Combined spinal-epidural anesthesia for renal transplant in a lung transplant recipient: a case report.

A 67-year-old lung transplant recipient with severe comorbidities was admitted for renal transplant. As anesthesia technique, combined spinal-epidural at the T11-T12 level was chosen, associated with intravenous sedation. Graft's function initially results altered, bringing to pulmonary fluid overload. Beginning from the postoperative day 5 there was a slow but constant gain-of-function of the graft, proven by an improvement of renal function indexes and by the resolution of the pulmonary edema. Conclusions: Whereas general anesthesia remains the gold standard anesthesia technique for kidney transplant, a locoregional anesthesia, could be a feasible and effective option in patients at high risk of respiratory complications. (www.actabiomedica.it).

Intraoperative neuromonitoring in traditional and miniinvasive thyroidectomy. A single center experience in 1652 nerve at risk.

BACKGROUND: The injury of laryngeal recurrent nerve (RLN) is one of the most severe adverse event in thyroid surgery. The rate in literature is reported as 2-11% for transient palsy and 0,6-1,6% for permanent palsy (after 6 months from surgical procedure). METHODS: The patients undergoing thyroid surgery associated to Intraoperative Neuromonitoring (IONM were enrolled consecutively from 21/08/2014 to 30/08/2018. WE collected data from I-IONM and not by Continuos IONM (C-IONM) because we have interrupted C-IONM after a case of cardiac arrest (15TH patient) during the APS placement. RESULTS: The utility of the intraoperative neuro-monitoring system was evaluated with the following statistical methods:• Mann Withney U-test with independent samples, T-samples with coupled samples, Wilcoxon signed sign test, Chi square test., Positive predictive value (PPV), Negative predictive value (NPV),we considered the values for p <0.05 statistically positive. CONCLUSIONS: In high-volume centers the rate of transitory / permanent vocal cord palsy is low but also in these Units the need of feel safety is related to IONM. The use of the IONM is an helpful tool for dissection and anatomical identification of the nerves. IONM has a high specificity and sensitivity and a high negative predictive value. PPV as 52% definable low, may be related to the transient stupor of nerve function.

Analysis of indication for laparoscopic right colectomy and conversion risks.

Laparoscopic surgery developed continuously over the past years becoming the gold standard for some surgical interventions. Laparoscopic colorectal surgery is well established as a safe and feasible procedure to treat benign and malignant pathologies. In this paper we studied in deep the role of laparoscopic right colectomy analysing the indications to this surgical procedure and the factors related to the conversion from laparoscopy to open surgery. We described the different surgical techniques of laparoscopic right colectomy comparing extra to intracorporeal anastomosis and we pointed out the different ways to access to the abdomen (multiport VS single incision). The indications for laparoscopic right colectomy are benign (inflammatory bowel disease and rare right colonic diverticulitis) and malignant diseases (right colon cancer and appendiceal neuroendocrine neoplasm): we described the good outcomes of laparoscopic right colectomy in all these illnesses. Laparoscopic conversion rates in right colectomy are reported as 12-16%; we described the different type of risk factors related to open conversion: patient-related, disease-related and surgeon-related factors, procedural factors and intraoperative complications. We conclude that laparoscopic right colectomy is considered superior to open surgery in the shortterm outcomes without difference in long-term outcomes. KEY WORDS: Conversion risks, Indication to treatment, Laparoscopy, Post-operative pain, Right colectomy.