The Funnel: From the Skull Base to the Sacrum. New Trends and Technologies in Anaesthesia for the Adult Patient.

The management of children affected by neurosurgical pathologies is multidisciplinary and should be set on several fronts.The potential need for massive blood components transfusions, the prolonged anaesthesia in paediatric age that may be often complicated by various forms of syndrome-related problems, and airway management are often encountered.The problems may be divided schematically into three large groups: preoperative, intraoperative and postoperative problems.The aim of this work is to optimize and make paediatric neurosurgery safe by highlighting the most important aspects in the various perioperative phases.

Technologies in Anaesthesia for the Paediatric Patient.

Spine surgery is an increasingly frequent surgery and includes a wide range of procedures, from minor surgeries (removal of herniated discs, simple laminectomies) to major surgeries (arthrodesis, removal of spinal meningiomas, etc.).These surgeries commonly involve complex patients (elderly population, ASA II-III) and are sometimes performed in emergency settings (polytrauma, cauda syndrome, pathological fractures), which require specific positions (pronation or lateral decubitus), whereby there can be difficulty in airway management, especially in surgeries that concern the cervical tract.One of the main peculiarities of spine surgery involves the prone position.Patient positioning on the operating bed is an action that must be carried out under medical supervision, in particular by the anaesthetist who is supposed to supervise the regular positioning of the patient at the very moment in which it is performed. The correct positioning of the patient is one of the most important moments of the patient care process in the operating room, given that an error in this field may cause serious damage to the patient by giving rise to permanent and significant nerve damage.The prone position is associated with a variety of complications (Kwee et al., Int Surg 100(2): 292-303, 2015). The points of greatest compression during pronation are eyes, nose, breasts, genitals and neck veins.Therefore, the main risks that can derive from an incorrect position are visual disturbances from inappropriate orbital compression, brachial plexus stretching, ulnar nerve compression and lateral femur-cutaneous nerve stretching. In addition, an inappropriate compression of the abdominal organs in this position, may cause ischemia and consequent organ failure resulting in hospitalization prolongation, permanent disability and sometimes even death (Edgcombe et al., Br J Anaesth 100: 165-183, 2008).In addition to the mechanical effects on anatomical structures, there are also the physiological effects of the prone position, which can be divided into circulatory and respiratory effects.These effects are even more pronounced in elderly patients, cardiopaths or patients with respiratory diseases.

The Role of the Anesthesiologist and the Modern Intraoperative Echography in Ventriculoatrial Shunt for Hydrocephalus: From Hakim to Nowadays.

The introduction of US-guided venipuncture in clinical practice has greatly facilitated the surgical approach to patients with hydrocephalus. Especially in infants and children, where it results in a lower technical failure rate, less time and fewer complications than the traditional referral method, this technique has become a clinical protocol. This dynamic or "real time" technique has become one of the anesthetist's tools. This allowed the anesthesiologists to be part of the surgical team, so they not only dedicate themselves to inducing and maintaining general anesthesia but also to performing venipuncture of the central vein of the neck and to locating the tip of the catheter.The anesthetist's tools have made it possible to perform a simple and safe method, and the anesthesiologists have become an active part of the surgical team, charged with a specific role during the positioning of the ventricular atrial shunt.

g-fractional diffusion models in bounded domains.

In the recent literature, the g-subdiffusion equation involving Caputo fractional derivatives with respect to another function has been studied in relation to anomalous diffusions with a continuous transition between different subdiffusive regimes. In this paper we study the problem of g-fractional diffusion in a bounded domain with absorbing boundaries. We find the explicit solution for the initial boundary value problem, and we study the first-passage time distribution and the mean first-passage time (MFPT). The main outcome is the proof that with a particular choice of the function g it is possible to obtain a finite MFPT, differently from the anomalous diffusion described by a fractional heat equation involving the classical Caputo derivative.

Run-and-tumble motion in one dimension with space-dependent speed.

We consider a particle performing run-and-tumble dynamics with space-dependent speed. The model has biological relevance as it describes motile bacteria or cells in heterogeneous environments. We give exact expression for the probability density function in the case of free motion in unbounded space. We then analyze the case of a particle moving in a confined interval in the presence of partially absorbing boundaries, reporting the probability density in the Laplace (time) domain and the mean time to absorption. We also discuss the relaxation to the steady state in the case of confinement with reflecting boundaries and drift effects due to direction-dependent tumbling rates, modeling taxis phenomena of cells. The case of diffusive particles with spatially variable diffusivity is obtained as a limiting case.

Pre-anesthesiological assessment in paediatric cataract surgery.

The authors underline the importance of accurate pre-anesthesiological assessment in children undergoing cataract. The alteration is frequently related to many genetic, metabolic and infectious pathologies that could interfere in anesthesia management whatever surgery is requested. Some possibly responsible congenital syndromes and related alterations are mentioned, particularly focusing on Down's syndrome.

Complicaciones cardiovasculares del trasplantado añoso / Cardiovascular complications of the elderly transplanted patient

En los últimos años, la muerte con riñón funcionante (sobre todo de origen cardiovascular) junto a la nefropatía crónica del trasplante son las causas más frecuente de pérdida de injerto renal según múltiples estudios practicados Aunque después del trasplante mejora el pronóstico desde el punto de vista cardiovascular, el riesgo de muerte por causa cardiovascular sigue siendo muy alto si lo comparamos con la población general. Tanto los factores bien determinados de riesgo cardiovascular (diabetes, hipertensión arterial, tabaquismo, dislipemia) como los ahora emergentes en la población general también afectan a la población de pacientes trasplantados que tiene sobreañadidos otros factores inherentes a la disfunción del injerto. El aumento progresivo de la mortalidad cardiovascular en trasplante renal se debe a factores demográficos, a la disminución de la mortalidad en el post-trasplante inmediato y al efecto del tratamiento inmunosupresor. Ante las evidencias científicas de que la patología cardiovascular en el trasplantado renal añoso es un importante problema, que además aumenta con los años, deben plantearse estrategias para intentar paliar el problema. Debe practicarse un screening pre-trasplante renal para seleccionara-los pacientes que pueden beneficiarse del mismo o corregir aquellas patologías cardiovasculares que ya existen pretrasplante, y intervenir sobre los factores de riesgo cardiovascular conocidos en la población general (colesterol, presión arterial diabetes y tabaquismo), dado que éstos son mucho más prevalentes en la población trasplantada. El manejo de algunos de los factores de riesgo pueden tener un efecto positivo en la enfermedad cardiovascular del trasplantado, tales como el uso de fármacos antihipertensivos e hipolipemiantes, el control de la glucosa, la profilaxis con aspirina y la abstinencia tabdquica. Sin embargo hay menos evidencia sobre el impacto real de la reducción de peso, el uso de antioxidantes, los agentes que disminuyen la homocisteína, la terapia substitutiva hormonal con estrógenos o la profilaxis de determinadas infecciones (AU)