Revista Espanola de Anestesiologia y Reanimacion最新文献

{"title":"Comparación de la administración intranasal de dexmedetomidina y ketamina para premedicación pediátrica: estudio aleatorizado","authors":"","doi":"10.1016/j.redar.2024.02.003","DOIUrl":"10.1016/j.redar.2024.02.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Paediatric patients are given premedication to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child-friendly method of administration is therefore needed.</div><div>We administered the Faces, Legs, Activity, Cry and Consolability (FLACC) scale in patients receiving intranasal dexmedetomidine and ketamine to compare their reactions to insertion of a catheter for induction of general anaesthesia in the operating room.</div></div><div><h3>Methods</h3><div>This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 and 2, scheduled for general anaesthesia were enrolled. Presedation behaviour was assessed using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received ketamine 5<!--> <!-->mg/kg intranasally. After 45<!--> <!-->minutes, patients were transferred to the operating table where intravenous cannulation was performed and patient response to needle insertion was assessed using the FLACC scale. Vital signs, including heart rate, respiratory rate, and blood oxygen levels were monitored. Side effects such as náusea, vomiting, and agitation were also recorded.</div></div><div><h3>Results</h3><div>The FLACC score was significantly higher in Group D vs. Group K <em>(P</em>=.001). Mean heart rate was significantly <em>(P</em>=.001) lower in Group D vs. Group K. However, adverse events occurred in 8% of patients who received ketamine.</div></div><div><h3>Conclusions</h3><div>Intranasal ketamine at a dose of 5<!--> <!-->mg/kg is clinically more effective for premedication in children aged 2-10 years compared with intranasal dexmedetomidine at a dose of 1 mcg/kg.</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":"141052484","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":"Estudio comparativo entre el bloqueo costoclavicular con inyección simple (con técnica corner pocket) y con doble inyección: ensayo aleatorizado de no inferioridad y de brazos paralelos","authors":"","doi":"10.1016/j.redar.2023.08.008","DOIUrl":"10.1016/j.redar.2023.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown that ultrasound-guided costoclavicular block may require a double shot to provide adequate, rapid sensory and motor blockade. In this trial, we hypothesized that if the corner pocket approach (between the axillary artery and median cord) is used instead of the central approach (at the midpoint of the 3 cords) when performing single-shot costoclavicular block, the onset of blockade would be non-inferior to the double-shot technique.</div></div><div><h3>Method</h3><div>Ninety patients undergoing upper limb surgery were randomized to 2 groups for ultrasound-guided costoclavicular block (CCB) at a tertiary hospital. One group received ultrasound guided single-shot CCB using the corner pocket approach and other received ultrasound guided double-shot – the first shot at the centre of the 3 cords and the second between the axillary artery and the median cord. An observer blinded to group assignment recorded blockade onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points).</div></div><div><h3>Results</h3><div>Of the 101 patients assessed for eligibility, 90 were recruited over 1 year (February 2022 to January 2023), with 45 in each group. Onset time was 22.1±3.1 min in the single-shot group and 22.4±2.9 min in the double-shot group. This difference was insignificant (p=0.3).</div></div><div><h3>Conclusion</h3><div>Time to onset of blockade and full anaesthesia are similar in single-shot corner pocket CCB and double-shot CCB. Further studies are required to determine the minimum effective volume of local anaesthetic required for the described technique.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402623","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":"Modelos de aprendizaje automático basados en ecografía y exploración física para la evaluación de la vía aérea","authors":"","doi":"10.1016/j.redar.2023.12.002","DOIUrl":"10.1016/j.redar.2023.12.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters.</div></div><div><h3>Methods</h3><div>This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values.</div></div><div><h3>Results</h3><div>We recruited 400 patients. Cormack-Lehanne patients ≥<!--> <!-->III had higher age, BMI, cervical circumference, Mallampati class membership ≥<!--> <!-->III, and bite test ≥<!--> <!-->II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the «Classic Model» achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models.</div></div><div><h3>Conclusions</h3><div>The use of machine learning models for diagnosing difficult airways is a real possibility, although it is still in a very preliminary stage of development.</div></div><div><h3>Clinical Registry</h3><div>ClinicalTrials.gov: <span><span>NCT04816435</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465188","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":"Protocolo de un ensayo clínico sobre la efectividad del bloqueo del nervio pudendo con y sin neuroestimulación para la disminución del dolor posthemorroidectomía","authors":"A. Soto Sánchez ,&nbsp;O. Cano Valderrama ,&nbsp;I. Vilela Ferrer ,&nbsp;N. Díaz Jiménez ,&nbsp;M. Hernández Barroso ,&nbsp;P.L. Bravo García ,&nbsp;G. Hernández Hernández ,&nbsp;J.J. Balanzá","doi":"10.1016/j.redar.2023.11.009","DOIUrl":"10.1016/j.redar.2023.11.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48<!--> <!-->hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24<!--> <!-->h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation.</div></div><div><h3>Methods</h3><div>The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected.</div></div><div><h3>Results</h3><div>Not avaliable until the end of the study.</div></div><div><h3>Conclusions</h3><div>The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425394","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":"Bloqueo del ganglio impar para el dolor crónico relacionado con el cáncer: revisión de la literatura actual","authors":"J. Oliveira ,&nbsp;G. Bem ,&nbsp;A. Agrelo","doi":"10.1016/j.redar.2024.01.004","DOIUrl":"10.1016/j.redar.2024.01.004","url":null,"abstract":"<div><div>Oncologic chronic pain is often difficult to control, especially in anatomical areas with multiple and complex innervation, such as the pelvic/perineal region. The ganglion impar block (GIB) is a procedure with growing interest and varied applicability. It has been used in several benign and malignant causes of pelvic and perineal pain refractory to pharmacological treatment. We conducted a review of all articles published in PUBMED® until the 30th of October 2022 regarding GIB in oncologic pain. 19 articles were identified with a total of 278 patients. Both chronic cancer pain and chronic postcancer treatment pain patients were included. We reviewed the various techniques, approaches, and therapeutic options that were employed. No serious adverse effects were reported. GIB appears to be an effective and safe procedure that should be considered in patients with intractable perineal cancer-related pain.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425061","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":"Factores de riesgo para PPC en cirugía abdominal laparoscópica no robótica frente a la laparoscópica robótica (LapRas): Razonamiento y protocolo mediante un análisis a nivel de paciente de LAS VEGAS y AVATaR","authors":"","doi":"10.1016/j.redar.2024.01.008","DOIUrl":"10.1016/j.redar.2024.01.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative pulmonary complications (PPC) vary in different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non-robotic versus laparoscopic robotic abdominal surgery.</div></div><div><h3>Methods and analysis</h3><div>LapRas (Risk Factors for PPCs in Laparoscopic Non-Robotic vs Laparoscopic Robotic Abdominal Surgery) analyses harmonized data from two observational studies on abdominal surgery patients and PPCs: Local ASsessment of VEntilatory management during General Anaesthesia for Surgery (LAS VEGAS), and Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR). The primary endpoint is the occurrence of one or more PPC within the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay, and in-hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the groups are driven by differences in duration of anaesthesia and/or the intensity of mechanical ventilation.</div></div><div><h3>Ethics and dissemination</h3><div>This analysis will address a clinically relevant research question by comparing laparoscopic and robotic surgery. No additional ethical committee approval is required for this meta-analysis. Data will be shared with the scientific community in the form of abstracts and original articles submitted to peer-reviewed journals.</div></div><div><h3>Registration</h3><div>The registration of this post-hoc analysis is pending; individual studies that were merged into the study database were registered at clinicaltrials.gov: LAS VEGAS with identifier <span><span>NCT01601223</span><svg><path></path></svg></span>, AVATaR with identifier <span><span>NCT02989415</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abordaje transcava para inserción de endoprótesis aórtica. Un nuevo reto anestésico","authors":"","doi":"10.1016/j.redar.2023.09.006","DOIUrl":"10.1016/j.redar.2023.09.006","url":null,"abstract":"<div><div>The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach.</div><div>The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence.</div><div>We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140464787","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":"Uso de cannabinoides en el dolor agudo posoperatorio","authors":"","doi":"10.1016/j.redar.2023.11.004","DOIUrl":"10.1016/j.redar.2023.11.004","url":null,"abstract":"<div><div>Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases. The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain.</div><div>The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions. Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966335","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":"Fracaso de la extubación: obstrucción de la vía aérea superior por chicle. Informe de un caso","authors":"","doi":"10.1016/j.redar.2023.11.001","DOIUrl":"10.1016/j.redar.2023.11.001","url":null,"abstract":"<div><div>Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139886169","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":"Aneurisma del seno de Valsalva causante de cierre espontáneo de defecto del tabique ventricular congénito","authors":"","doi":"10.1016/j.redar.2023.03.009","DOIUrl":"10.1016/j.redar.2023.03.009","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019993","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}