Revista Espanola de Anestesiologia y Reanimacion最新文献

{"title":"Encuesta nacional sobre disfunción cognitiva perioperatoria","authors":"E.M. Aldana ,&nbsp;N. Pérez de Arriba ,&nbsp;J.L. Valverde ,&nbsp;C. Aldecoa ,&nbsp;N. Fábregas ,&nbsp;J.L. Fernández-Candil ,&nbsp;en representación del grupo de Trabajo de la Sección de Neurociencias","doi":"10.1016/j.redar.2024.02.004","DOIUrl":"10.1016/j.redar.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population. The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity.</div></div><div><h3>Material and methods</h3><div>Prospective online survey conducted by the Neurosciences Section and distributed by SEDAR.</div></div><div><h3>Results</h3><div>544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed.</div></div><div><h3>Conclusions</h3><div>Among Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis debida a absceso hepático diagnosticada mediante ultrasonidos en la UCI","authors":"","doi":"10.1016/j.redar.2023.04.003","DOIUrl":"10.1016/j.redar.2023.04.003","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrecuencia del nervio supraescapular como estrategia analgésica para el dolor crónico de hombro. Revisión sistemática y metaanálisis","authors":"","doi":"10.1016/j.redar.2024.03.004","DOIUrl":"10.1016/j.redar.2024.03.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects.</div></div><div><h3>Methods</h3><div>We performed a systematic review of clinical trials retrieved from Medline, Embase and the cCentral databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I² test.</div></div><div><h3>Results</h3><div>We identified 3030 trials, of which 8 met the inclusion criteria (n<!--> <!-->=<!--> <!-->408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of −0.9 (95% CI: −1.1-0.33; <em>P</em>=.29; I² 88%; <em>P</em>&lt;.001) and −1.17 (95% CI: −2.49-0.14; <em>P</em>=.08; I² 97%; <em>P</em>&lt;.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of -0.31 (95% CI: −0.91-0.29; <em>P</em>=.31; I² 80%; <em>P</em>&lt;.001) and −1.54 (95% CI: −3.26-0.19; <em>P</em>=.08; I² 98%; <em>P</em>&lt;.001), respectively. No RFS-related adverse events were described.</div></div><div><h3>Conclusion</h3><div>The evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¿Por qué mi máquina de anestesia detecta halotano tras la administración de broncodilatadores? Un dato curioso","authors":"","doi":"10.1016/j.redar.2023.05.007","DOIUrl":"10.1016/j.redar.2023.05.007","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Un dolor de bolsillo: prevalencia de dolor en los pacientes con implantación de sistemas de neuromodulación: estudio retrospectivo","authors":"","doi":"10.1016/j.redar.2024.02.001","DOIUrl":"10.1016/j.redar.2024.02.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Implantable pulse generator (IPG) is a neurostimulation therapy mediated by electrodes and surgically implanted in a subcutaneous “pocket” used for the control of numerous pathologies. This study examines both the prevalence of pain associated with IPG implantation (“pain pocket syndrome”) and its associated characteristics.</div></div><div><h3>Materials and methods</h3><div>56 patients with an IPG were included in the study. A health questionnaire was conducted to determine the presence of pain associated with the pocket and its neuropathic characteristics, as well as associated aesthetic concerns, location, situations that accentuate or alleviate pain, medications used for baseline and pocket pain control and other factors associated.</div></div><div><h3>Results</h3><div>Pain in the area of implantation of the IPG had a prevalence of 52.6% of patients (n = 27), in our sample, with a mean score on the visual analogic scale (VAS) of 4.9 points [3.9 - 5.8 points], with neuropathic characteristics in 53.3% (n = 16) of the patients with pain, with differences between the mean VAS score of the female (5.5 [4.3 - 5.8 points]) and males (3.5 points [2.1 - 4.9 points]) <em>(P</em>=.04).</div></div><div><h3>Conclusion</h3><div>Pocket pain is a condition with a higher prevalence than described in previous studies, being of a higher intensity in females, involving a moderate pain in the area of implantation of the neuromodulating therapy. This pain has neuropathic characteristics and could require a repositioning intervention. Hence, more studies in this field should be carried to detect and prevent this syndrome.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforación traqueal tardía tras tiroidectomía total","authors":"","doi":"10.1016/j.redar.2023.04.004","DOIUrl":"10.1016/j.redar.2023.04.004","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139889987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxigenación por membrana extracorpórea veno-arterial (ECMO VA) como parte de un abordaje multimodal para protección de la isquemia medular en la reparación quirúrgica de un aneurisma toracoabdominal","authors":"F.E. Fernández-Suárez ,&nbsp;J.M. López-González ,&nbsp;C.M. Fernández-Vallina ,&nbsp;V. Cueva-Carril ,&nbsp;B.M. Jiménez Gómez ,&nbsp;J. García-Menéndez","doi":"10.1016/j.redar.2023.11.010","DOIUrl":"10.1016/j.redar.2023.11.010","url":null,"abstract":"<div><div>Spinal cord ischaemia leading to paraplegia or paraparesis is one of the most devastating complications of aortic surgery. The risk of ischaemia is particularly high in repairs involving both the thoracic and abdominal segments, because in these cases blood flow to the spinal arteries can be interrupted.</div><div>Multimodal protocols have now been developed to reduce the incidence of this complication, and include measures such as cerebrospinal fluid (CSF) drainage, avoidance of hypotension and anaemia, systemic hypothermia, neuromonitoring, maintaining distal perfusion during proximal clamping of the aorta, and reimplantation of intercostal or lumbar arteries, whenever feasible.</div><div>We describe a case in which, due to the special characteristics of the surgery, veno-arterial extracorporeal membrane oxygenation (VA ECMO) was used to maintain distal blood flow in the lumbar, inferior mesenteric, and hypogastric arteries during aortic clamping. This approach reduced the risk of spinal cord and visceral ischaemia, and also eliminated the need for thoracotomy because partial left bypass was not required.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitorización del índice biespectral para sedación en colonoscopias electivas de pacientes adultos: ensayo controlado aleatorizado","authors":"","doi":"10.1016/j.redar.2023.12.003","DOIUrl":"10.1016/j.redar.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy.</div></div><div><h3>Methods</h3><div>We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1)<!--> <!-->the BIS group or 2)<!--> <!-->a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and duration of colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction.</div></div><div><h3>Results</h3><div>Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; <em>P</em> <!-->=<!--> <!-->.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95%<!--> <!-->CI: 1.013-1.091; <em>P</em> <!-->=<!--> <!-->.0087) and in men (95%<!--> <!-->CI: 1.129-7.668; <em>P</em> <!-->=<!--> <!-->.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups.</div></div><div><h3>Conclusions</h3><div>Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manejo anestésico de banding de la arteria pulmonar en un paciente adulto con ventrículo único y transposición de grandes arterias no corregida","authors":"","doi":"10.1016/j.redar.2023.09.008","DOIUrl":"10.1016/j.redar.2023.09.008","url":null,"abstract":"<div><div>Pulmonary artery banding (PAB) is a procedure mainly performed during the neonatal period as an initial stage to definitive palliative reconstruction, a scenario in which the criteria for banding adjustment are well defined. However, the indication for BAP in the adult is extraordinarily rare, even more in patients with single ventricle and unrepaired transposition of the great arteries (TGA), and there are no established criteria for banding adjustment. Due to the small number of these procedures,</div><div>there is</div><div>limited experience in their anesthetic management and complications.</div><div>We describe a case of a 29-year-old patient diagnosed with a cyanotic congenital heart disease of double-inlet left ventricle with TGA and unrepaired mitral stenosis, who underwent to a hybrid procedure of PAB and enlargement of the communication between the two atria.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estrategia de manejo del dolor agudo posoperatorio en las Unidades de Cirugía Mayor Ambulatoria de España. Proyecto Directorio de Unidades de Cirugía Mayor Ambulatoria 2.0","authors":"","doi":"10.1016/j.redar.2024.02.005","DOIUrl":"10.1016/j.redar.2024.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain.</div></div><div><h3>Methods</h3><div>A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country.</div></div><div><h3>Results</h3><div>We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs.</div></div><div><h3>Conclusions</h3><div>The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}