (n=7) as main anesthetic agents. General anesthesia was induced with 1 mg x kg-1 fentanyl, 6 mg x kg-1 sodium thiopental, and 1 mg x kg-1 succinylcholine followed by 0.

Randomized comparison of isoflurane and sevoflurane for laparoscopic gastric banding in morbidly obese patients.

Study Objective: To compare the efficacy and recovery profile of sevoflurane and isoflurane as the main anesthetics for morbidly obese patients.

Design: Randomized, blinded study.

Setting: Inpatients.

Clinical comparison of either small doses of fentanyl or remifentanil for blunting cardiovascular changes induced by tracheal intubation.

Background: To compare in a prospective, randomized study the effects on cardiovascular changes after tracheal intubation produced by small doses of either remifentanil or fentanyl.

Methods: With Ethical Committee approval, after intravenous midazolam premedication (0.05 mg.

0.2% ropivacaine with or without fentanyl for patient-controlled epidural analgesia after major abdominal surgery: a double-blind study.

Study Objective: To evaluate the effects of adding low concentration of fentanyl to 0.2% ropivacaine when providing patient-controlled epidural analgesia (PCEA) outside the Post-Anesthesia Care Unit.

Design: Prospective, randomized, double-blind study.

Effects of pneumoperitoneum and reverse Trendelenburg position on cardiopulmonary function in morbidly obese patients receiving laparoscopic gastric banding.

We prospectively evaluated the effects of pneumoperitoneum and reverse Trendelenburg position on cardiopulmonary function in 20 ASA physical status II-III morbidly obese patients (body mass index > 35 kg m(-2)) undergoing laparoscopic gastric banding. After general anaesthesia was induced, patients' lungs were ventilated using intermittent positive pressure ventilation (at measurement times, the following parameters were used: tidal volume 12 mL kg(-1) ideal body weight, respiratory rate of 12 bpm, an inspiratory to expiratory time ratio of 1:2). Haemodynamic variables, blood gas parameters, and lung/chest compliance were recorded: in the supine position, after induction of general anaesthesia (T0, baseline) and induction of pneumoperitoneum (T1); after placing the patient in a 25 degree reverse Trendelenburg position (T2); during the surgical time (T3); before deflating the abdomen (T4); after pneumoperitoneum resolution (T5), and before the end of anaesthesia, with the patient supine (T6).

An analysis of the diagnostic contribution of double-radiocompound renography.

The diagnostic contribution of double-radiocompound renography was tested by applying discriminant analysis to the data obtained in one group of normal subjects and in some groups of selected pathological cases which included glomerulonephritis, pyelonephritis, and hypertension. The results obtained confirm the reliability of the test and give evidence of its usefulness in diagnostic clinical work.

[Comparison of the diagnostic efficacy of various in vitro tests for the study of thyroid performance (author's transl)].

Discriminating analysis was employed in an evaluation of the diagnostic efficacy of individual in vitro tests of thyroid performance (T3 resin uptake, T4, FTI, ETR) and PB131I determination, and their combinations, when used for the differentiation of euthyroid, Basedow hyperthyroid, hyperfunctioning autonomous adenoma, and hypothyroid cases. The results are discussed with reference to optimization of the data: radiation dose ratio.