Valoración del daño miocárdico mediante la medición de la heart-fatty acid-binding protein en cirugía de revascularización coronaria sin circulación extracorpórea. Estudio preliminar

Resumen Introduccion y objetivos del estudio El infarto de miocardio posoperatorio es una complicacion grave y frecuente de la cirugia cardiaca. El diagnostico en este contexto es, en ocasiones, dificil. El objetivo de este estudio es evaluar la cinetica y la precision diagnostica de un nuevo marcador, la heart-type fatty acid-binding protein (h-FABP), en la deteccion precoz de dano miocardico en pacientes sometidos a cirugia de revascularizacion coronaria sin circulacion extracorporea en comparacion con los biomarcadores clasicos. Materiales y metodos Se estudiaron prospectivamente 17 pacientes consecutivos sometidos a cirugia cardiaca de revascularizacion sin circulacion extracorporea. Se…

Epidural anesthesia: Simulated intravascular test dose with S(+) ketamine, lidocaine and adrenaline. A prospective, randomized, double blind and placebo controlled study

Abstract Objective The use of a test dose in epidural anesthesia is a safety recommendation. However, specificity and sensitivity of the drugs used with this indication have not been conclusive. The main objective of this study was to compare the effectiveness and the adverse effects of a simulated intravascular test dose of adrenaline, lidocaine and S(+)-ketamine. Material and methods A prospective, randomized, double blinded, placebo controlled study was designed. ASA I patients scheduled for elective surgery were included. These were randomized to the following study groups: S(+)-ketamine 0.5 mg kg −1 (S+K group), 5% lidocaine 1.5 mg kg −1 (L5% group), adrenaline 15 μg (ADR group), and p…

Hipertensión arterial y el paciente quirúrgico

Effect of depth of neuromuscular blockade on the abdominal space during pneumoperitoneum establishment in laparoscopic surgery.

To evaluate the effect of neuromuscular blockade (NMB) upon the abdominal space during pneumoperitoneum establishment in laparoscopic surgery, comparing moderate NMB and deep NMB.Prospective, randomized, crossover clinical trial.Operating room.Seventy-six American Society of Anesthesiologists 1 to 2 patients scheduled for elective laparoscopic surgery.Two independent evaluations were performed at the establishment of pneumoperitoneum for a preset intraabdominal pressures (IAPs) of 8 and 12 mm Hg, both during moderate NMB (train-of-four count, 1-3) and deep NMB (posttetanic count,5). Rocuronium was used to induce NMB, and sugammadex was used for reversal.We evaluated (i) the volume of CO2 in…

Ultrasound observation of tissue fluid infiltration causing stridor in a woman undergoing shoulder arthroscopy

Respiratory stridor developed rapidly during an interscalene brachial plexus block for shoulder arthroscopy in an obese woman. Extensive cervicothoracic edema due to tissue diffusion of the arthroscopic fluid was suspected. The outcome of patient after conservative management was satisfactory. We give a brief review of how this complication develops, the ultrasound findings, and briefly discuss similar cases.

Single shot spinal anaesthesia with hypobaric bupivacaine for hip fracture repair surgery in the elderly. Randomized, double blinded comparison of 3.75 mg vs. 7.5 mg.

Arterial hypotension is the most frequent adverse effect of subarachnoid anaesthesia in the elderly sustaining a femoral proximal fracture. Decreasing the local anaesthetic dose reduces the incidence of hypotension but shortens sensory block duration that could be insufficient in some surgical procedures. Sensory block duration could be prolonged using hypobaric local anaesthetics. We evaluated whether low hypobaric bupivacaine doses were adequate for this type of surgery while maintaining the haemodynamic stability.A prospective, randomized, double blinded study was designed. Patients over 65 years old, sustaining traumatic hip fracture, were assigned to one of two groups: B0.5 group, hypo…

Relación de la sonda de ultrasonidos y la aguja con las estructuras anatómicas (nervios) en los bloqueos de plexos y nervios periféricos

Crítica de libros

Influence of depth of neuromuscular blockade on surgical conditions during low-pressure pneumoperitoneum laparoscopic cholecystectomy: A randomized blinded study.

Abstract Study objective To evaluate the influence of neuromuscular blockade (NMB) on surgical conditions during low-pressure pneumoperitoneum (8mmHg) laparoscopic cholecystectomy (LC), while comparing moderate and deep NMB. Secondary objective was to evaluate if surgical conditions during low-pressure pneumoperitoneum LC performed with deep NMB could be comparable to those provided during standard-pressure pneumoperitoneum (12mmHg) LC. Design Prospective, randomized, blinded clinical trial. Setting Operating room. Patients Ninety ASA 1–2 patients scheduled for elective LC. Interventions Patients were allocated into 3 groups: Group 1: low-pressure pneumoperitoneum with moderate-NMB (1–3 TOF…

Preeclampsia grave. Propuesta de actuación basada en la evidencia

Resumen Objetivos Aunque hay numerosas pautas de tratamiento de la preeclampsia en la paciente obstetrica, hay escasa evidencia acerca de lo adecuado del tratamiento estandar. Por otra parte, organismos sanitarios internacionales recomiendan que haya disponibles recomendaciones, protocolos o guias escritas para la atencion de situaciones frecuentes o graves por parte de hospitales o servicios de anestesia. Nuestro objetivo fue elaborar recomendaciones basadas en la evidencia sobre el abordaje terapeutico de la paciente con preeclampsia grave. Material y metodos Se realizo una revision de la bibliografia obtenida de diversas fuentes, bases de datos, recomendaciones de sociedades y revisiones…

Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study

Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia.In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administrat…

Some Considerations Regarding the Pro and Con articles between Drs. Hedenstierna and Pelosi on Intraoperative Ventilation and Pulmonary Outcomes

Anestesia epidural: dosis test intravascular simulada con S(+)-ketamina, lidocaína y adrenalina. Estudio prospectivo, aleatorizado, doble ciego, controlado con placebo

ResumenObjetivo La dosis test en anestesia epidural es una recomendacion de seguridad. La especificidad y sensibilidad de los farmacos empleados no ha resultado concluyente. Nuestro objetivo fue comparar la efectividad de adrenalina, lidocaina y S(+)-ketamina como dosis test intravascular simulada, asi como sus efectos adversos. Material y metodos Estudio prospectivo, aleatorizado, doble ciego, controlado con placebo. Pacientes ASA I, sometidos a cirugia electiva. Los grupos de estudio fueron (asignacion aleatoria): S(+)-ketamina 0,5 mg/kg-1 (grupo S + K), lidocaina 5% 1,5 mg/kg-1 (grupo L5%), adrenalina 15 μg (grupo ADR) y suero fisiologico 3 ml (grupo SF; grupo control). Se evaluaron los …

Observaciones sobre la miocardiopatía no compactante

319: Single shot spinal anaesthesia with low dose hyperbaric bupivacaine (3.75 mg), for hip fracture repair surgery in the elderly

COVID-19 psychological impact in 3109 healthcare workers in Spain: The PSIMCOV group

AbstractBackgroundThe current coronavirus disease (COVID-19) has a great impact worldwide. Healthcare workers play an essential role and are one of the most exposed groups. Information about the psychosocial impact on healthcare workers is limited.Methods3109 healthcare workers completed a national, internet-based, cross-sectional 45-item survey between 9 and 19 April 2020. The objective is to assess the psychological impact of the COVID-19 pandemic in Spanish healthcare workers. A Psychological Stress and Adaptation at work Score (PSAS) was defined combining four modified versions of validated psychological assessment tests (A) Healthcare Stressful Test, (B) Coping Strategies Inventory, (C…

Bloqueo neuromuscular residual en la sala de recuperación postanestésica. Análisis secundario del estudio ReCuSS. Estudio observacional transversal de una cohorte multicéntrica

Spinal anaesthesia in a patient with post-spine surgery dural ectasia.

Dural sac ectasia is a very infrequent anatomical abnormality, usually caused by connective tissue diseases, as Marfan syndrome. Very few cases have been described being a consequence of a previous spine surgical procedure. We describe the case of an elderly patient who should be operated on twice due to sub-occlusive colon disease. Surgery was performed under spinal anaesthesia. A dural sac ectasia was suspected after the first procedure and the abdominal X-ray was reviewed. The characteristics of the anatomical alteration and the course of both anaesthetic procedures were described. X-ray and CT images were provided.

Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring

Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1 mg/kg boluses increases, total dose neede…

An Infrequent Case of Fire in the Operating Room During Open Surgery of a Tracheobronchopleural Fistula

Ultrasonidos (ecografía) aplicados a las punciones y accesos vasculares

Toxicidad de los anestésicos locales. Prevención y tratamiento

Resumen Aunque infrecuentes, las reacciones de toxicidad general a los anestesicos locales pueden ser muy graves, y resultar en dano irreversible o muerte del paciente. Por ello se requiere un protocolo de actuacion que siga unas lineas claras para el diagnostico y tratamiento rapidos, que son fundamentales para la recuperacion completa del paciente. Se revisa la fisiopatologia de la toxicidad por anestesicos locales, asi como las posibilidades de prevencion y el tratamiento una vez instaurada. Aunque hay pocos aspectos que se puedan basar en la evidencia, se recogen las medidas recomendadas haciendo especial hincapie en la reanimacion cardiopulmonar avanzada, el tratamiento farmacologico y…

Discordancia clínico-radiológica y resolución espontánea de un hematoma postcateterización epidural

Neuraxial techniques are considered safe if certain guidelines are followed, but they are not risk free. We report the case of an 81-year-old woman with an invasive bladder tumor who underwent radical cystectomy with a Bricker-type procedure. General anesthesia was used and epidural analgesia was also provided for surgical and postoperative pain management. Late in the postoperative recovery period a large epidural hematoma was diagnosed based on radiologic signs of spinal cord compression, in the absence of symptoms other than mild and progressive back pain that developed after extubation. The surgeon decided against emergency surgery to reduce compression. Symptoms resolved gradually, and…

Comentarios sobre un caso de neuritis braquial idiopática después de una anestesia general: ¿neuritis idiopática o yatrogénica?

Bloqueo interescalénico guiado por ecografía en un paciente con alteraciones anatómicas de la región supraclavicular secundarias a radioterapia y cirugía

Regional blocks can be difficult in surgical patients with certain superficial anatomical abnormalities. Such blocks may be possible, however, under ultrasound guidance. We report a case in which a man with a fractured right humerus required an ultrasound-guided interscalene brachial plexus block. Secondary to radiotherapy, the patient had right cervical and facial abnormalities that had altered the location of external anatomical landmarks. We describe the approach used to insert the catheter and the exploration of the region by ultrasound. Nerve stimulation was not used to avoid painful contractions. Analgesia was excellent during surgery and over the following 24 hours.

Hemorragia y transfusión masivas. Recomendaciones para la elaboración de un protocolo

Because of the substantial morbidity and mortality provoked by massive bleeding, a protocol to guide treatment of this event in each hospital is required. The present article reviews the physiopathology of massive bleeding. The literature on massive hemorrhage and transfusion is extensively reviewed with a view to designing a practical document that could serve as a template to be adapted to the specific needs and resources of each center.

Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery

Abstract Background and goal of study Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker “heart-type fatty acid-binding protein” (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. Materials and methods A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2-month period. Blood samples were drawn for measurement of myocardial ischem…

Crítica de libros

Bloqueo del nervio femoral e introducción de catéter guiado por ultrasonidos en una paciente con dismorfias óseas

Anesthetic management of a patient diagnosed with CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy)

CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leu-koencephalopathy) is an infrequent inherited disease that could have anesthetic implica-tions. However these have rarely been reported. We present a male patient previously diagnosed with CADASIL, who had suffered an ischemic vascular cerebral accident with a MRI compatible with leukoencephalopathy, and who was dependent for daily activities, and sustained dementia, mood alterations, apathy, and urine incontinence. He had famil-ial antecedents of psychiatric symptoms and ischemic stroke events in several relatives including his father, two brothers and one sister. He was scheduled for arthrodesis of the le…