Revista espanola de anestesiologia y reanimacion最新文献

{"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, Á V Espinosa, P Fernández-Valdes-Bango, R Navarro-Pérez, A Abad-Motos, J V Lorente, M J Colomina, A Abad-Gurumeta, M I Monge-García","doi":"10.1016/j.redare.2024.501653","DOIUrl":"https://doi.org/10.1016/j.redare.2024.501653","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"501653"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","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, A Abad-Motos, M Barquero-López, R Delestal Aldaria, Á M Muñoz de Solano Palacios, A Pajares, S Aguilar López, I Fornet, M Quintana-Díaz, G Yanes, M J Colomina","doi":"10.1016/j.redare.2024.501650","DOIUrl":"https://doi.org/10.1016/j.redare.2024.501650","url":null,"abstract":"<p><p>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. 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. 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. 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.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"501650"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","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":"","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, C Palau-Martí, A Tejedor-Bosqued","doi":"10.1016/j.redare.2024.501655","DOIUrl":"https://doi.org/10.1016/j.redare.2024.501655","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"501655"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","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":"Perioperative anesthetic management and postoperative outcomes of patients treated with CyberKnife® robotic radiosurgery.","authors":"D Gallego González, S Ramírez Pulgarín, K Marisancén Carrasquilla, Y A Colina Vargas, C Vera Marín, L F Botero Posada","doi":"10.1016/j.redare.2024.501652","DOIUrl":"https://doi.org/10.1016/j.redare.2024.501652","url":null,"abstract":"<p><strong>Background and objective: </strong>The CyberKnife® 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® radiosurgery at a reference center for neurosurgery in the city of Medellín, Colombia.</p><p><strong>Methods: </strong>A descriptive, retrospective study was conducted on patients treated with CyberKnife® under sedation or general anesthesia between 2012 and 2022.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"501652"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","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":"Literature search for healthcare management decision-making on how to increase productivity by performing more surgical cases in the same staffed time.","authors":"Franklin Dexter, Manuel Ángel Gómez-Ríos, Richard H Epstein","doi":"10.1016/j.redare.2024.501656","DOIUrl":"https://doi.org/10.1016/j.redare.2024.501656","url":null,"abstract":"<p><p>This report shows an example of using literature search for healthcare management decision making, specifically, how anesthesiologists can enhance operating room (OR) productivity. A search was conducted using Scopus to gather relevant research on increasing surgical case numbers. References and citations were then examined. The search identified strategies to reduce non-operative times, facilitate overlapping surgeries, and optimize OR scheduling. Key findings indicate that reducing anesthesia-controlled times alone is insufficient to reliably add extra surgical cases within an eight-hour workday. Instead, significant productivity gains are realized by managing OR turnover times, using induction rooms, and revising workflows to maximize efficiency. Studies show that overlapping surgeries and strategic use of adjacent spaces can significantly increase the number of daily surgical cases performed. Most surgical growth is driven by accommodating low caseload surgeons across multiple specialties. Facilitating OR time access for these surgeons through flexible scheduling and re-sequencing of cases is crucial. Additionally, anesthesiologists should be engaged in daily OR scheduling and case sequencing, particularly within two days of surgery. The dual goals are to increase OR utilization and reduce patient wait times. These results from the management case report underscores the importance of evidence-based OR management practices and proactive involvement of anesthesiologists in scheduling decisions to enhance surgical productivity effectively.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"501656"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857490","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":"Anesthetic management of pregnant women with skeletal dysplasia and short stature: a case report.","authors":"Á Barranco de Santiago, À Alandes-Gallego, I García-Rojas, B Tena, M Magaldi","doi":"10.1016/j.redare.2024.101625","DOIUrl":"https://doi.org/10.1016/j.redare.2024.101625","url":null,"abstract":"<p><p>Skeletal dysplasias and short stature are a heterogeneous group of pathologies in which achondroplasia is the most common presentation. The presence of bone deformities leads to thoracic and airway changes that can complicate ventilation and airway management. Most individuals with skeletal dysplasia present spinal abnormalities that increase the difficulty of administering neuraxial anaesthesia. In pregnant patients, physiological and anatomical changes further complicate obstetric and anaesthesia management. We report the case of a patient with skeletal dysplasia and short stature who was admitted to our hospital in week 34.3 of her pregnancy due to labour and respiratory difficulties. It was decided to perform an emergency caesarean section due to the disproportionate size of the foetal head with respect to the pelvis. We also review the different anaesthesia techniques described in the literature, and discuss their potential advantages and difficulties.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"101625"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857487","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 management of the patients with hip fracture under anticoagulant or antiaggregants treatment. Consensus recommendations from the hemostasis section of SEDAR.","authors":"C Cassinello, R Ferrandis, A Gómez-Luque, F Hidalgo, J V Llau, G Yanes-Vidal, P Sierra","doi":"10.1016/j.redare.2024.501651","DOIUrl":"10.1016/j.redare.2024.501651","url":null,"abstract":"<p><strong>Background: </strong>Antiaggregant and anticoagulant therapy complicate the management of patients with osteoporotic hip fracture.</p><p><strong>Objective: </strong>To homogenize and improve daily clinical practice with simple recommendations.</p><p><strong>Methods: </strong>The haemostasis section of SEDAR established a working group to define an action plan for the management of antiaggregated or anticoagulated patients with an osteoporotic hip fracture. The suggested recommendations are based on evidence of best practices, and have been validated by a multidisciplinary group formed by 6 specialties.</p><p><strong>Results: </strong>Early surgery reduces complications and mortality and improves patient comfort and functional recovery, with no difference in mortality between intradural and general anaesthesia.</p><p><strong>Conclusion: </strong>Although uncertainties remain, it is recommended to perform surgery within 24-48 h of admission, adapting peripheral nerve blocks and type of anaesthesia (neuraxial or general) an to the haemostatic conditions. A multimodal management of antithrombotics, and the optimisation of haemostasis, haemoglobin and venous thromboprophylaxis since admission are suggested.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"501651"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786968","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 through fluid administration to optimize the stroke volume: A meta-analysis of randomized controlled trials.","authors":"J Ripollés-Melchor, Á V Espinosa, P Fernández-Valdes-Bango, R Navarro-Pérez, A Abad-Motos, J V Lorente, M J Colomina, E Sáez-Ruiz, A Abad-Gurumeta, M I Monge-García","doi":"10.1016/j.redare.2024.09.004","DOIUrl":"10.1016/j.redare.2024.09.004","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, 0.78-1.00), postoperative AKI (OR 0.97; (95% IC, 0.55-1.70), and mortality (OR 0.80; 95% CI, 0.50-1.29). 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, 0.65-0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04-1.12).</p><p><strong>Conclusions: </strong>In adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"719-731"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147251","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":"Recommendations of the Pre-anaesthesia Teleconsultation Task Force.","authors":"A Aroca Tanarro, R Casans Francés, M Á Gómez-Ríos, E Mendez Arias, M Otero Pérez, L Quecedo Gutierrez, V Rojas Pernia, A Abad Gurumeta","doi":"10.1016/j.redare.2024.09.001","DOIUrl":"10.1016/j.redare.2024.09.001","url":null,"abstract":"<p><p>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. 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.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"701-709"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147252","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":"Preoperative coagulation tests: A narrative review of current guidelines.","authors":"J L Jover Pinillos, R Ferrandis Comes, D Zamudio Penko, M Bermúdez López, M Basora Macaya, M J Colomina Soler","doi":"10.1016/j.redare.2024.09.005","DOIUrl":"10.1016/j.redare.2024.09.005","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methodology: </strong>A narrative literature review was conducted using the PubMed data-base. 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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":" ","pages":"740-747"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305203","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}