Revista Espanola de Anestesiologia y Reanimacion最新文献

{"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":"71 9","pages":"Pages 698-699"},"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":"71 9","pages":"Pages 692-696"},"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":"71 9","pages":"Pages 633-644"},"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":"71 9","pages":"Pages 687-691"},"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":"71 9","pages":"Pages 670-677"},"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}

{"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":"71 9","pages":"Pages 652-659"},"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":"71 8","pages":"Pages 576-583"},"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":"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":"71 8","pages":"Pages 570-575"},"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":"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":"71 8","pages":"Pages 563-569"},"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":"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":"71 8","pages":"Pages 608-618"},"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}