Revista Espanola de Anestesiologia y Reanimacion最新文献

{"title":"Lavado pulmonar total bilateral bajo soporte con membrana de oxigenación extracorpórea veno-venosa en un caso de proteinosis alveolar grave","authors":"","doi":"10.1016/j.redar.2023.07.005","DOIUrl":"10.1016/j.redar.2023.07.005","url":null,"abstract":"<div><p>We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48 hours. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 7","pages":"Pages 549-552"},"PeriodicalIF":0.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189542","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":"Masa intracardíaca","authors":"J. Llau García,&nbsp;J. Moreno Pachón,&nbsp;E. Mateo Rodríguez,&nbsp;J. de Andrés Ibáñez","doi":"10.1016/j.redar.2023.02.004","DOIUrl":"10.1016/j.redar.2023.02.004","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 499-500"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135349189","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":"Diseños de formación en anestesia en Europa: estudio basado en una encuesta realizado por el comité de residentes de la European Society of Anaesthesiology and Intensive Care (ESAIC)","authors":"I. Abramovich ,&nbsp;I. Crisan ,&nbsp;D. Sobreira Fernandes ,&nbsp;S. De Hert ,&nbsp;A. Lukic ,&nbsp;G. Norte ,&nbsp;B. Matias ,&nbsp;M. Majić ,&nbsp;J. Berger-Estilita","doi":"10.1016/j.redar.2023.08.005","DOIUrl":"10.1016/j.redar.2023.08.005","url":null,"abstract":"<div><h3>Background</h3><p>Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe.</p></div><div><h3>Methods</h3><p>Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives.</p></div><div><h3>Results</h3><p>Forty-three anaesthesiologists from the 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n<!--> <!-->=<!--> <!-->23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK.</p></div><div><h3>Conclusion</h3><p>This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 427-437"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792606","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":"Presión media de la vía aérea: ¿parámetro integrador de ventilación pulmonar y circulatoria protectoras?","authors":"A. Placenti,&nbsp;F. Fratebianchi","doi":"10.1016/j.redar.2024.01.006","DOIUrl":"10.1016/j.redar.2024.01.006","url":null,"abstract":"<div><p>Mean airway pressure (MAP) is the mean pressure generated in the airway during a single breath (inspiration<!--> <!-->+<!--> <!-->expiration), and is displayed on most anaesthesia and intensive care ventilators. This parameter, however, is not usually monitored during mechanical ventilation because it is poorly understood and usually only used in research. One of the main determinants of MAP is PEEP. This is because in respiratory cycles with an I:E ratio of 1:2, expiration is twice as long as inspiration. Although MAP can be used as a surrogate for mean alveolar pressure, these parameters differ considerably in some situations. Recently, MAP has been shown to be a useful prognostic factor for respiratory morbidity and mortality in mechanically ventilated patients of various ages. Low MAP has been associated with a lower incidence of 90-day mortality, shorter ICU stay, and shorter mechanical ventilation time. MAP also affects haemodynamics: there is evidence of a causal relationship between high MAP and low perfusion index, both of which are associated with poor prognosis in mechanically ventilated patients. Elevated MAP values have also been associated with high central venous pressure and lactate, which are indicative of ventilator-associated right ventricular failure and tissue hypoperfusion, respectively. MAP, therefore, is an important parameter to measure in clinical practice. The aim of this review has been to identify the determinants of MAP, the pros and cons of using MAP instead of traditional protective ventilation parameters, and the evidence that supports the use of MAP in clinical practice.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 466-478"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405234","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 de la anemia periquirúrgica en cirugía electiva. Conclusiones y recomendaciones según metodología Delphi-UCLA","authors":"V. Moral ,&nbsp;A. Abad Motos ,&nbsp;C. Jericó ,&nbsp;M.L. Antelo Caamaño ,&nbsp;J. Ripollés Melchor ,&nbsp;E. Bisbe Vives ,&nbsp;J.A. García Erce ,&nbsp;en nombre del Panel de expertos seleccionado para la realización del ejercicio Delphi","doi":"10.1016/j.redar.2023.11.008","DOIUrl":"10.1016/j.redar.2023.11.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Preoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The «Patient Blood Management» (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;To make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;p&gt;A coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety.&lt;/p&gt;&lt;p&gt;Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants).&lt;/p&gt;&lt;p&gt;In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14).&lt;/p&gt;&lt;p&gt;The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants’ comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations.&lt;/p&gt;&lt;p&gt;Stati","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 454-465"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0034935624000215/pdfft?md5=baf9801d6052151a9b4cd98809bab99d&pid=1-s2.0-S0034935624000215-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465023","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":"Neumorraquis extradural extenso relacionado con analgesia obstétrica","authors":"M.J. Garcia-Cebrián ,&nbsp;I.M. Fontan-Atalaya ,&nbsp;J. Garcia-Perez ,&nbsp;B. Fernandez-Torres","doi":"10.1016/j.redar.2023.04.001","DOIUrl":"10.1016/j.redar.2023.04.001","url":null,"abstract":"<div><p>Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia. We describe a very extensive extradural pneumorrachisis (T9-S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symptomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 491-495"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918635","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":"Nuevo logotipo de la «Societat Catalana d’Anestesiologia, Reanimació i Terapèutica del Dolor», tras 70 años de historia","authors":"X. Sala-Blanch ,&nbsp;C. Morros ,&nbsp;R. Adalia ,&nbsp;M. Bausili","doi":"10.1016/j.redar.2023.11.005","DOIUrl":"10.1016/j.redar.2023.11.005","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 497-498"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465313","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":"Antes de culpar a la cirugía lumbar de un neumoencéfalo deben descartarse completamente las causas alternativas","authors":"J. Finsterer","doi":"10.1016/j.redar.2023.06.001","DOIUrl":"10.1016/j.redar.2023.06.001","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 496-497"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139825250","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":"Impacto de la coadministración de 10 mg/kg de cloruro cálcico y neostigmina en el tiempo de extubación: ensayo controlado aleatorizado","authors":"S. Elkenany,&nbsp;M.M. Alseoudy,&nbsp;M.E. Elshehawi,&nbsp;S. Bakrey,&nbsp;M. Aboelela","doi":"10.1016/j.redar.2023.10.003","DOIUrl":"10.1016/j.redar.2023.10.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Some studies investigating the effect of calcium on neostigmine-induced recovery of neuromuscular blockade have shown that this combination promotes neuromuscular recovery, but does not significantly affect the incidence of postoperative residual curarization and time to extubation. This study aimed to evaluate the effects of 10<!--> <!-->mg/kg calcium chloride co-administered with neostigmine on early recovery and time to extubation.</p></div><div><h3>Patients and methods</h3><p>This prospective, randomized, double-blinded, placebo-controlled study included 88 ASA I–II patients aged between 18 and 65 years who were scheduled for elective surgery lasting at least 1 hour under general anaesthesia in which 10<!--> <!-->mg/kg of calcium chloride or the same volume of normal saline was co-administered with 5<!--> <!-->μg/kg of neostigmine at the end of surgery. Time to extubation (time from neostigmine administration to extubation), time from neostigmine administration to TOF ratio (TOFr) 0.9 (neuromuscular recovery), and the incidence of residual neuromuscular blockade (RNMB) and other adverse effects were recorded.</p></div><div><h3>Results</h3><p>Median (Q1, Q3) extubation time was significantly shorter in the calcium group vs. the placebo group (6.5<!--> <!-->min [5.52-7.43] vs. 9.78<!--> <!-->min [8.35-11]), <em>P</em>&lt;.001. Median neuromuscular recovery time in the calcium group was 5<!--> <!-->min vs. 7.1<!--> <!-->min in the placebo group, <em>P</em>&lt;.001. Patients in the calcium group had significantly higher TOFr and lower incidence of RNMB at 5 and 10<!--> <!-->minutes vs. the placebo group, and no significant side effects.</p></div><div><h3>Conclusion</h3><p>Calcium chloride at a dose of 10<!--> <!-->mg/kg co-administered with neostigmine promotes early neuromuscular recovery and reduces time to extubation by about 32%.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 438-444"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402842","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":"Fundamento y diseño del estudio para una estrategia ventilatoria de pulmón abierto perioperatoria individualizada en laparotomía/laparoscopia abdominal urgente (iPROVE): protocolo del estudio para ensayo controlado aleatorizado prospectivo internacional","authors":"G. Laguna ,&nbsp;F. Suárez-Sipmann ,&nbsp;G. Tusman ,&nbsp;J. Ripollés ,&nbsp;O. Díaz-Cambronero ,&nbsp;R. Pujol ,&nbsp;E. Rivas ,&nbsp;I. Garutti ,&nbsp;R. Mellado ,&nbsp;J. Vallverdú ,&nbsp;A. Jacas ,&nbsp;A. Fervienza ,&nbsp;R. Marrero ,&nbsp;J. Librero ,&nbsp;J. Villar ,&nbsp;C. Ferrando","doi":"10.1016/j.redar.2023.11.003","DOIUrl":"10.1016/j.redar.2023.11.003","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative pulmonary complications (PPCs) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse.</p></div><div><h3>Methods</h3><p>Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH₂O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis.</p></div><div><h3>Discussion</h3><p>The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.</p></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"71 6","pages":"Pages 445-453"},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769276","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}