Revista Espanola de Anestesiologia y Reanimacion最新文献

{"title":"Terapia hemodinámica guiada por objetivos mediante la administración de líquidos para optimizar el volumen sistólico: metaanálisis de ensayos controlados aleatorizados","authors":"J. Ripollés-Melchor ,&nbsp;Á.V. Espinosa ,&nbsp;P. Fernández-Valdes-Bango ,&nbsp;R. Navarro-Pérez ,&nbsp;A. Abad-Motos ,&nbsp;J.V. Lorente ,&nbsp;M.J. Colomina ,&nbsp;E. Sáez-Ruiz ,&nbsp;A. Abad-Gurumeta ,&nbsp;M.I. Monge-García","doi":"10.1016/j.redar.2024.04.004","DOIUrl":"10.1016/j.redar.2024.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical impact of optimizing stroke volume (SV) through fluid administration as part of goal-directed hemodynamic therapy (GDHT) in adult patients undergoing elective major abdominal surgery.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO database in January 2024. The intervention was defined as intraoperative GDHT based on the optimization or maximization of SV through fluid challenges, or by using dynamic indices of fluid responsiveness, including stroke volume variation, pulse pressure variation, and plethysmography variation index compared to usual fluid management. The primary outcome was postoperative complications. Secondary outcome variables included postoperative acute kidney injury (AKI), length of stay (LOS), intraoperative fluid administration, and 30-day mortality.</div></div><div><h3>Results</h3><div>A total of 29 randomized controlled trials (RCTs) met the inclusion criteria. There were no significant differences in the incidence of postoperative complications (RR 0.89; 95% CI, 0.78 to 1.00), postoperative AKI (OR 0.97; (95% IC, 0.55 to 1.70), and mortality (OR 0.80; 95% CI, 0.50 to 1.29). GDHT was associated with a reduced LOS compared to usual care (SMD: −0.17 [−0.32; - 0.03]). The subgroup in which hydroxyethyl starch was used for hemodynamic optimization was associated with fewer complications (RR 0.79; 95% CI, 0.65 to 0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04 to 1.12).</div></div><div><h3>Conclusions</h3><div>In adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 719-731"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851595","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":"Brote de policondritis recurrente con afectación grave del árbol traqueobronquial en una mujer embarazada con preeclampsia y criterios de gravedad. Manejo anestésico","authors":"E. Sarrió Badenes ,&nbsp;M. Durá Aranda ,&nbsp;L. Molero Sala ,&nbsp;P. Martín Serrano","doi":"10.1016/j.redar.2023.05.012","DOIUrl":"10.1016/j.redar.2023.05.012","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 760-761"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539728","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":"Encuesta Nacional sobre la Práctica Clínica en Analgesia Obstétrica en España","authors":"L. Hernández González ,&nbsp;N. Brogly ,&nbsp;S. Manrique Muñoz ,&nbsp;C. Suárez Castaño ,&nbsp;G. Yerga Pozo ,&nbsp;M. Raynard Ortiz ,&nbsp;E. Guasch Arévalo","doi":"10.1016/j.redar.2024.07.001","DOIUrl":"10.1016/j.redar.2024.07.001","url":null,"abstract":"<div><h3>Introduction</h3><div>A national survey was conducted among maternity hospitals nationwide to understand the variability in clinical practice for obstetric analgesia and to reach a consensus on optimal care in the future in Spain.</div></div><div><h3>Materials and methods</h3><div>Spanish experts in obstetric anesthesiology designed a survey on the practice of obstetric analgesia during childbirth, following a Delphi process. The survey was sent to 195 Spanish maternity hospitals between April and September 2022 using Google Forms. A descriptive study of the results was performed.</div></div><div><h3>Results</h3><div>Responses were obtained from 108 centers (55.4%), of which 88 (83.8%) were public hospitals. The most commonly used technique was epidural analgesia in 97 (92.4%) centers. Nine (8.6%) centers used the combined spinal-epidural (CSE) technique, 5 (4.8%) used spinal analgesia, and 3 (2.9%) used dural puncture epidural (DPE) analgesia. The most commonly used local anesthetic was levobupivacaine 0.1-0.25% in 82 (78.1%) centers. Fentanyl or sufentanil were added to the local anesthetic in 96 (91.4%) centers. Epidural maintenance was performed with continuous epidural infusion (CEI) + patient-controlled epidural analgesia (PCEA) or programmed intermittent epidural bolus (PIEB) + PCEA in 64 (60.9%) and 33 (30.5%) centers, respectively. Fifteen (14.3%) centers lacked alternative techniques to epidural analgesia and 25 (23.8%) did not follow obstetric analgesia protocols.</div></div><div><h3>Conclusion</h3><div>Despite the variability in clinical practice for obstetric analgesia in Spain, the vast majority of centers follow recommendations in this field. There is room for improvement, which should be considered a fundamental strategy for progressing towards excellence.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 732-739"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758772","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":"Pruebas de hemostasia preoperatorias: una revisión narrativa de las guías existentes","authors":"J.L. Jover Pinillos ,&nbsp;R. Ferrandis Comes ,&nbsp;D. Zamudio Penko ,&nbsp;M. Bermúdez López ,&nbsp;M. Basora Macaya ,&nbsp;Maria J. Colomina","doi":"10.1016/j.redar.2024.06.002","DOIUrl":"10.1016/j.redar.2024.06.002","url":null,"abstract":"<div><h3><em>Introduction</em></h3><div>Hemostasis tests are traditionally requested for all patients requiring any surgical act or invasive diagnostic-therapeutic procedure to prevent hemorrhagic complications. The aim of this study is to assess the necessity of requesting standard pre-procedure hemostasis tests.</div></div><div><h3><em>Material and methods</em></h3><div>A narrative literature review was conducted using the PubMed database. Search terms included «Hemostasis» or «Blood coagulation» in combination with «Preoperative care», «Preoperative period», or «Preoperative procedure». Additionally, a targeted search was performed to find recommendations from international societies related to the topic.</div></div><div><h3><em>Results</em></h3><div>A total of 233 articles were found, 17 were pre-selected, and after full-text evaluation, 14 relevant articles were identified. The targeted search yielded an additional 12 articles. The request for tests should be individualized according to the clinical history. Standardized screening questionnaires for hemostasis disorders are useful and complement the aforementioned approach. Factors such as age, ASA classification, bleeding potential-complexity of the procedure, and anesthetic technique may influence their request.</div></div><div><h3><em>Discussion</em></h3><div>The incidence of hemostasis disorders in the general population is very low, and these can mostly be detected through clinical history. Thus, it is the clinical history that should guide the need for laboratory test requests.</div></div><div><h3><em>Conclusions</em></h3><div>Preoperative hemostasis tests should not be indiscriminately requested for all patients needing an intervention or invasive diagnostic-therapeutic procedure, but rather when there are doubts about their hemostatic competence or as advised by the nature of the procedure they are undergoing.</div><div>invasivo. e hemostasia preoperat a cialquier der a la pregunta de que si es preceptivo solicitar pruebas de hemostasia preoperat</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 740-747"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758773","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":"Recomendaciones del Grupo de Trabajo de la Consulta de Preanestesia Digitalizada","authors":"A. Aroca Tanarro ,&nbsp;R. Casans Francés ,&nbsp;M.Á. Gómez-Ríos ,&nbsp;E. Mendez Arias ,&nbsp;M. Otero Pérez ,&nbsp;L. Quecedo Gutierrez ,&nbsp;V. Rojas Pernia ,&nbsp;A. Abad Gurumeta","doi":"10.1016/j.redar.2024.03.007","DOIUrl":"10.1016/j.redar.2024.03.007","url":null,"abstract":"<div><div>The main objectives of the pre-anaesthesia consultation are to establish the patient's anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies, e-Health, has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit.</div><div>The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Pages 701-709"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758766","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":"Intubación transorbitaria en una paciente con vía aérea difícil por cirugía previa","authors":"M.E. Navio Poussivert,&nbsp;A. Martinez-Garcia,&nbsp;M.I. de la Rosa Jimenez","doi":"10.1016/j.redar.2023.05.011","DOIUrl":"10.1016/j.redar.2023.05.011","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 10","pages":"Page 772"},"PeriodicalIF":0.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638140","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":"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":"71 9","pages":"Pages 660-669"},"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":"71 9","pages":"Page 697"},"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":"71 9","pages":"Pages 678-686"},"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":"71 9","pages":"Page 700"},"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}