Emergence delirium (ED) is an acute change in cognition after general anesthesia (GA) occurring in operative room, recovery room or in postanesthesia care. The automated propofolremifentanil titration by Bispectral index (BIS) (AutoTIVA) avoids period of deep (BIS<40) anesthesia and could potentially decrease the ED. The aim of this study was to evaluate ED in surgical patients under AutoTIVA, manual titration of propofol-remifentanil (ManualTIVA) or volatile BIS-guided GA. Secondarly, we aimed to evaluate age-related postoperative Mini-Mental State Examination (MMSE) changes.

Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia.

Background: Blood haematopoietic stem cells expressing the CD34 cell surface marker (CD34+) may differentiate under appropriate stimula into a variety of cell types to repair damaged organs. Purposes of this study were to verify whether lung surgical trauma can activate bone marrow mobilizing peripheral CD34+ cells and the time course of their activation. Methods and findings: In fifty-one patients undergoing elective surgical lung resection under general anesthesia, ASA II-III, without chronic obstructive pulmonary disease, blood samples for white blood cells (WBC) and circulating blood CD34+ were collected before surgery (T0), at 24 (T24h) and 72 (T72h) hours, 5 (T5d) and 7 (T7d) days postoperatively. CD34+ cells quantification was performed by flow cytometry. A hierarchical clustering analysis identified two clusters based on the CD34+ time course: in cluster #1 (14 patients), CD34+ decreased by 46% on T24h (p=0.0023 vs T0) and then increased constantly reaching 230% on T7d (p=0.00016 vs all previous time points), in cluster #2 (37 patients), CD34+ remained stable throughout the study. Patients entering cluster #1 were younger (58+4 years vs 66+1 years, p=0.03), had a higher baseline CD34+ count (on T0 CD34+ 2.55+1.5 n/10-3 vs 1.2+0.57 n/10-3, p=0.0023) and the pre-operative FEV1/FVC was significantly higher (95.66 vs 76.6, p=0.02). Conclusions: Our data show that peripheral blood CD34+ are mobilized from the bone marrow in patients undergoing lung resection and their count seems to be correlated with WBC and CD34+ basal values and with patients age.