Revista espanola de anestesiologia y reanimacion最新文献

{"title":"Perioperative anesthetic management and postoperative outcomes of patients treated with CyberKnife® robotic radiosurgery","authors":"D. Gallego González ,&nbsp;S. Ramírez Pulgarín ,&nbsp;K. Marisancén Carrasquilla ,&nbsp;Y.A. Colina Vargas ,&nbsp;C. Vera Marín ,&nbsp;L.F. Botero Posada","doi":"10.1016/j.redare.2024.501652","DOIUrl":"10.1016/j.redare.2024.501652","url":null,"abstract":"<div><h3>Background and objective</h3><div>The CyberKnife<strong>®</strong> is a robotic stereotactic radiosurgery system designed for non-invasive treatment of tumor lesions. Some of these procedures are performed under sedation or general anesthesia, depending on the patient and the lesion being treated. The objective of this study is to describe the anesthetic management and postoperative outcomes of patients treated with CyberKnife<strong>®</strong> radiosurgery at a reference center for neurosurgery in the city of Medellín, Colombia.</div></div><div><h3>Methods</h3><div>A descriptive, retrospective study was conducted on patients treated with CyberKnife<strong>®</strong> under sedation or general anesthesia between 2012 and 2022.</div></div><div><h3>Results</h3><div>75 patients were included, 56% of whom were female, with a median age of 59 years, primarily operated on for uveal melanomas (40%) and other tumor pathologies of the central nervous system; most frequently scheduled for a total of 5 radiosurgery sessions (66,7%), on an outpatient basis in 96% of cases. The main anesthetic technique used was balanced general anesthesia (76%) with sevoflurane, propofol, lidocaine, fentanyl. Neuromuscular relaxation was used in 58,7% of patients. Airway management was performed with a laryngeal mask in most cases (64%). The main minor side effects or complications identified were postoperative headache (22,7%), followed by intraoperative hypotension (18,7%) and bradycardia (16%). No major complications associated with anesthetic management were reported.</div></div><div><h3>Conclusions</h3><div>Balanced general anesthesia with neuromuscular relaxation was the main anesthetic technique used for CyberKnife® radiosurgery. Despite the logistical difficulties in this type of procedure, no major complications during the perioperative period were found.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501652"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857492","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":"Inorganic phosphorus as a predictor of postoperative low cardiac output syndrome in congenital heart disease surgery","authors":"M.A. Murillo-Pozo ,&nbsp;A.M. Vázquez-Florido ,&nbsp;A. Ortiz-Alvarez ,&nbsp;V. Modesto i Alapont ,&nbsp;A. González-Calle ,&nbsp;E. Sánchez-Valderrábanos","doi":"10.1016/j.redare.2025.501654","DOIUrl":"10.1016/j.redare.2025.501654","url":null,"abstract":"<div><h3>Background and objective</h3><div>Low cardiac output syndrome (LCOS) is the most common complication after cardiac surgery in children with congenital heart disease (CHD). The aim of this study was to assess the predictive value of serum inorganic phosphorus (SIPL) as an indicator of LCOS in the postoperative period.</div></div><div><h3>Materials and methods</h3><div>From June 2018 to December 2019, a single-center prospective study was conducted in patients with CHD undergoing surgery who required extracorporeal circulation (ECC). In the postoperative period, patients were divided into group 1 with LCOS and group 2 without LCOS. Blood samples were extracted in pre and postoperative periods. Serial measurements of SIPL, NT-proBNP, troponin T and creatinine were collected and compared between both groups. Multivariate analyses were conducted to identify the risk factors of SBGC.</div></div><div><h3>Results</h3><div>A total of 97 patients were included, with 31 in group 1 and 66 in group 2. There was an increment of SIPL which peaked at the 8-h postsurgery (5.3 mg/dL, 4.6–5.8). Postoperative median SIPL in the group 1 were significantly higher than in the group 2. All consecutive SIPL measurements also were significantly higher in group 1. Changes in SIPL over time approached statistical significance (<em>p</em> &lt; 0.001). Logistic regression analyses indicated that ECC (OR: 1.01; 95% CI: 0,9–1.01), SIPL (OR: 1.02; 95% CI: 1–1.04), NT-ProBNP (OR: 1; 95% CI; 1–1.0) were the independent risk factors of LCOS.</div></div><div><h3>Conclusions</h3><div>The increase in SIPL was more pronounced in LCOS group 1. SIPL emerged as a new predictive risk factors of LCOS.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501654"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026230","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":"Gastric POCUS, an emergent tool in the assessment of perioperative fasting: Narrative review","authors":"C. Juliá-Romero,&nbsp;C. Palau-Martí,&nbsp;A. Tejedor-Bosqued","doi":"10.1016/j.redare.2024.501655","DOIUrl":"10.1016/j.redare.2024.501655","url":null,"abstract":"<div><div>Pulmonary aspiration during anaesthesia induction is a serious adverse event that can lead to catastrophic consequences for the patient, including death. Preoperative fasting has so been assessed on the basis of the clinical history and fasting schedules recommended by clinical guidelines. This assessment is not objective, since the presence or absence of gastric contents cannot be guaranteed. Gastric point of care ultrasound (POCUS) is an objective, simple, and rapid method for assessing fasting prior to anaesthesia induction that stratifies risk and aids in decision-making. The aim of this review is to summarize the existing literature on gastric POCUS in the assessment of preoperative fasting. For this purpose, the Pubmed and Embase were searched for relevant studies published between 2014 and 2024.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501655"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866814","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":"Intraoperative goal-directed hemodynamic therapy targeting both arterial pressure and flow parameters using uncalibrated pulse contour techniques: A meta-analysis of randomized controlled trials","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;A. Abad-Gurumeta ,&nbsp;M.I. Monge-García","doi":"10.1016/j.redare.2024.501653","DOIUrl":"10.1016/j.redare.2024.501653","url":null,"abstract":"<div><h3>Background</h3><div>Goal-directed haemodynamic therapy (GDHT) aims to optimize haemodynamic variables. However, its effectiveness in reducing postoperative complications in major abdominal surgery, particularly when targeting both arterial pressure and flow variables, remains unclear. This meta-analysis addresses this by evaluating GDHT using uncalibrated pulse contour (uPC) methods.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) in adult patients undergoing major abdominal surgery who received GDHT using uncalibrated pulse contour (uPC) methods for cardiac output monitoring, with predefined targets for both blood flow and blood pressure. The primary outcome was postoperative complications; secondary outcomes included postoperative acute kidney injury (AKI), hospital length of stay (EH), intraoperative fluid administration and mortality.</div></div><div><h3>Results</h3><div>Initial search retrieved 860 reports, with 12 RCTs (1367 patients) meeting the inclusion criteria. Our meta-analysis showed a significant reduction in postoperative complications (RR 0.78, 95% CI 0.68–0.90), AKI (RR 0.7, 95% CI 0.51–0.97), and hospital LOS (SMD −0.30, 95% CI −0.54 to −0.06) with uPC-guided GDHT. No significant differences were observed in intraoperative fluid volume and mortality.</div></div><div><h3>Conclusions</h3><div>Implementing GDHT in major abdominal surgery with predefined arterial pressure and blood flow targets significantly reduces postoperative morbidity and hospital EH without increasing intraoperative fluid administration.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501653"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873768","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":"Patient Blood Management: A conceptual and analytical vision from the leadership in Spain","authors":"E. Méndez-Arias ,&nbsp;A. Abad-Motos ,&nbsp;M. Barquero-López ,&nbsp;R. Delestal Aldaria ,&nbsp;Á.M. Muñoz de Solano Palacios ,&nbsp;A. Pajares ,&nbsp;S. Aguilar López ,&nbsp;I. Fornet ,&nbsp;M. Quintana-Díaz ,&nbsp;G. Yanes ,&nbsp;M.J. Colomina","doi":"10.1016/j.redare.2024.501650","DOIUrl":"10.1016/j.redare.2024.501650","url":null,"abstract":"<div><div>The evolution of blood saving programs to Patient Blood Management (PBM) represents a broader and more comprehensive approach to optimize the use of the patient's own blood, thus improving clinical outcomes and minimizing the risks associated with allogeneic blood transfusion with a holistic view of socio-economic sustainability.</div><div>Implementing the strategies of the three PBM pillars in any hospital center involves a transversal change throughout the organization in which it can be very useful to apply the strategy defined by Kotter at the business level for change management.</div><div>The support of renowned institutions such as the World Health Organization and the European Commission demonstrates the importance and urgency of implementing PBM programs, setting guidelines at an international level and supporting the adoption of effective strategies in the management of blood transfusion at a national and institutional level.</div><div>In Spain, we need to have health managers at both the Hospital Management level and the Regional Health Services and/or Ministry of Health that provide the necessary resources for its proper implementation in the health system from primary care to hospital care and also the resources for the timely evaluation of the results.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501650"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873770","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":"Perioperative anemia: Protocols and guidelines to facilitate the appropriate approach","authors":"S. Aragón Álvarez ,&nbsp;E. Bisbe Vives","doi":"10.1016/j.redare.2025.501725","DOIUrl":"10.1016/j.redare.2025.501725","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501725"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442973","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":"Patient blood management: it's now or never!","authors":"C. Jericó ,&nbsp;J.A. García Erce","doi":"10.1016/j.redare.2025.501752","DOIUrl":"10.1016/j.redare.2025.501752","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501752"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426885","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":"Pneumocephalus following a combined spinal-epidural technique: a case report","authors":"I. Martins de Carvalho,&nbsp;P. Costa Antunes,&nbsp;A. Nunes Miranda,&nbsp;J. Marques Vinagre","doi":"10.1016/j.redare.2024.101628","DOIUrl":"10.1016/j.redare.2024.101628","url":null,"abstract":"<div><div>Pneumocephalus refers to the presence of air within the intracranial cavity, and albeit its occurrence following neuraxial techniques is rare, it is commonly associated with a loss of resistance to air technique.</div><div>This case report describes a parturient who underwent neuraxial analgesia for pain management during labour. Epidural space identification with loss of resistance to saline technique was used and she went on to develop a symptomatic pneumocephalus.</div><div>The pneumocephalus had an atypical presentation without immediate headache but with a sudden change in consciousness, likely due to an increase in intracranial pressure following migration of air into the intracranial cavity through the ventricular system.</div><div>Although in most cases it is benign, asymptomatic, and self-limiting, early diagnosis is helpful as treatment with supplemental oxygen can speed recovery. In this case, due to its atypical and sudden presentation, supportive treatment was essential for the prognosis of both mother and baby.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 101628"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873772","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":"Difficult airway due to multiple sclerotic fibromas in a patient with Cowden’s syndrome","authors":"G. Ballout,&nbsp;R. Berge Ramos,&nbsp;L. Gómez-López,&nbsp;M. López-Baamonde","doi":"10.1016/j.redare.2024.101622","DOIUrl":"10.1016/j.redare.2024.101622","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 101622"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873719","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":"Perioperative transfusion management in craniotomies: A national survey, a starting point for the evaluation of improvements in health care","authors":"P. Hurtado ,&nbsp;M. Garcia-Orellana ,&nbsp;A. Martinez-Simon ,&nbsp;G. Pujol-Fontrodona ,&nbsp;E. Méndez ,&nbsp;P. Doménech-Asensi ,&nbsp;A. Pajares ,&nbsp;A. López-Gómez ,&nbsp;L. Valencia ,&nbsp;M.J. Colomina ,&nbsp;J. Fernández-Candil ,&nbsp;Grupo de trabajo de Neurociencias y Hemostasia, Medicina Transfusional y Fluidoterapia de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR)","doi":"10.1016/j.redare.2024.501661","DOIUrl":"10.1016/j.redare.2024.501661","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the perioperative management of haemostasis and transfusion practices in adult patients undergoing craniotomies.</div></div><div><h3>Method</h3><div>Online questionnaire addressed to Spanish anaesthesiologists and promoted by the Neurosciences and Haemostasis, Transfusion Medicine and Fluid Therapy Sections of SEDAR. The questionnaire was sent by email and social media, and was active between June and October 2022.</div></div><div><h3>Results</h3><div>We obtained 155 responses from 67 centres; 59.4% perform &gt;100 craniotomies per year. 61.7% were regularly involved in neuroanaesthesiology. Only 21.9% of respondents had pre-anaesthesia assessment performed by a member of that section, and in most of them (83.0%) the assessment was performed ≤3 weeks in advance. Of the respondents with Patient Blood Management programmes, 58.2% had no specific protocols for craniotomies. 90.3% reported that haemoconcentrates are systematically reserved. A lower platelet limit of 100,000/µL is considered acceptable by 76.8%. 99.4% of respondents discontinued antiplatelet medication based on half-life. Only 23.9% respondents routinely discontinued non-steroidal anti-inflammatory drugs. The transfusion threshold for haemoglobin during surgical bleeding was &lt;10 g/dL in 18.7%, &lt;9 g/dL in 38.1%, &lt;8 g/dL in 38.7% and &lt;7 g/dL in 4.5%.</div></div><div><h3>Conclusions</h3><div>Preoperative anaemia screening and treatment programmes are not implemented and blood product reserves are systematised in patients scheduled for craniotomy. Anti-aggregation therapy is discontinued according to the half-life of the drug without checking platelet functionality.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 3","pages":"Article 501661"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873771","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}