Background: This study aims to characterize the clinical impact of endovascular treatment in Chronic Pelvic Pain (CPP) patients due to Pelvic Congestion Syndrome (PCS) and to assess the diagnostic value of surface electromyography (sEMG) studies of pelvic floor musculature (PFM) in PCS patients pre- and post-endovascular treatment. Between January 2019 and July 2023, we studied consecutive patients who were referred for interventional radiology assessment and treatment to a tertiary trauma care hospital, had evidence of non-obstructive PCS from Magnetic Resonance Imaging (MRI), had sEMG of PFM and who had undergone endovascular treatment. The primary outcome was clinical, defined as a change in symptom severity after endovascular treatment. The secondary outcome was a difference in the sEMG values pre- and post-endovascular therapy. Results: We included 32 women (mean age 38 years). CPP was the leading symptom in 100% patients, followed by dysmenorrhea (75%) and post-coital pain (68.7%). Endovascular therapy included ovarian vein embolization in 28 patients (87.5%) and internal iliac vein embolization in only 2 patients (6.2%). After a median of 8 (range 6–10) months from endovascular treatment, 29 (90%) of patients reported an improvement of the main symptoms, and 15 (46%) were symptom-free. The sEMG values did not show a statistical difference pre- and post-PCS endovascular treatment. Conclusions: Endovascular treatment appeared to be highly effective in CPP due to PCS and was associated with a low rate of complication. sEMG study could be useful in revealing alterations of PFM electrophysiology, but a difference pre- and post-embolization in PCS patients was not demonstrated.

The COVID-19 pandemic, besides stimulating new integrated assistance systems 1, has altered the clinical approach in I.C.U., the management of medical information, and the methods of communication between doctors and family members. The transmission of news between the hospital and the family was ensured via a multimedia network, replacing the understanding between doctor and family established with de visu meetings. The pandemic emergency has forced healthcare professionals to adopt this new method of communication, exposing the doctor to a series of critical issues related to the transmission of sensitive data. A review of the scientific literature underlines that not many articles deal with regulations and issues related to the processing of health data in the COVID period; however, there are many challenges such as security risks, privacy, ethical and process standardization issues. We believe that this topic should be the subject of an urgent debate, deepening the matter with a specific medico-legal background.

Key Clinical Message: We report five case series of obese patients with severe left ventricular ejection fraction impairment undergoing Serratus Anterior Plane Block during S‐ICD Implantation. This anesthesia approach has a reduced impact on the patient's hemodynamics and adequately manages postprocedural pain. Subcutaneous implantable cardioverter‐defibrillator (S‐ICD) procedures are frequently performed under analgosedation or general anesthesia, leading to prolonged postoperative hospital stays and increased costs. This anesthetic technique may also have a greater hemodynamic impact, particularly in obese and cardiac patients. However, an alternative anesthetic technique can be employed: ultrasound‐guided serratus anterior plane block (US‐SAPB). We analyzed the anesthetic clinical course in 5 patients, 3 males and 2 females, who were obese (BMI ≥ 30) and underwent S‐ICD implantation for primary prevention using a two‐incision intermuscular technique and ultrasound‐guided serratus anterior plane block. All patients had a left ventricular ejection fraction less than or equal to 35%. It significantly facilitated pain control during the procedure and, especially, in the postoperative phase. However, the data available in the literature are mostly derived from case reports and small comparative studies. Therefore, further studies with a larger sample size and direct comparison with general anesthesia or deep sedation are needed.

Introduzione: l’insufficienza respiratoria acuta viene generalmente definita come la nuova insorgenza di un disturbo clinicamente importante. Può essere ipossica, ipercapnica oppure mista. Tra le metodiche di trattamento dell’insufficienza respiratoria acuta di tipo ipossiemica, rientra l’utilizzo dell’ossigenoterapia convenzionale, che permette di aumentare la frazione di ossigeno inspirato (FiO2) utilizzando semplici interfacce. Una valida alternativa, è rappresentata dall’utilizzo delle cannule nasali ad alto flusso (HFNC), in quanto offre la possibilità di avere flussi di gas sempre più elevati, umidificati e riscaldati. Materiali e Metodi: verrà condotta una ricerca preliminare per verificare la presenza di precedenti revisioni sull’argomento e successivamente, una revisione della letteratura sulla comparazione delle cannule nasali ad alto flusso rispetto alla ventilazione non invasiva a pressione positiva nei pazienti critici gravemente ustionati e con insufficienza respiratoria acuta. Risultati: i risultati che emergeranno, potrebbero potenzialmente contribuire a perfezionare le attuali teorie sulle indicazioni all’utilizzo delle HFNC nel paziente ustionato. Discussione: le implicazioni future per la ricerca e per la pratica clinica, dovranno avere un approccio sempre più orientato e mirato nell’utilizzo di interfacce efficaci nel migliorare la compliance del paziente in termini di miglioramento degli scambi gassosi, confortevoli in termini di riduzione delle lesioni da pressione causate dall’utilizzo prolungato.

Objectives: Low tidal volume ventilation (LTVV) is a ventilatory strategy with the advantages of minimizing diaphragm movements and reducing hypercapnia and barotrauma risks. This preliminary study aims to report on the safety and effectiveness of LTVV applied during percutaneous US-guided liver ablations of focal malignancies. Methods: Patients affected by focal liver malignancies treated with percutaneous microwaves ablation were retrospectively included in this single-center analysis. Arterial gas analysis was performed immediately before and after ablation to evaluate the arterial pH, partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen (pO₂), and plasma lactate levels. The primary endpoint of this study was to evaluate the safety and efficacy of LTVV during percutaneous liver cancer ablation. The secondary endpoint was to assess the procedural technical success in terms of correct needle probe targeting without the need for repositioning. Results: Ten patients affected by a single liver lesion had been analyzed. The ASA score was three in all patients, with three patients also suffering from COPD. The procedural technical success was 100%: ablations were performed with a single liver puncture without the need for changing access or repositioning the needle. No variations in post-ablation arterial gas analysis requiring anesthesiological management remodulation occurred. Lactate levels remained stable and hemodynamic balance was preserved during all procedures. No switch to standard volume ventilation was required. Conclusions: In this preliminary study, LTVV was a safe and effective anesthesiological protocol in patients treated with percutaneous ablations of liver malignancies, offering an ideal balance between patient safety and percutaneous needle probe positioning precision. Larger prospective studies are needed to confirm these findings.

Neuroendoscopy is a minimally invasive surgical technique used to treat brain pathologies such as hydrocephalus, arachnoid cysts, and skull base tumors. While it offers several advantages, including reduced tissue trauma and lower morbidity, it is associated with a high risk of postoperative nausea and vomiting (PONV). This paper provides a narrative review of the literature on the incidence, pathophysiology, and management of PONV in patients undergoing neuroendoscopic procedures. The review includes several studies published between 2001 and 2024, analyzing specific risk factors such as female gender, postoperative opioid use, extended endoscopic approaches, and cavernous sinus dissection. PONV prevention strategies include a multimodal approach combining total intravenous anesthesia (TIVA) with propofol, perioperative hydration, and pharmacological prophylaxis (5-HT3 receptor antagonists, NK1 antagonists, dexamethasone, and droperidol). Despite advances in surgical and anesthetic techniques, further research is needed to develop procedure-specific protocols and optimize PONV management in neuroendoscopy.