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Prim T, Brogly N, Guasch E, Díez J, Gilsanz F. Efficacy and safety of three inflation methods of the laryngeal mask airway Ambu® Auraonce™: a randomized controlled study. J Clin Monit Comput 2024; 38:37-45. [PMID: 37540323 DOI: 10.1007/s10877-023-01061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
The laryngeal mask airway (LMA) is commonly used for airway management. Cuff hyperinflation has been associated with complications, poor ventilation and increased risk of gastric insufflation. This study was designed to determine the best cuff inflation method of AuraOnce™ LMA during bronchoscopy and EBUS (Endobronquial Ultrasound Bronchoscopy) procedure. We designed a Randomized controlled, doble-blind, clinical trial to compare the efficacy and safety of three cuff inflation methods of AuraOnce™ LMA. 210 consenting patients scheduled for EBUS procedure under general anesthesia, using AuraOnce™ LMA were randomized into three groups depending on cuff insufflation: residual volume (RV), half of the maximum volume (MV), unchanged volume (NV). Parameters regarding intracuff pressure (IP), airway leak pressure (OLP), leakage volume (LV) were assessed, as well as postoperative complications (PC). 201 (95.7%) patients completed the study. Mean IP differed between groups (MV: 59.4 ± 32.4 cm H2O; RV: 75.1 ± 21.1 cm H2O; NV: 83.1 ± 25.5 cmH20; P < 0.01). The incidence of IP > 60 cmH2O was lower in the MV group compared to the other two (MV: 20/65(30.8%); RV:47/69 (68.1%); NV 48/67 (71.6%); p < 0.01). The insertion success rate was 89,6% (180/201) at first attempt, with no difference between groups (p = 0.38). No difference between groups was found either for OLP (p = 0.53), LV (p = 0.26) and PC (p = 0.16). When a cuff manometer is not available, a partial inflation of AuraOnce™ LMA cuff using MV method allows to control intracuff pressure, with no significant changes of OLP and LV compared to RV and NV insufflation method.Registration clinical trial: NCT04769791.
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Affiliation(s)
- Teresa Prim
- Department of Anesthesiology and Reanimation Surgical Intensive Care, Hospital Universitario La Paz /Cantoblanco/Carlos III, Madrid, Spain.
| | - Nicolas Brogly
- Department of Anesthesiology and Reanimation Surgical Intensive Care, Hospital Universitario La Paz /Cantoblanco/Carlos III, Madrid, Spain
| | - Emilia Guasch
- Department of Anesthesiology and Reanimation Surgical Intensive Care, Hospital Universitario La Paz /Cantoblanco/Carlos III, Madrid, Spain
| | - Jesús Díez
- Department of Biostatistics, Hospital Universitario La Paz, Pº de la Castellana, 261, Madrid, 28046, Spain
| | - Fernando Gilsanz
- Department of Surgery, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo, 4, Madrid, 28029, Spain
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Guasch E, Ioscovich A, Brogly N, Orbach-Zinger S, Kranke P, Morau E, Gilsanz F. Obstetric anaesthesia manpower and service provision issues (introduction and European perspective). Int J Obstet Anesth 2023; 55:103647. [PMID: 37085390 DOI: 10.1016/j.ijoa.2023.103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
Global health is an important and far-reaching concept in which health and access to surgical and anaesthetic care is crucial. Universal access to anaesthesia is a challenge in many countries. Manpower shortages are an important cause of difficulties and each European country has found different ways of facing a lack of healthcare professionals. In obstetric anaesthesia, the availability of competent anaesthesiologists has been related to the morbidity and mortality outcomes of patients. In this narrative review, authors from different European countries explain how manpower is managed in obstetric anaesthesia in delivery suites and obstetric operating rooms in different settings. To address manpower difficulties and issues, the goals are to achieve a minimum standard of care and at the same time, to promote clinical excellence through training, delegation to younger or less experienced colleagues, direct or at-a-distance supervision, or other means. The experience of sharing knowledge about the way in which manpower and service provision are organised in other healthcare settings is a significant opportunity to develop strategies for advancing tomorrow's obstetric anaesthesia in the world. While taking into account the level of socio-economic development in different countries, the aim is to standardise practice and workload organisation. Co-operative international projects in training and education in obstetric anaesthesia are ways in which better obstetric patient care can be achieved in the future.
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Affiliation(s)
- E Guasch
- Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
| | - A Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Affiliated with The Hebrew University, Israel
| | - N Brogly
- Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain; Department of Anaesthesiology, Hospital Universitario La Zarzuela, Madrid, Spain
| | - S Orbach-Zinger
- Department of Anaesthesiology, Beilinson Hospital, Petah Tikvah, Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - P Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - E Morau
- Department of Anaesthesia Intensive Care and Perioperative Medicine, CHU Nîmes, Nîmes, France
| | - F Gilsanz
- Anaesthesiology and Intensive Care Medicine, Department of Surgery, Universidad Autónoma de Madrid, Spain
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Guasch E, Brogly N, Gilsanz F. Teaching and Learning Obstetric Anaesthesia in Low- and Middle-Income Countries: Current Situation and Perspectives. Curr Anesthesiol Rep 2023; 13:76-82. [PMID: 37168832 PMCID: PMC10113969 DOI: 10.1007/s40140-023-00557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Purpose of Review Our goal in this review is to describe the current context and peculiarities of obstetric anaesthesia in low- and middle-income countries (LMIC) and the ongoing actions and perspectives in terms of teaching and learning, focusing on improving maternal outcomes. Recent Findings Correct identification of barriers and lack of infrastructures and anaesthesia providers are still major problems despite efforts of different stakeholders. International consensus and commitment for 2030 goals are trying to be achieved. Summary Structured training courses look a good option as short- and long-term evaluations show a positive impact. Future efforts will have to be also focused on indicators that may help to decrease the high mortality and morbidity ratios in LMIC.
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Affiliation(s)
- Emilia Guasch
- Anaesthesia and Reanimation Department, Hospital Universitario La Paz, Servicio Anestesia Y Reanimación, Paseo Castellana, 261, 28046 Madrid, Spain
- WFSA Obstetric Anaesthesia Committee and WFSA Council Member, London, UK
| | - Nicolas Brogly
- Anesthesia and Reanimation Department, European Society of Anaesthesia and Intensive Care (ESAIC), Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- European Society of Anaesthesia and Intensive Care (ESAIC), Spanish Royal Academy of Medicine (RANME), Universidad Autónoma de Madrid, Madrid, Spain
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Guasch E, Brogly N, Gilsanz F. Clinical practice and organizational standards in obstetric analgesia and anesthesia (EUROMISTOBAN): A European document. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:449-453. [PMID: 36085143 DOI: 10.1016/j.redare.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/17/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Guasch
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - N Brogly
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - F Gilsanz
- Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma de Madrid, Honorary Member ESAIC, Madrid, Spain
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Tapia B, Garrido E, Cebrian JL, Del Castillo JL, Gonzalez J, Losantos I, Gilsanz F. Impact of Goal Directed Therapy in Head and Neck Oncological Surgery with Microsurgical Reconstruction: Free Flap Viability and Complications. Cancers (Basel) 2021; 13:cancers13071545. [PMID: 33801607 PMCID: PMC8037950 DOI: 10.3390/cancers13071545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Based on the proven benefits of goal directed therapy (GDT) in the perioperative management of different surgical procedures and in high-risk patients, we hypothesised that this approach would also be beneficial in microvascular free flap reconstruction in head and neck cancer. In this study, we investigated whether GDT would directly benefit flap viability in addition to improving morbidity and mortality. As this reconstructive technique is gradually being introduced in more specialist fields, particularly radical oncological surgery, the benefits of GDT in this context could be extended to numerous procedures. Abstract (1) Background: Surgical outcomes in free flap reconstruction of head and neck defects in cancer patients have improved steadily in recent years; however, correct anaesthesia management is also important. The aim of this study has been to show whether goal directed therapy can improve flap viability and morbidity and mortality in surgical patients. (2) Methods: we performed an observational case control study to analyse the impact of introducing a semi invasive device (Flo Trac®) during anaesthesia management to optimize fluid management. Patients were divided into two groups: one received goal directed therapy (GDT group) and the other conventional fluid management (CFM group). Our objective was to compare surgical outcomes, complications, fluid management, and length of stay between groups. (3) Results: We recruited 140 patients. There were no differences between groups in terms of demographic data. Statistically significant differences were observed in colloid infusion (GDT 53.1% vs. CFM 74.1%, p = 0.023) and also in intraoperative and postoperative infusion of crystalloids (CFM 5.72 (4.2, 6.98) vs. GDT 3.04 (2.29, 4.11), p < 0.001), which reached statistical significance. Vasopressor infusion in the operating room (CFM 25.5% vs. GDT 74.5%, p < 0.001) and during the first postoperative 24h (CFM 40.6% vs. GDT 75%, p > 0.001) also differed. Differences were also found in length of stay in the intensive care unit (hours: CFM 58.5 (40, 110) vs. GDT 40.5 (36, 64.5), p = 0.005) and in the hospital (days: CFM 15.5 (12, 26) vs. GDT 12 (10, 19), p = 0.009). We found differences in free flap necrosis rate (CMF 37.1% vs. GDT 13.6%, p = 0.003). One-year survival did not differ between groups (CFM 95.6% vs. GDT 86.8%, p = 0.08). (4) Conclusions: Goal directed therapy in oncological head and neck surgery improves outcomes in free flap reconstruction and also reduces length of stay in the hospital and intensive care unit, with their corresponding costs. It also appears to reduce morbidity, although these differences were not significant. Our results have shown that optimizing intraoperative fluid therapy improves postoperative morbidity and mortality.
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Affiliation(s)
- Blanca Tapia
- Anesthesia and Intensive Care Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain;
- Correspondence: or ; Tel.: +34-678-787-670
| | - Elena Garrido
- Anesthesia and Intensive Care Department, Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA;
| | - Jose Luis Cebrian
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.L.C.); (J.L.D.C.); (J.G.)
| | - Jose Luis Del Castillo
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.L.C.); (J.L.D.C.); (J.G.)
| | - Javier Gonzalez
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain; (J.L.C.); (J.L.D.C.); (J.G.)
| | - Itsaso Losantos
- Statistics Department, Hospital La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain;
| | - Fernando Gilsanz
- Anesthesia and Intensive Care Department, University Hospital La Paz, Universidad Autónoma de Madrid, 28046 Madrid, Spain;
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Abstract
PURPOSE OF REVIEW This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers. RECENT FINDINGS COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean section. Epidural failure is a concern: it may lead to a general anesthesia in case of emergency cesarean section. Local protocols and well-trained anesthesiologists will be helpful. COVID-19 patients require special circuits and every step (transfer to and from theatre, recovery, analgesia, and so on) should be planned in advance. For cesarean section under general anesthesia, personal protection equipment must be enhanced. Postoperative analgesia with neuraxial opioids, NSAIDs, or regional blocks are recommended. COVID-19 and pregnancy increase the risk of thrombosis, so thromboprophylaxis has to be considered and protocolized. SUMMARY Anesthetic care for delivery in COVID-19 parturients should include neuraxial blocks. Special attention should be paid on the risk of thrombosis.
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Affiliation(s)
- Emilia Guasch
- Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz
| | - Nicolas Brogly
- Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz
| | - Fernando Gilsanz
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Gupta A, von Heymann C, Magnuson A, Alahuhta S, Fernando R, Van de Velde M, Mercier FJ, Schyns-van den Berg AMJV, Bryon B, Soetens F, Dewandre PY, Lambert G, Christiaen J, Schepers R, Van Houwe P, Kalmar A, Vanoverschelde H, Bauters M, Roofthooft E, Devroe S, Van de Velde M, Jadrijevic A, Jokic A, Marin D, Sklebar I, Mihaljević S, Kosinova M, Stourac P, Adamus M, Kufa C, Volfová I, Zaoralová B, Froeslev-Friis C, Mygil B, Krebs Albrechtsen C, Kavasmaa T, Alahuhta S, Mäyrä A, Mennander S, Rautaneva K, Hiekkanen T, Kontinen V, Linden K, Toivakka S, Boselli E, Greil PÉ, Mascle O, Courbon A, Lutz J, Simonet T, Barbier M, Hlioua T, Meniolle d’Hauthville F, Quintin C, Bouattour K, Lecinq A, Soued M, Bonnet MP, Carbonniere M, Fischer C, Picard PC, Bonnin M, Storme B, Bouthors AS, Detente T, Nguyen Troung M, Keita H, Nebout S, Osse L, Delmas A, Vial F, Kaufner L, Hoefing C, Mueller S, Becke K, Blobner M, Lewald H, Schaller SJ, Muggleton E, Bette B, Neumann C, Weber S, Grünewald M, Ohnesorge H, Helf A, Jelting Y, Kranke P, von Heymann C, Welfle S, Staikou C, Stavrianopoulou A, Tsaroucha A, Kalopita K, Loukeri A, Valsamidis D, Matsota P, Thorsteinsson A, Tome R, Eidelman LA, Davis A, Orbach-Zinger S, Ioscovich A, Ramona I, De Simone L, Pesetti B, Brazzi L, Zito A, Camorcia M, Della Rocca G, Aversano M, Frigo MG, Todde C, Morina Q, Macas A, Keraitiene G, Rimaitis K, Borg F, Tua C, Kuijpers-Visser AG, Schyns-van den Berg A, Hollmann MW, Van den Berg T, Koolen E, Dons I, van der Knijff A, van der Marel C, Ruysschaert N, Pelka M, Pluymakers C, Koopman S, Teunissen AJ, Cornelisse D, van Dasselaar N, Verdouw B, Beenakkers I, Dahl V, Hagen R, Vivaldi F, Eriksen JR, Wiszt R, Aslam Tayyaba N, Ringvold EM, Chutkowski R, Skirecki T, Wódarski B, Faria MA, Ferreira A, Sampaio AC, Ferreira I, Matias B, Teixeira J, Araujo R, Cabido H, Fortuna R, Lemos P, Cardoso C, Moura F, Pereira C, Pereira S, Tavares F, Vasconcelos P, Abecasis M, Lança F, Muchacho P, Ormonde L, Guedes-Araujo I, Pinho-Oliveira V, Paredes P, Bentes C, Gouveia F, Milheiro A, Castanheira C, Neves M, Pacheco V, Cortez M, Tranquada R, Tareco G, Furtado I, Pereira E, Marinho L, Seabra M, Bulasevic A, Kendrisic M, Jovanovic L, Pujić B, Kutlesic M, Grochova M, Simonova J, Pavlovic G, Rozman A, Blajic I, Graovac D, Stopar Pintraic T, Chiquito T, Monedero P, Carlos-Errea DJ, Guillén-Casbas R, Veiga-Gil L, Basso M, Garcia Bartolo C, Hernandez C, Ricol L, De Santos MP, Gràcia Solsona JA, López-Baamonde M, Magaldi Mendaña M, Plaza Moral AM, Vendrell M, Trillo L, Perez Garcia AR, Alamillo Salas C, Moret E, Ramió L, Aguilar Sanchez JL, Soler Pedrola M, Valldeperas Hernandez MI, Aldalur G, Bárcena E, Herrera J, Iturri F, Martínez A, Martínez L, Serna R, Gilsanz F, Guasch Arevalo E, Iannuccelli F, Latorre J, Rodriguez Roca C, Pérez Pardo OC, Sierra Biddle N, Suárez Cendaña C, Hernández González L, Remacha González C, Sánchez Nuez R, Anta D, Beleña JM, García-Cuadrado C, Garcia I, Manrique S, Suarez E, Hein A, Arbman E, Hansson H, Tillenius M, Al-Taie R, Ledin-Eriksson S, Lindén-Söndersö A, Rosén O, Austruma E, Gillberg L, Darvish B, Gupta A, Nordstöm JL, Persson J, Rosenberg J, Brühne L, Forshammar J, Ugarph Edfeldt M, Rolfsson H, Hellblom A, Levin K, Rabow S, Thorlacius K, Bansch P, Robertson (Baeriswyl) M, Stamer U, Mathivon S, Savoldelli G, Auf der Maur P, Filipovic M, Dullenkopf A, Brunner M, Girard T, Vonlanthen C, Ozbilgin S, Gunaydin D B, Corman Dincer P, Tas Tuna A. Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study. Br J Anaesth 2020; 125:1045-1055. [PMID: 33039123 DOI: 10.1016/j.bja.2020.07.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/05/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. METHODS Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. RESULTS A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. CONCLUSIONS Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
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Affiliation(s)
- Anil Gupta
- Department of Perioperative Medicine and Intensive Care and Institution of Physiology and Pharmacology, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden.
| | - Christian von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Roshan Fernando
- Department of Anesthesiology and Intensive Care Medicine, The Womens Wellness and Research Centre, Doha, Qatar
| | | | - Frédéric J Mercier
- Département d'Anesthésie, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, France
| | - Alexandra M J V Schyns-van den Berg
- Department of Anesthesiology, Albert Schweitzer Ziekenhuis, Dordrecht and Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
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De Andrés Ares J, Gilsanz F. Randomized Pragmatic Pilot Trial Comparing Perpendicular Thin Electrode Versus Parallel Thick Electrode Approaches for Lumbar Medial Branch Neurotomy in Facetogenic Low Back Pain. Pain Pract 2020; 20:889-907. [DOI: 10.1111/papr.12928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
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Guasch E, Brogly N, Gilsanz F. Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations. Curr Opin Anaesthesiol 2020; 33:284-290. [DOI: 10.1097/aco.0000000000000866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tapia B, Garrido E, Cebrian JL, Castillo JLD, Alsina E, Gilsanz F. New techniques and recommendations in the management of free flap surgery for head and neck defects in cancer patients. Minerva Anestesiol 2020; 86:861-871. [PMID: 32486605 DOI: 10.23736/s0375-9393.20.13997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Free flap surgery is the gold standard surgical treatment for head and neck defects in cancer patients. Outcomes have improved considerably, probably due to recent advances in surgical techniques. In this article, we review improvements in the parameters traditionally used to optimize hematocrit levels and body temperature and to prevent vasoconstriction, and describe the use of cardiac output-guided fluid management, a technique that has proved useful in other procedures. Finally, we review other parameters used in free flap surgery, such as clotting/platelet management and nutritional optimization.
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Affiliation(s)
- Blanca Tapia
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain -
| | - Elena Garrido
- Department of Anesthesia an Intensive Care, Wexner Medical Center, Columbus, OH, USA
| | - Jose L Cebrian
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | - Jose L Del Castillo
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | - Estibaliz Alsina
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Fernando Gilsanz
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
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Diez-Picazo LD, Guasch E, Brogly N, Gilsanz F. Is breakthrough pain better managed by adding programmed intermittent epidural bolus to a background infusion during labor epidural analgesia? A randomized controlled trial. Minerva Anestesiol 2019; 85:1097-1104. [PMID: 31213040 DOI: 10.23736/s0375-9393.19.13470-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Breakthrough pain (BTP) is a common problem during labor analgesia. Programmed intermittent epidural bolus (PIEB) has demonstrated superior to background epidural infusion (BEI) concerning BTP, but the effect of combining both modes remains unknown. We hypothesized that this combination could reduce BTP incidence. METHODS Nulliparous parturients with early cervical dilation were randomized to receive 5 mL/h BEI of levobupivacaine 0.125% plus fentanyl 1.45 µg/mL (standard group) or 5 mL/h BEI + 10 mL/h PIEB (PIEB group). In case of BTP, patient-controlled epidural analgesia (PCEA) boluses of 10 mL (20-min lockout interval) were administered. If PCEA was insufficient, a 10-mL clinician bolus was delivered. The primary endpoint was the percentage of parturients who required supplementary epidural boluses. RESULTS One hundred and twenty women were recruited. Eighty-nine percent of parturients required supplementary boluses in standard group versus 30% in PIEB group (RR=3.07; 95% CI: 1.99-4.76; P<0.001). Adding PIEB prevented BTP in 70% of cases. Duration of effective analgesia was longer in PIEB than in standard group (P=0.003). Supplementary boluses were decreased (P<0.001), while local anesthetic consumption increased (P<0.001) by PIEB addition. Sensory-motor block, mode of delivery, maternal satisfaction and neonatal outcomes were equally distributed in both groups. CONCLUSIONS Adding PIEB to BEI+PCEA improved labor analgesia by significantly reducing the needs of rescue analgesia and prolonging the duration of effective analgesia. This combination provoked a higher consumption of local anesthetic with no detected clinical consequences.
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Affiliation(s)
- Luis D Diez-Picazo
- Department of Anesthesia, Critical Care and Pain Treatment, La Paz University Hospital, Madrid, Spain -
| | - Emilia Guasch
- Department of Anesthesia, Critical Care and Pain Treatment, La Paz University Hospital, Madrid, Spain
| | - Nicolas Brogly
- Department of Anesthesia, Critical Care and Pain Treatment, La Paz University Hospital, Madrid, Spain
| | - Fernando Gilsanz
- Department of Anesthesia, Critical Care and Pain Treatment, La Paz University Hospital, Madrid, Spain
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de Andrés Ares J, Gilsanz F. Diagnostic nerve blocks in the management of low back pain secondary to facet joint syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:213-221. [PMID: 30683428 DOI: 10.1016/j.redar.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 06/09/2023]
Abstract
Low back pain is currently one of the main public health problems. Among the multiple causes, pain in the zygapophysial joints, also called facets or posterior vertebral joints, are an important cause, usually secondary to osteoarthritis. The source of low back pain is often difficult to find, making the therapeutic approach to the patient sub-optimal. Diagnostic blocks are a very important tool in establishing an adequate treatment for patients with low back pain, as long as they are performed accurately, with an adequate local anaesthetic volume, with a suitable image and fluoroscopic projection and its result are precisely interpreted. In this article a review is presented on the importance of diagnostic blocks, as well as how they should be performed in order to obtain the maximum information and the greatest therapeutic benefit.
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Affiliation(s)
- J de Andrés Ares
- Servicio de Anestesiología-Unidad del Dolor, Hospital Universitario La Paz, Madrid, España.
| | - F Gilsanz
- Servicio de Anestesiología-Unidad del Dolor, Hospital Universitario La Paz, Madrid, España
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13
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Kollmann Camaiora A, Brogly N, Alsina E, de Celis I, Huercio I, Gilsanz F. Validation of the Zero-Heat-Flux thermometer (SpotOn®) in major gynecological surgery to monitor intraoperative core temperature: a comparative study with esophageal core temperature. Minerva Anestesiol 2018; 85:351-357. [PMID: 29945430 DOI: 10.23736/s0375-9393.18.12188-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Zero-Heat-Flux technology of the SpotOn® sensor to measure core temperature has been validated in vascular and cardiac surgery. Our aim was to assess its validity in gynecological surgery in terms of time of measurement, thermic status (hypo-, normo-, or hyperthermia) and the use of different warming devices. METHODS Prospective study in patients scheduled for major gynecological surgery using three warming systems (Snuggle Warm®, Lithotomy Underbody Blanket® and Warmtac Pad®). Intraoperative temperature was simultaneously monitored using the SpotOn® sensor and a Dräger® esophageal probe; measurements were taken after induction (T0), between 0 and 60 min (T1), between 60 and 120 minutes (T2) and after 120 minutes (T3). We calculated the level of correlation between pairs of measurements both overall and in subgroups with an acceptable difference of less than 0.5 °C. We built Bland-Altman plots, and calculated the Pearson correlation (PC) and intraclass correlation coefficient (ICC) to test our data. RESULTS We recruited 70 patients and included 66 for analysis, giving a total of 401 paired measurements. Overall, the PC and ICC for paired temperature readings were 0.82 and 0.90, respectively. The lowest levels of correlation were observed after intubation, when a convective blanket was placed under the patient, and in hypothermic patients. The highest correlations were observed at T2, and in normothermic patients. CONCLUSIONS We found a high overall correlation between the SpotOn® and the esophageal probe, with negligible differences and almost perfect agreement. The warming system used, time of measurement, and thermic status appear to influence the level of correlation, but these differences were not clinically significant.
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Affiliation(s)
| | - Nicolas Brogly
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Estibaliz Alsina
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Isabel de Celis
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Ivan Huercio
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Fernando Gilsanz
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
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14
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Maseda E, Grau S, Luque S, Castillo-Mafla MP, Suárez-de-la-Rica A, Montero-Feijoo A, Salgado P, Gimenez MJ, García-Bernedo CA, Gilsanz F, Roberts JA. Population pharmacokinetics/pharmacodynamics of micafungin against Candida species in obese, critically ill, and morbidly obese critically ill patients. Crit Care 2018; 22:94. [PMID: 29655372 PMCID: PMC5899833 DOI: 10.1186/s13054-018-2019-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 01/05/2023]
Abstract
Background Dosing in obese critically ill patients is challenging due to pathophysiological changes derived from obesity and/or critical illness, and it remains fully unexplored. This study estimated the micafungin probability of reaching adequate 24-h area under the curve (AUC0–24h)/minimum inhibitory concentration (MIC) values against Candida spp. for an obese/nonobese, critically ill/noncritically ill, large population. Methods Blood samples for pharmacokinetic analyses were collected from 10 critically ill nonobese patients, 10 noncritically ill obese patients, and 11 critically ill morbidly obese patients under empirical/directed micafungin treatment. Patients received once daily 100–150 mg micafungin at the discretion of the treating physician following the prescribing information and hospital guidelines. Total micafungin concentrations were determined by high-performance liquid chromatography (HPLC). Monte-Carlo simulations were performed and the probability of target attainment (PTA) was calculated using the AUC0–24/MIC cut-offs 285 (C. parapsilosis), 3000 (all Candida spp.), and 5000 (nonparapsilosis Candida spp.). Intravenous once-daily 100-mg, 150-mg, and 200-mg doses were simulated at different body weights (45, 80, 115, 150, and 185 kg) and age (30, 50, 70 and 90 years old). PTAs ≥ 90% were considered optimal. Fractional target attainment (FTA) was calculated using published MIC distributions. A dosing regimen was considered successful if the FTA was ≥ 90%. Results Overall, 100 mg of micafungin was once-daily administered for nonobese and obese patients with body mass index (BMI) ≤ 45 kg/m2 and 150 mg for morbidly obese patients with BMI > 45 kg/m2 (except two noncritically ill obese patients with BMI ~ 35 kg/m2 receiving 150 mg, and one critically ill patient with BMI > 45 kg/m2 receiving 100 mg). Micafungin concentrations in plasma were best described using a two-compartment model. Weight and age (but not severity score) were significant covariates and improved the model. FTAs > 90% were obtained against C. albicans with the 200 mg/24 h dose for all body weights (up to 185 kg), and with the 150 mg/24 h for body weights < 115 kg, and against C. glabrata with the 200 mg/24 h dose for body weights < 115 kg. Conclusion The lack of adequacy for the 100 mg/24 h dose suggested the need to increase the dose to 150 mg/24 h for C. albicans infections. Further pharmacokinetic/pharmacodynamic studies should address optimization of micafungin dosing for nonalbicans Candida infections.
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Affiliation(s)
- Emilio Maseda
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Universidad Autónoma de Madrid, Madrid, Spain.
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sonia Luque
- Pharmacy Department, Hospital del Mar, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maria-Pilar Castillo-Mafla
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Alejandro Suárez-de-la-Rica
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Ana Montero-Feijoo
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Patricia Salgado
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - Fernando Gilsanz
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
| | - Jason A Roberts
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
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15
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Brogly N, Guasch E, Alsina E, García C, Puertas L, Dominguez A, Diez J, Gómez J, Gilsanz F. Epidural Space Identification With Loss of Resistance Technique for Epidural Analgesia During Labor. Anesth Analg 2018; 126:532-536. [DOI: 10.1213/ane.0000000000002593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Suarez-de-la-Rica A, Castro-Arias C, Latorre J, Gilsanz F, Maseda E. Prognosis and predictors of mortality in critically ill elderly patients. ACTA ACUST UNITED AC 2017; 65:143-148. [PMID: 29242031 DOI: 10.1016/j.redar.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES to evaluate mortality of patients≥80 years admitted to the Surgical Intensive Care Unit (SICU), global hospital mortality and factors related to it. MATERIAL AND METHODS observational retrospective study of patients≥80 years admitted to SICU between June 2012 and June 2015. RESULTS a total of 299 patients were included, 54 of them died in the SICU (18.1%) and 80 patients (26.8%) died during their hospital stay. SICU mortality was independently related to age (OR=1.125; 95%CI: 1.042-1.215; P=.003), SAPS II (OR=1.026; 95% CI: 1.008-1.044; P=.004), need for renal replacement therapy (RRT) (OR=1.960; 95%CI: 1.046-3.671; P=.036) and need for mechanical ventilation for more than 24hours (OR=2.834; 95%CI: 1.244-6.456; P=.013). Factors independently related to hospital mortality were age (OR=1.125; 95%CI: 1.054-1.192; P<.001), SOFA score (OR=1.154; 95% CI: 1.079-1.235; P<.001), need for RRT (OR=1.924; 95%CI: 1.121-3.302; p=0.018) and need for mechanical ventilation for more than 24hours (OR=3.144; 95% CI: 1.771-5.584; P<.001). CONCLUSIONS In critically ill patients over 80 years hospital mortality was independently related to age, SOFA score, RRT need and need for mechanical ventilation for more than 24hours. Our results raise important issues about end-of-life care and life-sustaining interventions in elderly, critically ill patients.
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Affiliation(s)
- A Suarez-de-la-Rica
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - C Castro-Arias
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J Latorre
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - E Maseda
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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17
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Candel FJ, Pazos Pacheco C, Ruiz-Camps I, Maseda E, Sánchez-Benito MR, Montero A, Puig M, Gilsanz F, Aguilar J, Matesanz M. Update on management of invasive candidiasis. Rev Esp Quimioter 2017; 30:397-406. [PMID: 29115366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Given the growing incidence of invasive candidiasis in critically ill and haemato-oncological patients and its poor outcomes, an early diagnosis and treatment are need for get a better prognosis. This document reviews the current ap-proaches that help in diagnosis of invasive candidiasis based on culture-independent microbiological tests. The combination of clinical prediction scores with fungal serological markers could facilitate the approach in antifungal therapy, optimiz-ing it. This article also reviews the epidemiology and primary risk factors for invasive candidiasis in these patients, updating the therapeutic approach algorithms in both clinical contexts based on the main evidence and international guidelines.
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Affiliation(s)
- F J Candel
- Dr Francisco Javier Candel González, Department of Clinical Microbiology and Infectious Diseases. Hospital Clínico San Carlos. IDISSC. Universidad Complutense. Avda Profesor Martín Lagos s/n, 28040. Madrid, Spain.
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18
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Montero A, Salgado Aranda P, Gilsanz F, Maseda E. Antimicrobial management in nosocomial peritonitis: microbiota, drug and time. Rev Esp Quimioter 2017; 30 Suppl 1:34-38. [PMID: 28882013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Complicated intra-abdominal infection requires surgical treatment and broad-spectrum empiric antibiotic treatment used early. The rapid spread of multidrug-resistant bacteria has become a serious threat, especially in critical care units. The excessive use of carbapenems has led to carbapenemase-producing Enterobacteriaceae, leaving tigecycline and colistin as therapeutical options. The new antimicrobials, ceftazidime-avibactam and ceftolozane-tazobactam open new horizons in the treatment of multi-drug resistant Enterobacteriaceae. Candida peritonitis causes a high mortality in the critical patient. Diagnosis and early treatment are associated with a better prognosis, the administration of an echinocandin being of choice in these patients.
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Affiliation(s)
| | | | | | - E Maseda
- Emilio Maseda, Servicio de Anestesia y Reanimación, Hospital Universitario La Paz; Paseo de la Castellana 261; 28046, Madrid, Spain.
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19
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Salinas BT, Camaiora AK, Marcos EA, Gilsanz F. Chest Pain During Cesarean Delivery in Relation to Anomalous Right Coronary Artery. ACTA ACUST UNITED AC 2017; 9:119-122. [DOI: 10.1213/xaa.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Labor epidural failure is a challenging situation for the obstetric anesthetist, especially when associated to high risk of caesarean delivery, obesity, and difficult airway predictors. Labor epidural failure is still not standardly defined, consequently its incidence is uncertain: improving the knowledge of risk factors related to failure will increase epidural block success rate. Prolonged labors, previous history of epidural failure, and repeated top-ups needed during labor are recognized risk factors for failure. Clinical experience and the use of modern equipment (ultrasound guided blocks), as well as the choice of neuraxial technique (epidural versus combined spinal-epidural) may affect failure rate. Software-controlled infusion pumps seem to increase epidural analgesia success rate. Among non-technical skills, good communication among medical team members and parturient women is another pivotal point to achieve a satisfactory analgesia for labor. Clear algorithms should be promoted where epidural failure during labor or caesarean delivery may occur.
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Affiliation(s)
- Emilia Guasch
- Department of Anesthesia, La Paz University Hospital, Madrid, Spain -
| | | | - Nicolas Brogly
- Department of Anesthesia, La Paz University Hospital, Madrid, Spain
| | - Fernando Gilsanz
- Department of Anesthesia, La Paz University Hospital, Madrid, Spain
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21
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Latorre J, Brogly N, Maggi G, Quinteros F, Peña del Ser N, Gilsanz F. Jet ventilation for the extraction of endobronchial foreing body in a patient with drained pneumothorax: A case report. Colombian Journal of Anesthesiology 2017. [DOI: 10.1016/j.rcae.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Latorre J, Brogly N, Maggi G, Quinteros F, Peña del Ser N, Gilsanz F. Ventilación jet para la extracción de un cuerpo extraño endobronquial en un paciente con neumotórax drenado: informe de caso. Revista Colombiana de Anestesiología 2017. [DOI: 10.1016/j.rca.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Kollmann-Camaiora A, Brogly N, Alsina E, Gilsanz F. Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block. ACTA ACUST UNITED AC 2017; 64:453-459. [PMID: 28342526 DOI: 10.1016/j.redar.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. METHODS We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. RESULTS We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. CONCLUSIONS The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum.
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Affiliation(s)
- A Kollmann-Camaiora
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - N Brogly
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - E Alsina
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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Hinojosa FQ, Revelo M, Salazar A, Maggi G, Schiraldi R, Brogly N, Gilsanz F. Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture. Braz J Anesthesiol 2016; 67:89-91. [PMID: 28017176 DOI: 10.1016/j.bjane.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022] Open
Abstract
Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.
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Affiliation(s)
| | - Margarita Revelo
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madrid, Spain
| | - Alexander Salazar
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madrid, Spain
| | - Genaro Maggi
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Renato Schiraldi
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madrid, Spain
| | - Nicolas Brogly
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madrid, Spain
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Domínguez A, Alsina E, Landín L, García-Miguel JF, Casado C, Gilsanz F. Transfusion requirements in burn patients undergoing primary wound excision: effect of tranexamic acid. Minerva Anestesiol 2016; 83:353-360. [PMID: 27827518 DOI: 10.23736/s0375-9393.16.10992-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early excision of burn wounds is the standard approach for burns, but it is usually associated with the need of allogeneic blood transfusion. Our aim was to determine if intravenous administration of tranexamic acid (TXA) was able to reduce packed red blood cell (pRBC) transfusion requirements in burn patients. METHODS We conducted a retrospective cohort study of 2 consecutive series of severely burned patients (≥20% total body surface are) admitted for primary burn surgery. We searched for differences in pRBC transfusion occurrence and requirements during surgery and up to 24 hours after surgery. RESULTS A total of 107 patients were included in the study, and 48.6% (52 patients) received TXA during primary excision. The use of TXA exhibited an absolute risk reduction in the need for transfusion during surgery of 24.2% (95% CI: 7.1-41.4%). In total, patients receiving TXA required 1.6 units of pRBC in the perioperative period vs. 2.6 units in those not receiving TXA (P=0.017). CONCLUSIONS The intraoperative use of TXA in burn patients undergoing primary burn excision reduced the incidence of allogeneic transfusion and the total number of pRBC transfused.
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Affiliation(s)
- Ana Domínguez
- Burn Center, Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain -
| | - Estíbaliz Alsina
- Burn Center, Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Luis Landín
- Burn Center, Department of Plastic, Cosmetic and Reconstructive Surgery, La Paz University Hospital, Madrid, Spain
| | | | - Cesar Casado
- Burn Center, Department of Plastic, Cosmetic and Reconstructive Surgery, La Paz University Hospital, Madrid, Spain
| | - Fernando Gilsanz
- Burn Center, Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
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Montero A, Gilsanz F, Maseda E. [Diagnostic and therapeutic approach of intraabdominal candidiasis]. Rev Esp Quimioter 2016; 29 Suppl 1:52-55. [PMID: 27608315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Invasive fungal disease is associated to a high mortality rate on critical ill patients. In the last decades an important epidemiological shift has been described. Early diagnosis and treatment are related with a better prognosis. The key factors lie in a set of predictive scores that allow to identify patients that will benefit of early treatment, as well as using diagnosis techniques that are culture independent. New diagnosis approximations are being developed with promising results: in situ hybridisation using PNA-FISH probes, MALDI-TOF MS and rapid nucleic acids detection assays. The use of echinocandin is recommended as antifungal therapy on critical ill patients with candida peritonitis.
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Affiliation(s)
| | | | - E Maseda
- Emilio Maseda, Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Paseo de la Castellana 261; 28046, Madrid, Spain.
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Salgado P, Gilsanz F, Maseda E. [Resistant gram-negative bacteria. Therapeutic approach and risk factors]. Rev Esp Quimioter 2016; 29 Suppl 1:26-30. [PMID: 27608309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The rapid spread of multidrug-resistant bacteria has become a serious threat, especially in critical care units, thereby prolonging the hospital stay. Enterobacteriaceae have a high capacity to adapt to any environment. Plasmids are the reason behind their expansion. The choice of empiric therapy for intra-abdominal or urinary infections requires knowledge of the intrinsic microbiological variability of each hospital or critical care unit, as well as the source of infection, safety or antibiotic toxicity, interaction with other drugs, the dosage regimen and the presence of risk factors. Carbapenems are the drug of choice in the case of suspected infection by ESBL-producing Enterobacteriaceae. The new ceftazidime/avibactam and ceftolozane/tazobactam drugs are opening up promising new horizons in the treatment of multidrug-resistant Enterobacteriaceae.
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Affiliation(s)
| | | | - E Maseda
- Emilio Maseda, Servicio de Anestesia y Reanimación, Hospital Universitario La Paz. Paseo de la Castellana 261; 28046, Madrid, Spain.
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Abstract
Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years. In general, studies describing epidemiology of sepsis outside the US use clinical definitions and intensive care unit (ICU) observational cohort designs instead of administrative databases and definitions. Incidence of sepsis has increased over years, probably due to progressive aging of population, the existence of more comorbidities and maybe the liberal use of sepsis codification, by including patients with less severity. Notwithstanding, mortality due to sepsis is clearly decreasing over years, probably to improvement in ICU care, although absolute mortality is growing on account of the raise in incidence. Risk factors for sepsis are the two ends of life, male sex, US black race, presence of comorbidities and certain genetic variants. Respiratory tract infections are the most common source of sepsis, and, nowadays, Gram-positive infections are more frequent that Gram-negative sepsis in most prospective studies.
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Affiliation(s)
- Alejandro Suarez De La Rica
- Department of Anesthesiology and Surgical Critical Care, Surgical Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- Department of Anesthesiology and Surgical Critical Care, Surgical Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Emilio Maseda
- Department of Anesthesiology and Surgical Critical Care, Surgical Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain
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Affiliation(s)
- A Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, Estados Unidos de América; TeamHealth Research Institute, Englewood, New Jersey, Estados Unidos de América.
| | - F Gilsanz
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, España
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Maseda E, Salgado P, Anillo V, Ruiz-Carrascoso G, Gómez-Gil R, Martín-Funke C, Gimenez MJ, Granizo JJ, Aguilar L, Gilsanz F. Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study. Enferm Infecc Microbiol Clin 2016; 35:333-337. [PMID: 27016135 DOI: 10.1016/j.eimc.2016.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/11/2016] [Accepted: 02/21/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In 2011, a hospital-wide outbreak of OXA-48 producing Klebsiella pneumoniae occurred in our hospital, an epidemiological setting of high ESBL-producing K. pneumoniae rates. This study identifies risk factors for colonization with carbapenemase-producing enterobacteria (CPE) at Surgical Intensive Care Unit (SICU) admission. METHODS A 2-year retrospective study was performed in all patients admitted to the SICU that following routine had a rectal swab collected upon admission. RESULTS Of 254 patients admitted, 41 (16.1%) harbored CPE (five showing two carbapenemase-producing isolates). Most frequent carbapenemase-producing isolates and carbapenemases were K. pneumoniae (39/46, 84.8%) and OXA-48 (31/46; 76.1%), respectively. Carriers significantly had higher rates of chronic renal disease, previous digestive/biliary endoscopy, hospitalization, ICU/SICU admission, intraabdominal surgery, and antibiotic intake, as well as higher median values of clinical scores (SOFA, SAPS II and APACHE II). In the multivariate analysis (R2=0.309, p<0.001), CPE carriage was associated with prior administration of 3rd-4th generation cephalosporins (OR=27.96, 95%CI=6.88, 113.58, p<0.001), β-lactam/β-lactamase inhibitor (OR=11.71, 95%CI=4.51, 30.43, p<0.001), abdominal surgery (OR=6.33, 95%CI=2.12, 18.89, p=0.001), and prior digestive/biliary endoscopy (OR=3.88, 95%CI=1.56, 9.67, p=0.004). CONCLUSIONS A strong association between production of ESBLs and carriage of CPE (mainly OXA-48 producing K. pneumoniae) was found. According to the model, the co-selection of β-lactamases by previous exposure to broad-spectrum cephalosporins and β-lactam/β-lactamase inhibitors (with lower relative risk), abdominal surgery and prior digestive/biliary endoscopy were factors associated with CPE carriage.
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Affiliation(s)
- Emilio Maseda
- Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.
| | - Patricia Salgado
- Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain
| | - Víctor Anillo
- Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain
| | | | - Rosa Gómez-Gil
- Microbiology Dpt., Hospital Universitario La Paz, Madrid, Spain
| | - Carmen Martín-Funke
- General Medicine Dpt., Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Fernando Gilsanz
- Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain
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Huercio I, Abad-Gurumeta A, Gilsanz F. Regional blocks for breast surgery: is it enough? Minerva Anestesiol 2016; 82:369-370. [PMID: 26337373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ivan Huercio
- Department of Anesthesia and Critical Care, La Paz University Hospital, Madrid, Spain -
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López MM, Guasch E, Schiraldi R, Maggi G, Alonso E, Gilsanz F. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis. Braz J Anesthesiol 2016; 66:82-5. [PMID: 26768936 DOI: 10.1016/j.bjane.2013.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/20/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm(2) or a mean aortic valve gradient >30 mmHg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair. CASE REPORT Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions. CONCLUSION Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.
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Affiliation(s)
| | | | | | | | | | - Fernando Gilsanz
- Hospital Universitario La Paz, Madrid, Spain; Sociedad Española de Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain
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López MM, Guasch E, Schiraldi R, Maggi G, Alonso E, Gilsanz F. Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva para cirurgia de reparação do quadril em dois pacientes com estenose aórtica grave. Rev Bras Anestesiol 2016. [DOI: 10.1016/j.bjan.2013.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Adequate management of severely ill patients with secondary peritonitis requires supportive therapy of organ dysfunction, source control of infection and antimicrobial therapy. Since secondary peritonitis is polymicrobial, appropriate empiric therapy requires combination therapy in order to achieve the needed coverage for both common and more unusual organisms. This article reviews etiological agents, resistance mechanisms and their prevalence, how and when to cover them and guidelines for treatment in the literature. Local surveillances are the basis for the selection of compounds in antibiotic regimens, which should be further adapted to the increasing number of patients with risk factors for resistance (clinical setting, comorbidities, previous antibiotic treatments, previous colonization, severity…). Inadequate antimicrobial regimens are strongly associated with unfavorable outcomes. Awareness of resistance epidemiology and of clinical consequences of inadequate therapy against resistant bacteria is crucial for clinicians treating secondary peritonitis, with delicate balance between optimization of empirical therapy (improving outcomes) and antimicrobial overuse (increasing resistance emergence).
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Affiliation(s)
- Emilio Maseda
- a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain
| | | | - Fernando Gilsanz
- a Anesthesiology and Surgical Critical Care Department , Hospital Universitario La Paz , Madrid , Spain
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Schiarite L, Calvo M, Maggi G, Abad A, Gilsanz F. Location of the sciatic nerve at the popliteal fossa in the adult population: Relationship with gender and anthropometric data studied. Implications for daily practice. Rev Esp Anestesiol Reanim 2015; 62:565-569. [PMID: 25896734 DOI: 10.1016/j.redar.2015.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 12/16/2014] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine whether the location of the sciatic nerve (SN) at the popliteal fossa is related to anthropometric variables in the adult population, and to identify possible anatomical variations and their possible implications for clinical practice. MATERIALS AND METHOD Prospective observational study in elective ambulatory surgery patients. Patients were examined using ultrasound, looking at depth, laterality and distance at which the SN bifurcates at the level of the popliteal fossa. These measurements were linked to gender and the anthropometric data of the patients. RESULTS A total of 62 patients were included, with 124 measurements. A statistically significant association was found between SN depth and the diameter of the thigh measured at 10 cm from the popliteal crease (P<.001). Mean depth: 3.32 ± 0.8 cm, mean laterality: 1.43 ± 0.9 cm, mean SN bifurcation distance: 61.78 ± 12 mm and mean SN diameter: 7.45 ± 1.17 mm. There were no statistical differences when comparing the measured variables with the age and gender. Similar results were obtained between measurements when comparing both lower limbs in the same patient. There was no statistical difference between height and distance at which the SN bifurcates. CONCLUSIONS The depth and laterality of SN are independent of gender, weight and height. The depth at which the SN is located at the level of the popliteal fossa is related to the diameter of the thigh. The bifurcation of SN in popliteal fossa is not related to height.
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Affiliation(s)
- L Schiarite
- Anestesiología, Asociación de Anesteria, Analgesia y Reanimación de Buenos Aires, Hospital J. M. Penna, Ciudad Autónoma de Buenos Aires, Argentina.
| | - M Calvo
- Anestesiología, Hospital Universitario La Paz, Madrid, España
| | - G Maggi
- Anestesiología, Hospital Universitario La Paz, Madrid, España
| | - A Abad
- Anestesiología, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
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González-Pizarro P, García-Fernández J, Canfrán S, Gilsanz F. Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study. Respir Care 2015; 61:142-8. [PMID: 26556900 DOI: 10.4187/respcare.04250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (<48 h old) with healthy lungs under general anesthesia. METHODS The primary outcome was peak inspiratory pressure (PIP) causing pneumothorax. Animals under anesthesia and bilateral chest tube catheterization were randomly allocated to 2 groups: one with PEEP and fixed inspiratory driving pressure of 15 cm H2O (PEEP group) and the second one with PEEP = 0 cm H2O and non-fixed inspiratory driving pressure (zero PEEP group). In both groups, the ventilation mode was pressure-controlled, and PIP was raised at 2-min intervals, with steps of 5 cm H2O until air leak was observed through the chest tubes. The PEEP group raised PIP through 5-cm H2O PEEP increments, and the zero PEEP group raised PIP through 5-cm H2O inspiratory driving pressure increments. RESULTS Pneumothorax was observed with a PIP of 90.5 ± 15.7 cm H2O with no statistically significant differences between the PEEP group (92 ± 14.8 cm H2O) and the zero PEEP group (89 ± 18.2 cm H2O). The zero PEEP group had hypotension, with a PIP of 35 cm H2O; the PEEP group had hypotension, with a PIP of 60 cm H2O (P = .01). The zero PEEP group presented bradycardia, with PIP of 40 cm H2O; the PEEP group presented bradycardia, with PIP of 70 cm H2O (P = .002). CONCLUSIONS Performing recruitment maneuvers in newborns without lung disease is a safe procedure in terms of pneumothorax. Pneumothorax does not seem to occur in the clinically relevant PIPs of <50 cm H2O. Hemodynamic impairment may occur with high driving pressures. More studies are needed to determine the exact hemodynamic impact of these procedures and pneumothorax PIP in poorly compliant lungs.
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Affiliation(s)
| | - Javier García-Fernández
- Anaesthesiology and Critical Care Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Susana Canfrán
- Veterinary Clinical Hospital, Complutense University, Madrid, Spain
| | - Fernando Gilsanz
- Anaesthesiology Department, La Paz University Hospital, Madrid, Spain
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Brogly N, Alsina E, de Celis I, Huercio I, Dominguez A, Gilsanz F. Perioperative temperature control: Survey on current practices. ACTA ACUST UNITED AC 2015; 63:207-11. [PMID: 26385450 DOI: 10.1016/j.redar.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/28/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. MATERIAL AND METHODS A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. RESULTS A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. DISCUSSION AND CONCLUSION Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future.
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Affiliation(s)
- N Brogly
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Alsina
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - I de Celis
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - I Huercio
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - A Dominguez
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
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Salgado P, Gilsanz F, Maseda E. [Therapeutic options for carbapenemase-producing Enterobacteriaceae]. Rev Esp Quimioter 2015; 28 Suppl 1:12-15. [PMID: 26365727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) has spread worldwide becoming a threat to public health. However, no randomized clinical trials about the efficacy of optimizing antibiotic treatment have been published. Experimental studies have been designed to find combinations of antibiotics with synergistic activity. Their main aim has been increasing the speed of bacterial destruction and decreasing resistance. The latest guidelines recommend combination therapy. The carbapenems has been chosen as the basis of such therapy. We face limited therapeutic options. Polymyxins, fosfomycin and gentamicin have reemerged in this context, becoming the basis of multiple combination regimens, with beneficial effects both in vitro and in murine models of infection.
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Affiliation(s)
| | | | - Emilio Maseda
- Emilio Maseda, Servicio de Anestesia y Reanimación, Hospital Universitario La Paz; Paseo de la Castellana 261, 2846, Madrid, Spain.
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Ramírez S, Gredilla E, Martínez B, Gilsanz F. Bilateral subdural hematoma secondary to accidental dural puncture. Braz J Anesthesiol 2015; 65:306-9. [PMID: 26123149 DOI: 10.1016/j.bjane.2014.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 10/23/2022] Open
Abstract
We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.
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Affiliation(s)
- Sofía Ramírez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - Elena Gredilla
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Blanca Martínez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
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Maseda E, García-Bernedo CA, Frías I, Navarro JA, Rico J, Iranzo R, Granizo JJ, Villagrán MJ, Samsó E, Gilsanz F. A practice-based observational study on the use of micafungin in Surgical Critical Care Units. Rev Esp Quimioter 2015; 28:132-138. [PMID: 26032997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Echinocandins are first-line therapy in critically ill patients with invasive Candida infection (ICI). This study describes our experience with micafungin at Surgical Critical Care Units (SCCUs). METHODS A multicenter, observational, retrospective study was performed (12 SCCUs) by reviewing all adult patients receiving 100 mg/24h micafungin for ≥72h during ad-mission (April 2011-July 2013). Patients were divided by ICI category (possible, probable + proven), 24h-SOFA (<7, ≥7) and outcome. RESULTS 72 patients were included (29 possible, 13 probable, 30 proven ICI). Forty patients (55.6%) presented SOFA ≥7. Up to 78.0% patients were admitted after urgent surgery (64.3% with SOFA <7 vs. 90.3% with SOFA ≥7, p=0.016), and 84.7% presented septic shock. In 66.7% the site of infection was intraabdominal. Forty-nine isolates were recovered (51.0% C. albicans). Treatment was empirical (59.7%), microbiologically directed (19.4%), rescue therapy (15.3%), or anticipated therapy and prophylaxis (2.8% each). Empirical treatment was more frequent (p<0.001) in possible versus probable + proven ICI (86.2% vs. 41.9%). Treatment (median) was longer (p=0.002) in probable + proven versus possible ICI (13.0 vs. 8.0 days). Favorable response was 86.1%, without differences by group. Age, blood Candida isolation, rescue therapy, final MELD value and %MELD variation were significantly higher in patients with non-favorable response. In the multivariate analysis (R2=0.246, p<0.001) non-favorable response was associated with positive %MELD variations (OR=15.445, 95%CI= 2.529-94.308, p=0.003) and blood Candida isolation (OR=11.409, 95%CI=1.843-70.634, p=0.009). CONCLUSION High favorable response was obtained, with blood Candida isolation associated with non-favorable response, in this series with high percentage of patients with intraabdominal ICI, septic shock and microbiological criteria for ICI.
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Affiliation(s)
- Emilio Maseda
- Emilio Maseda, Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Maseda E, Suarez-de-la-Rica A, Anillo V, Tamayo E, García-Bernedo CA, Ramasco F, Villagran MJ, Maggi G, Gimenez MJ, Aguilar L, Granizo JJ, Buño A, Gilsanz F. Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: A multicenter retrospective study. J Crit Care 2015; 30:537-42. [DOI: 10.1016/j.jcrc.2014.12.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/01/2014] [Accepted: 12/21/2014] [Indexed: 02/04/2023]
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Suarez-de-la-Rica A, Maseda E, Anillo V, Tamayo E, García-Bernedo CA, Ramasco F, Hernández-Gancedo C, López-Tofiño A, Gimenez MJ, Granizo JJ, Aguilar L, Gilsanz F. Biomarkers (Procalcitonin, C Reactive Protein, and Lactate) as Predictors of Mortality in Surgical Patients with Complicated Intra-Abdominal Infection. Surg Infect (Larchmt) 2015; 16:346-51. [DOI: 10.1089/sur.2014.178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Emilio Maseda
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain
| | - Víctor Anillo
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo Tamayo
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Fernando Ramasco
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Carmen Hernández-Gancedo
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain
| | - Araceli López-Tofiño
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Juan-Jose Granizo
- Preventive Medicine Department, Hospital Infanta Cristina, Parla, Madrid, Spain
| | | | - Fernando Gilsanz
- Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Madrid, Spain
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Hinojosa FQ, Revelo M, Salazar A, Maggi G, Schiraldi R, Brogly N, Gilsanz F. [Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture]. Rev Bras Anestesiol 2015; 67:89-91. [PMID: 25896643 DOI: 10.1016/j.bjan.2014.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/07/2014] [Indexed: 10/23/2022] Open
Abstract
Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.
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Affiliation(s)
| | - Margarita Revelo
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madri, Espanha
| | - Alexander Salazar
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madri, Espanha
| | - Genaro Maggi
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Renato Schiraldi
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madri, Espanha
| | - Nicolas Brogly
- Hospital Universitario de La Paz, Servicio de Anestesiologia, Madri, Espanha
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Guasch E, Gilsanz F. Treatment of Postpartum Hemorrhage With Blood Products in a Tertiary Hospital: Outcomes and Predictive Factors Associated With Severe Hemorrhage. Clin Appl Thromb Hemost 2015; 22:685-92. [PMID: 25712981 PMCID: PMC5006099 DOI: 10.1177/1076029615573303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality and morbidity worldwide. This retrospective observational study describes patient characteristics and hemostatic therapies administered to 352 parturients experiencing PPH and analyzes risk factors for developing severe PPH. During the study period, bleeding was controlled in all cases and 99.4% survived. The majority (98%) of patients received packed red blood cells. The most frequent hemostatic therapies administered were fibrinogen concentrate (56%), fresh frozen plasma (49%), and platelets (30%). A total of 124 (35%) women experienced severe PPH. Significant independent predictors for evolution to severe PPH were age, obstetric comorbidity, and plasma fibrinogen concentration. The latter was based on records from 267 (76%) patients. Plasma fibrinogen concentration before labor was the only modifiable prepartum risk factor independently associated with severe PPH, indicating that fibrinogen monitoring is warranted in these patients.
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Affiliation(s)
- Emilia Guasch
- Anesthesia and Intensive Care Department, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- Anesthesia and Intensive Care Department, Hospital Universitario La Paz, Madrid, Spain
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Maseda E, Suárez-de-la-Rica A, Anillo V, Salgado P, Tamayo E, García-Bernedo CA, Ramasco F, Villagrán MJ, López-Tofiño A, Giménez MJ, Granizo JJ, Hernández-Gancedo C, Aguilar L, Gilsanz F. A practice-based observational study identifying factors associated with the use of high-dose tigecycline in the treatment of secondary peritonitis in severely ill patients. Rev Esp Quimioter 2015; 28:47-53. [PMID: 25690145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Based on tigecycline linear pharmacokinetic/pharmacodynamics, dose increases have been advocated to maximise activity especially when severe infections with high bacterial load and/or multidrug resistance are suspected. This practice-based observational study explored factors associated with tigecycline administration (100 mg/12h, 200 mg loading dose) in severely ill patients with complicated intra-abdominal infection (cIAI) admitted to four Surgical Critical Care Units (SCCUs). METHODS Medical records of all consecutive adult patients with cIAI and controlled infection source requiring surgery and admission for ≥ 48 h to SCCU were reviewed and divided into patients treated with a regimen including tigecycline (tigecycline group) and those that not (control group). A logistic regression model was performed using "tigecycline administration" (dependent variable) and variables showing differences (p ≤ 0.1) in bivariate analyses (independent variables). RESULTS One hundred and twenty one patients were included. In the tigecycline group, higher percentage of patients (vs. controls) presented colon as surgical site (66.7% vs. 41.8%, p = 0.006), nosocomial infection (55.6% vs. 26.9%, p = 0.001), mechanical ventilation (48.1% vs. 28.4%, p = 0.025), chronic renal replacement therapy (40.7% vs. 19.4%, p =0.008), septic shock (72.2% vs. 46.3%, p = 0.004), and higher values of SAPS II (48.0 ± 15.0 vs. 39.6 ± 15.5, p = 0.003), SOFA at admission (7.0 ± 3.3 vs. 5.5 ± 3.7, p = 0.020), lactate-24h (2.5 ± 2.8 vs. 1.6 ± 0.9, p = 0.029) and CRP-72 h (207.4 ± 87.9 vs. 163.7 ± 76.8, p = 0.021). In the multivariate analysis (R2 = 0.187, p < 0.001) nosocomial infection (OR = 7.721; 95%CI = 2.193, 27.179; p = 0.001), colon as infection site (OR = 4.338; 95%CI = 1.432, 13.145; p = 0.009) and CRP-72 h (OR = 1.009 per-unit; 95%CI = 1.002, 1.016; p = 0.012) were associated with tigecycline administration. CONCLUSIONS In severely ill patients with cIAI, high-dose tigecycline administration was associated with nosocomial origin of cIAI and colon as source infection site.
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Affiliation(s)
- Emilio Maseda
- Emilio Maseda, Anesthesiology and Surgical Critical Care Department. Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Salgado P, Suarez-de-la-Rica A, Maseda E, Maggi G, Hernández-Gancedo C, Lopez-Tofiño A, Palacios E, Ruiz E, Gilsanz F. Severe Mucor necrotizing fasciitis associated to dipyrone-induced agranulocytosis. Rev Esp Quimioter 2015; 28:58-60. [PMID: 25690148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Patricia Salgado
- Emilio Maseda, Anesthesiology and Surgical Critical Care Department. Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Suarez de la Rica A, Maseda E, Anillo V, Hernandez-Gancedo C, Lopez-Tofiño A, Villagran M, Gilsanz F. Risk factors for acute kidney injury in patients with complicated intra-abdominal infection. Crit Care 2015. [PMCID: PMC4471267 DOI: 10.1186/cc14364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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García DE, Maggi G, Gredilla E, Gilsanz F. [Airway management in a patient with Niemann-Pick disease]. Rev Esp Anestesiol Reanim 2014; 61:583. [PMID: 24581933 DOI: 10.1016/j.redar.2014.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/04/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Affiliation(s)
- D E García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España.
| | - G Maggi
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
| | - E Gredilla
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
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Schiraldi R, Calderón L, Maggi G, Brogly N, Guasch E, Gilsanz F. In reply. Int J Obstet Anesth 2014; 23:395-6. [PMID: 25266317 DOI: 10.1016/j.ijoa.2014.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Affiliation(s)
- R Schiraldi
- Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain
| | - L Calderón
- Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain
| | - G Maggi
- Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain.
| | - N Brogly
- Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain
| | - E Guasch
- Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain
| | - F Gilsanz
- Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain
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Alsina E, Matute E, Ruiz-Huerta A, Gilsanz F. The Effects of Sevoflurane or Remifentanil on the Stress Response to Surgical Stimulus. Curr Pharm Des 2014; 20:5449-68. [DOI: 10.2174/1381612820666140325105723] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022]
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