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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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2
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Brogly N, Guasch E. Should we abandon the brachial plexus block for more peripheral blocks for shoulder arthroscopy? Is it efficient and safe? Minerva Anestesiol 2024; 90:6-8. [PMID: 38059747 DOI: 10.23736/s0375-9393.23.17858-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Nicolas Brogly
- Service of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain -
- Service of Anesthesia, La Zarzuela University Hospital, Madrid, Spain -
| | - Emilia Guasch
- Service of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
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Guasch Arévalo E, Brogly N. Intravenous remifentanil for labour analgesia: is it effective, safe, and feasible? Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:487-490. [PMID: 37865140 DOI: 10.1016/j.redare.2023.03.005] [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: 01/10/2023] [Accepted: 03/01/2023] [Indexed: 10/23/2023]
Affiliation(s)
- E Guasch Arévalo
- Sección Anestesia-Reanimación Obstétrica, Hospital Universitario La Paz, Madrid; Comité de Anestesia Obstétrica de la Federación Mundial de Sociedades de Anestesia (WFSA); Board Europeo de Anestesia de la Unión Europea de Médicos Especialistas (EBA-UEMS); Board y Council WFSA, Spain.
| | - N Brogly
- Servicio Anestesia-Reanimación, Hospital Universitario La Paz, Madrid; Servicio de Anestesia, Hospital Universitario La Zarzuela; Madrid; Sección de Anestesia Obstétrica de la Sociedad Española de Anestesia-Reanimación (SEDAR); Subforum de Anestesia obstétrica Sociedad Europea de Anestesia y Cuidados Intensivos (ESAIC); Chair SubComité Parte 1 del Diploma Europeo Anestesia y Cuidados intensivos (EDAIC part 1) de la Sociedad Europea de Anestesia y Cuidados Intensivos (ESAIC), 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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Brogly N, Varvinskiy A, Varosyan A, Ateleanu B, Engelhardt W, Geldner G, Madách K, Ringvold EM, Zerafa M. On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:454-462. [PMID: 36089526 DOI: 10.1016/j.redare.2022.08.006] [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] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/14/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The EDAIC is a diploma of the European Society of Anaesthesiology and Intensive Care (ESAIC). which is obtained after passing two a written MCQ-based (Part1) and a structured oral (part2) examinationIn 2011, a formative On-Line Assessment (OLA) was introduced to help candidates to prepare for EDAIC Part1 examination (EDAIC-I). This retrospective observational study evaluated the results of the OLA and its impact on the EDAIC-1 between 2013 and 2019. METHODS After obtaining the authorisation from the ESAIC Examinations Committee, all the results of candidates registered to OLA and/or EDAIC-I between 2013 and 2019 were included. The total number of registrations and the results were analysed and compared for both. RESULTS Over 17,000 candidates (17,401) sat any of the written exams of the EDAIC. The overall pass-rate for the EDAIC-1 was 68.95%. The OLA score increased significantly with the number of attempts for Paper A (Basic Science) (p=0.006). Overall success of the EDAIC-I was higher in candidates who took the OLA before (72.9% versus 68.3%; OR: 1.25; 95% CI [1.12; 1.39]; p<0.001). Candidates who failed in their first attempt for EDAIC-I were more likely to sit the exam again if they had performed the OLA before (OR: 1.396, 95% CI [1.237; 1.574]; p<0.001). CONCLUSION The OLA was associated with an improvement of the results in basic science and success rate in the EDAIC-I.
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Affiliation(s)
- N Brogly
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesiology and Intensive Care, Hospital Universitario La Paz, Madrid, Spain.
| | - A Varvinskiy
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesia and Intensive Care, Torbay Hospital, Torquay, UK
| | - A Varosyan
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesiology and Intensive Care, Yerevan State Medical University, Erebouni Medical Centre, Yerevan, Armenia
| | - B Ateleanu
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - W Engelhardt
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesiology and Intensive Care Medicine, Offenburg Hospital, Offenburg, Germany
| | - G Geldner
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, RKH-Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K Madách
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - E M Ringvold
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesiology, Pain Medicine and Intensive Care, Akershus University Hospital, Nordbyhagen, Norway
| | - M Zerafa
- Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC); Department of Anaesthesia and Intensive Care Medicine, Mater Dei Hospital, Msida, Malta
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Brogly N, Guasch E. Postoperative analgesia after spine surgery: towards a multimodal approach including regional anaesthesia for an enhanced recovery. Minerva Anestesiol 2022; 88:428-430. [PMID: 35416470 DOI: 10.23736/s0375-9393.22.16628-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nicolas Brogly
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain - .,Servicio de Anestesia, Hospital Universitario La Zarzuela, Madrid, Spain -
| | - Emilia Guasch
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
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Rodríguez Roca MC, Brogly N, Gredilla Diaz E, Pinedo Gil P, Diez J, Guasch E, Gilsanz Rodríguez F. Neuropathic component of postoperative pain for predicting post-caesarean chronic pain at three months. A prospective observational study. Minerva Anestesiol 2021; 87:1290-1299. [PMID: 34337914 DOI: 10.23736/s0375-9393.21.15654-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent investigations have showed that caesarean section (CS) might be a cause of chronic pain, with a consequent decrease in quality of life. METHODS Prospective observational study in a Spanish tertiary hospital. Main Outcome measure was to assess early neuropathic characteristics of pain (DN2 score ≥ 3) one week after CS as a potential risk factor for post-caesarean section chronic pain (PCSCP) at three months. Secondary outcome was to identify other risk factors. 610 consecutive consenting patients undergoing CS were interviewed preoperatively, at discharge from recovery room and 24h postoperatively. Telephone follow-up interviews were conducted one week, three months and twelve months following surgery. RESULTS We analysed 597 consecutive patients. The incidence of PCSCP at three and twelve postoperative months were 6.2% and 1% respectively. Subjects with NRS score superior to five on movement one week after CS presented higher incidence of PCSCP (NRS superior to five: 19 (52,2%); NRS equal or lower to five: 172 (30,9%); p=0,009). On multivariate analysis neuropathic pain one week after CS was associated with a higher risk of PCSCP (AOR: 1.63 (95% CI: 1.26-2.11; p<0.001). Other identified risk factors for PCSCP were: uterine exteriorization during CS (AOR: 3.89 (95% CI 1.25-12.10; p=0.019) and a lower gestational age (AOR: 0.87 (95% CI: 0.78-0.96; p=0.008). CONCLUSIONS Incidence of PCSCP at three and twelve postoperative months was low, 6.2% and 1% respectively. Early neuropathic characteristics of pain after one week measured by neuropathic pain questionnaire, consisting of two questions (DN2) ≥ 3/7 could be used to identify patients at risk for chronic post-surgical pain and develop preventive strategies.
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Affiliation(s)
- María C Rodríguez Roca
- Department of Anesthesiology and Intensive Care Medicine, La Paz University Hospital, Madrid, Spain -
| | - Nicolas Brogly
- Department of Anesthesiology and Intensive Care Medicine, La Paz University Hospital, Madrid, Spain
| | - Elena Gredilla Diaz
- Department of Anesthesiology and Intensive Care Medicine, La Paz University Hospital, Madrid, Spain
| | - Paula Pinedo Gil
- Department of Anesthesiology and Intensive Care Medicine, La Paz University Hospital, Madrid, Spain
| | - Jesús Diez
- Department of biostatistics, La Paz University Hospital, Madrid, Spain
| | - Emilia Guasch
- Department of Anesthesiology and Intensive Care Medicine, La Paz University Hospital, Madrid, Spain
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Ioscovich A, Guasch E, Brogly N, Shatalin D, Manrique-Muñoz S, Sánchez Royo ME, Zimro S, Ginosar Y, Lages N, Weinstein J, Berkenstadt H, Greenberger C, Lazutkin A, Izakson A, Ioscovich D, Orbach-Zinger S, Weiniger CF. Peripartum anesthetic management of women with SARS-CoV-2 infection in eight medical centers across three European countries: prospective cohort observation study. J Matern Fetal Neonatal Med 2021; 35:7756-7763. [PMID: 34107853 DOI: 10.1080/14767058.2021.1937105] [Citation(s) in RCA: 1] [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] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Several reports of obstetric anesthesia management have been published since the onset of the COVID-19 pandemic. We aimed to collect high-quality broad and detailed data from different university medical centers in several European Society of Anesthesiologist countries. METHODS This prospective observational survey was performed in eight medical centers in Spain, Israel and Portugal from 1st April to 31st July 2020. Institutional review board approval was received at each participating center. Inclusion criteria: all women with a positive test for COVID-19. Retrieved data included maternal, delivery, anesthetic, postpartum details, and neonatal outcomes. Descriptive data are presented, and outcomes were compared for women with versus without respiratory signs and symptoms. RESULTS Women with respiratory symptoms (20/12.1%) had significantly higher mean (standard deviation) temperature (37.2 °C (0.8) versus 36.8 °C (0.6)), were older (34.1 (6.7) years versus 30.5 (6.6)) and had higher body mass index kg m-2 - (29.5 (7.5) versus 28.2 (5.1)). Women with respiratory symptoms delivered at a significantly earlier gestational age (50% < 37 weeks) with a 65% cesarean delivery rate (versus 22.1% in the group without respiratory symptoms) and 5-fold increased rate of emergency cesarean delivery, 30% performed under general anesthesia. A higher rate of intrauterine fetal death (3%) was observed than expected from the literature (0.2-0.3%) in developed countries. There was no evidence of viral vertical transmission. CONCLUSION Well-functioning neuraxial analgesia should be available to manage laboring women with respiratory symptoms, as there is a higher frequency of emergency cesarean delivery. We report a higher rate of undiagnosed parturient and intrauterine fetal death.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Emilia Guasch
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Nicolas Brogly
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | - Sabastine Zimro
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yehuda Ginosar
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Neusa Lages
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jacob Weinstein
- The Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Haim Berkenstadt
- The Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | | | | | | | | | - Sharon Orbach-Zinger
- Beilinson Hospital, Petah Tikvah, Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Brogly N, Guasch E. New insights in perioperative care after open gynecological surgery: has the time come to change neuraxial blocks to ultrasound peripheral blocks? Minerva Anestesiol 2021; 87:391-393. [PMID: 33688700 DOI: 10.23736/s0375-9393.21.15596-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nicolas Brogly
- Service of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain - .,Service of Anesthesia, La Zarzuela University Hospital, Madrid, Spain -
| | - Emilia Guasch
- Service of Anesthesia and Intensive Care, La Paz University Hospital, 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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Rodríguez Alcalá C, Brogly N, Díez-Picazo LD, Guasch Arévalo E, Gilsanz Rodríguez F. Anaesthetic management in neurological disorders: is combined spinal-epidural a suitable option? Case report. Colomb J Anesthesiol 2020. [DOI: 10.5554/22562087.e957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.
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Guasch E, Brogly N, Manrique S. Practical recommendations in the obstetrical patient with a COVID-19 infection. ACTA ACUST UNITED AC 2020; 67:438-445. [PMID: 32814634 PMCID: PMC7351396 DOI: 10.1016/j.redar.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
La infección por COVID-19 afecta también a las pacientes obstétricas. La atención obstétrica habitual ha continuado a pesar de la pandemia. Existen series de casos de pacientes obstétricas. Parece que las técnicas neuroaxiales son seguras y es importante asegurarse que los bloqueos funcionen correctamente antes de una cesárea. Es por esto que se recomienda que los bloqueos sean realizados por anestesiólogos expertos. La protección y seguridad de los profesionales es un punto fundamental y, en caso de anestesia general, también se recomienda acudir al anestesiólogo más experto. Las pacientes gravemente enfermas deben reconocerse rápida y precozmente, para poder suministrarles el tratamiento adecuado lo antes posible. La susceptibilidad a las trombosis hace que la anticoagulación profiláctica sea prioritaria.
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MESH Headings
- Analgesia, Epidural/methods
- Analgesia, Epidural/standards
- Analgesia, Obstetrical/standards
- Anesthesia, General
- Anesthesia, Obstetrical/standards
- Anesthesiologists
- Betacoronavirus
- COVID-19
- Cesarean Section/methods
- Cesarean Section/standards
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Cross Infection/prevention & control
- Female
- Humans
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/standards
- Pandemics/prevention & control
- Patient Isolation/standards
- Personal Protective Equipment
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Postoperative Care/methods
- Postoperative Care/standards
- Pregnancy
- Pregnancy Complications, Infectious
- SARS-CoV-2
- Severity of Illness Index
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Affiliation(s)
- E Guasch
- Hospital Universitario La Paz, Madrid, España.
| | - N Brogly
- Hospital Universitario La Paz, Madrid, España
| | - S Manrique
- Hospital Universitario Vall d'Hebron, Barcelona, España
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15
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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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16
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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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17
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Brogly N, Guasch E. Low dose spinal anesthesia plus epidural volume extension for ambulatory obstetric surgery: is it a suitable option? Minerva Anestesiol 2019; 85:568-570. [DOI: 10.23736/s0375-9393.18.13286-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Brogly N, Engelhardt W, Hill S, Ringvold EM, Varosyan A, Varvinskiy A, Zerafa M. European Diploma in Anaesthesiology and Intensive Care in Spain: Results for the part 1 and part 2 exams in the last five years. Are we going in the right direction? ACTA ACUST UNITED AC 2019; 66:206-212. [PMID: 30678812 DOI: 10.1016/j.redar.2018.12.009] [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: 10/24/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. MATERIAL AND METHODS After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P<.05. RESULTS For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74±5.98% for basic science (paperA) and 74.48±4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. CONCLUSIONS The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates.
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Affiliation(s)
- N Brogly
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC); Departamento de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - W Engelhardt
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC); Department of Anaesthesiology and Intensive Care Medicine, Offenburg Hospital, Offenburg, Alemania
| | - S Hill
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC)
| | - E-M Ringvold
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC); Department of Anaesthesiology and Intensive Care, Vestfold Hospital Trust, Tønsberg, Noruega
| | - A Varosyan
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC); Department of Anaesthesiology and Intensive Care, Yerevan State Medical University, Erebouni Medical Centre, Yerevan, Armenia
| | - A Varvinskiy
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC); Department of Anaesthesia, Torbay Hospital, Torquay, Reino Unido
| | - M Zerafa
- Examinations Committee of the European Diploma in Anaesthesiology and Intensive Care (EDAIC); Department of Anaesthesia and Intensive Care Medicine, Mater Dei Hospital, Msida, Malta
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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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20
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Affiliation(s)
- Nicolas Brogly
- Service of Anesthesia and Reanimation, University Hospital of La Paz, Madrid, Spain -
| | - Emilia Guasch
- Service of Anesthesia and Reanimation, University Hospital of La Paz, Madrid, Spain
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21
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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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22
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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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23
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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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24
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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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25
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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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26
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Brogly N, Guasch Arévalo E, Kollmann Camaiora A, Alsina Marcos E, García García C, Gilsanz Rodríguez F. Modern approach to an old technique: Narrative revision of techniques used to locate the epidural space. ACTA ACUST UNITED AC 2017; 64:460-466. [PMID: 28318532 DOI: 10.1016/j.redar.2016.11.010] [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: 09/11/2016] [Revised: 11/20/2016] [Accepted: 11/23/2016] [Indexed: 11/17/2022]
Abstract
Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice.
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Affiliation(s)
- N Brogly
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Guasch Arévalo
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - A Kollmann Camaiora
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - E Alsina Marcos
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - C García García
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz Rodríguez
- 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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28
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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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29
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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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30
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Brogly N, Schiraldi R, Puertas L, Maggi G, Yanci EA, Maldonado EHM, Arévalo EG, Rodríguez FG. [Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy]. Rev Bras Anestesiol 2014; 66:329-32. [PMID: 25441226 DOI: 10.1016/j.bjan.2013.09.005] [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: 06/28/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. CASE REPORT We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. CONCLUSION This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.
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Affiliation(s)
- Nicolas Brogly
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Espanha
| | - Renato Schiraldi
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Espanha
| | - Laura Puertas
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Espanha
| | - Genaro Maggi
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Espanha.
| | - Eduardo Alonso Yanci
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Espanha
| | | | - Emilia Guasch Arévalo
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Espanha
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31
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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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Brogly N, Gilsanz F. Advances in weaning patients from mechanical ventilation: could near-infrared spectroscopy help? Minerva Anestesiol 2014; 80:632-634. [PMID: 24287673] [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: 06/02/2023]
Affiliation(s)
- N Brogly
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Universitario La Paz, Madrid, Spain -
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Schiraldi R, Calderón L, Maggi G, Brogly N, Guasch E, Gilsanz F. Transoesophageal Doppler-guided fluid management in massive obstetric haemorrhage. Int J Obstet Anesth 2014; 23:71-4. [DOI: 10.1016/j.ijoa.2013.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 07/02/2013] [Accepted: 07/06/2013] [Indexed: 01/18/2023]
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Brogly N, Schiraldi R, Puertas L, Maggi G, Yanci EA, Maldonado EHM, Arévalo EG, Rodríguez FG. Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. Braz J Anesthesiol 2013; 66:329-32. [PMID: 27108834 DOI: 10.1016/j.bjane.2013.09.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/28/2013] [Accepted: 09/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. CASE REPORT We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. CONCLUSION This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.
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Affiliation(s)
- Nicolas Brogly
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain
| | - Renato Schiraldi
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain
| | - Laura Puertas
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain
| | - Genaro Maggi
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain.
| | - Eduardo Alonso Yanci
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain
| | | | - Emilia Guasch Arévalo
- Sociedad Española Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain
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Maggi G, Schiraldi R, Brogly N, Arevalo EG, Rodriguez FG. Successful airway management of a patient with progressive supranuclear palsy during the induction of anesthesia. Acta Anaesthesiol Taiwan 2012; 50:87-8. [PMID: 22769866 DOI: 10.1016/j.aat.2012.05.006] [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] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/03/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
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Sánchez Gil JC, Guasch Arévalo E, Brogly N, Gilsanz Rodríguez F. [Reasons residents choose to specialize in anesthesiology and postoperative critical care in the autonomous community of Madrid]. ACTA ACUST UNITED AC 2012; 58:477-84. [PMID: 22141215 DOI: 10.1016/s0034-9356(11)70122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Our main objective was to determine the reasons why residents chose to specialize in anesthesiology and postoperative critical care in the autonomous community of Madrid. We also wished to know if prior contact with this specialty influenced their choice, if those who chose it as a second specialization differed from those who were doing a first residency, what expectations the residents had and if they had been met, and if they were satisfied with their training. MATERIAL AND METHODS Survey of all residents in anesthesiology and postoperative critical care medicine in the community of Madrid between November 2008 and February 2010. The questionnaire items covered demographic data, prior specialty training, undergraduate contact with the specialty, reasons for choosing this specialty (technical, social, or employment-related interests), satisfaction, and expectations met. RESULTS We received 89 valid questionnaires, a sample that represented 35% of the residents. The reasons expressed most often were learning and performing techniques (97.8%); that the specialty was dynamic, with broad theoretical and practical content (98.9%), and an interest in providing critical care (93.3%). These 3 reasons were considered important or very important by most of the respondents; 55.8% considered that learning and carrying out techniques was the most important reason. All the respondents who had previously done specialty training said they were dissatisfied. Prior contact with the specialty was associated with having different reasons and interests, such as an interest in pain (F = .037) or emulating a role model (P = .014). CONCLUSIONS The specialty's mix of theoretical and practical content and the chance to perform techniques and provide critical care are the features the residents find most attractive. Residents who already have another specialty are less satisfied and their expectations are not as well met.
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Affiliation(s)
- J C Sánchez Gil
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid
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Brogly N, Schiraldi R, Vazquez B, Perez J, Guasch E, Gilsanz F. A randomized control trial of patient-controlled epidural analgesia (PCEA) with and without a background infusion using levobupivacaine and fentanyl. Minerva Anestesiol 2011; 77:1149-1154. [PMID: 21623342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Continuous infusion associated with patient-controlled epidural analgesia (PCEA) is used in many maternal units. This randomized controlled study evaluated the effect of a 10 mL/h background infusion associated with a 10 mL-20 minutes lockout time demand-only PCEA protocol using L-bupivacaine plus fentanyl in terms of local anaesthetic consumption, pain management and maternal satisfaction. METHODS Forty consenting parturients were randomly assigned to receive a 0.125% levobupivacaine plus 1.5 mcg/mL fentanyl PCEA (10 mL bolus with a 20 min lock time) with or without a 10 mL/h background infusion. The total volume of local anesthetic, the number of PCEA demand boluses, pain levels, delivery outcome and maternal satisfaction were evaluated. RESULTS The total volume of local anaesthetic was 35[20-120] mL in demand-only PCEA group versus 63.8[22.5-123] mL in PCEA plus background infusion group (P<0.001). This decrease in total volume was associated with an increase of self-administrated boluses in demand-only group (3.5[2-12] boluses, versus 1[0-3] bolus in PCEA plus background infusion group) (P<0.001). Pain scores were comparable between groups at any time of the study (P>0.05). Maternal satisfaction did not differ between groups (10[8-10] vs. 10[7-10]; P=0.11). CONCLUSION When a levobupivacaine plus fentanyl PCEA protocol with high volume boluses and long lockout interval is used for labour analgesia, the background infusion increased the total local anesthetic dose with no change in pain management and maternal satisfaction.
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Affiliation(s)
- N Brogly
- Department of Anesthesia and Resuscitation, La Paz University Hospital, Madrid, Spain.
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Georges H, Brogly N, Alfandari S, Leroy O. Community-Acquired Pneumonia: Response. Chest 2011. [DOI: 10.1378/chest.11-0010] [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: 11/01/2022] Open
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Brogly N, Guasch E, Puertas L, Alsina E, López T, Gilsanz F. Défaillance cardiaque aiguë associée à une cardiomyopathie dilatée en post-partum précoce : traitement par ballon de contrepulsion aortique et lévosimendan. ACTA ACUST UNITED AC 2010; 29:807-10. [DOI: 10.1016/j.annfar.2010.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 08/27/2010] [Indexed: 10/19/2022]
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Brogly N, Wattier JM, Andrieu G, Peres D, Robin E, Kipnis E, Arnalsteen L, Thielemans B, Carnaille B, Pattou F, Vallet B, Lebuffe G. Gabapentin Attenuates Late but Not Early Postoperative Pain After Thyroidectomy with Superficial Cervical Plexus Block. Anesth Analg 2008; 107:1720-5. [DOI: 10.1213/ane.0b013e318185cf73] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O. Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect 2007; 55:136-40. [PMID: 17350105 DOI: 10.1016/j.jinf.2007.01.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 01/14/2007] [Accepted: 01/24/2007] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the prevalence and the prognostic value of thrombocytopenia in patients admitted to ICU for severe community-acquired pneumonia. METHODS Multicentre observational study was conducted in 7 ICUs in the north of France over a 19-year period (1987-2005). The primary outcome measure was the ICU mortality. RESULTS Eight hundred and twenty-two patients were studied. A platelet count < 150x10(9)/L was observed at ICU admission in 202 (25%) patients. Admission platelet count was between 101 and 149x10(9)/L, 51 and 100x10(9)/L, 21 and 50x10(9)/L, and < or = 20x10(9)/L in 100, 61, 32 and 9 patients, respectively. ICU mortality rate was 35.4%. Classifying patients into 3 categories with the following cut-offs of platelet count, > or = 150x10(9)/L, 51-149x10(9)/L, and < or = 50x10(9)/L, we observed a significant increase in ICU mortality rates which were 30.8% in the first group, 44.1% in the second group and 70.7% in the last one (p<0.0001). In multivariate analysis, thrombocytopenia < or = 50x10(9)/L appeared as an independent predictor of mortality (AOR=4.386). CONCLUSIONS In patients admitted to ICU for severe community-acquired pneumonia, thrombocytopenia has a high prevalence and influences the outcome.
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Affiliation(s)
- Nicolas Brogly
- Service de Réanimation Médicale et Maladies Infectieuses, Université de Lille, Hôpital G. Chatiliez, 135 rue du Président Coty, 59208 Tourcoing, France
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